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Blüher M, Ceriello A, Davies M, Rodbard H, Sattar N, Schnell O, Tonchevska E, Giorgino F. Managing weight and glycaemic targets in people with type 2 diabetes—How far have we come? Endocrinol Diabetes Metab 2022; 5:e00330. [PMID: 35298097 PMCID: PMC9094453 DOI: 10.1002/edm2.330] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction As the vast majority of people with type 2 diabetes (T2D) are also overweight or obese, healthcare professionals (HCP) are faced with the task of addressing both weight management and glucose control. In this narrative review, we aim to identify the challenges of reaching and maintaining body weight targets in people with T2D and highlight current and future treatment interventions. Methods A search of the PubMed database was conducted using the search terms “diabetes” and “weight loss.” Results According to emerging evidence, treating obesity may be antecedent to the development and progression of T2D. While clinical benefits typically set in upon achieving a weight loss of 3–5%, these benefits are progressive leading to further health improvements, and weight loss of >15% can have a disease‐modifying effect in people with T2D, an outcome that up to recently could not be achieved with any blood glucose‐lowering pharmacotherapy. However, advanced treatment options with weight‐loss effects currently in development including the dual GIP/GLP‐1 receptor agonists may enable simultaneous achievement of individual glycemic and weight goals. Conclusion Despite considerable therapeutic progress, there is still a large unmet medical need in patients with T2D who miss their individualized glycemic and weight‐loss targets. Nonetheless, it is to be expected that development of future therapies and their use will favourably change the scenario of weight and glucose control in T2D.
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Affiliation(s)
- Matthias Blüher
- Medical Department III – Endocrinology, Nephrology, Rheumatology University of Leipzig Medical Center Leipzig Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI‐MAG) of the Helmholtz Zentrum München at the University of Leipzig Leipzig Germany
| | - Antonio Ceriello
- Department of Cardiovascular and Metabolic Diseases IRCCS MultiMedica Milan Italy
| | - Melanie Davies
- Diabetes Research Centre University of Leicester Leicester UK
- NIHR Leicester Biomedical Research Centre Leicester UK
| | - Helena Rodbard
- Endocrine and Metabolic Consultants Rockville Maryland USA
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Oliver Schnell
- Sciarc GmbH Baierbrunn Germany
- Forschergruppe Diabetes e. V. Munich Germany
| | | | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases University of Bari Aldo Moro Bari Italy
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Danne T, Pettus J, Giaccari A, Cariou B, Rodbard H, Weinzimer SA, Bonnemaire M, Sawhney S, Stewart J, Wang S, Castro RDC, Garg SK. Sotagliflozin Added to Optimized Insulin Therapy Leads to Lower Rates of Clinically Relevant Hypoglycemic Events at Any HbA1c at 52 Weeks in Adults with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:471-477. [PMID: 31335194 PMCID: PMC6708262 DOI: 10.1089/dia.2019.0157] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Hypoglycemia rates usually increase when insulin treatment is intensified to improve glycemic control. We evaluated (post hoc) hypoglycemic rates in adult patients with type 1 diabetes (T1D) on sotagliflozin (a dual sodium-glucose cotransporter [SGLT] 1 and 2 inhibitor) in two phase 3, 52-week clinical trials (inTandem 1 and 2; NCT02384941 and NCT02421510). Materials and Methods: We analyzed rates of documented hypoglycemia (level 1, blood glucose ≥54 to <70 mg/dL) and clinically important hypoglycemia (level 2, glucose <54 mg/dL) in a patient-level pooled analysis (n = 1362) using a negative binomial model adjusted for hemoglobin A1c (HbA1c) at 52 weeks in patients receiving placebo, sotagliflozin 200 mg, and sotagliflozin 400 mg. Results: Rates of level 1 hypoglycemia events per patient-year were 58.25 (95% confidence interval: 50.26-67.50) with placebo, 44.86 (38.83-51.82; P = 0.0138 vs. placebo) with sotagliflozin 200 mg, and 45.68 (39.52-52.81; P = 0.0220) with sotagliflozin 400 mg. Sotagliflozin was also associated with lower rates of level 2 hypoglycemia: 15.95 (14.37-17.70), 11.51 (10.39-12.76; P < 0.0001), and 11.13 (10.03-12.35; P < 0.0001) for placebo and sotagliflozin 200 and 400 mg, respectively. The difference in rates of hypoglycemia with sotagliflozin versus placebo became more pronounced as HbA1c decreased. Conclusions: At week 52, level 1 and 2 hypoglycemia events were 22% to 30% less frequent with sotagliflozin added to optimized insulin therapy versus placebo in adults with T1D at any HbA1c level, with greater differences at lower HbA1c values. These findings support the use of sotagliflozin as an insulin adjunct in T1D.
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Affiliation(s)
- Thomas Danne
- Diabetes Center, Children and Youth Hospital Auf der Bult, Hannover Medical School, Hannover, Germany
- Address correspondence to: Thomas Danne, MD, Diabetes Center, Children and Youth Hospital Auf der Bult, Hannover Medical School, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Jeremy Pettus
- Department of Medicine, University of California San Diego, San Diego, California
| | - Andrea Giaccari
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bertrand Cariou
- Department of Endocrinology, L'institut du thorax, Nantes, France
| | - Helena Rodbard
- Endocrine and Metabolic Consultants, Rockville, Maryland
| | | | | | | | | | | | | | - Satish K. Garg
- Department of Medicine and Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado
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Abstract
The progressive nature of type 2 diabetes (T2D) means that many patients will require basal insulin therapy at some point in the course of the disease due to β-cell failure. As basal insulin primarily targets fasting plasma glucose, patients may still experience considerable postprandial glucose excursions and therefore require an additional agent to achieve good glycemic control. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) provide an alternative to prandial insulin, with the benefits of fewer daily injections, and a lower risk of hypoglycemia and weight gain. Two fixed-ratio combinations (FRCs) of basal insulin and a GLP-1 RA are now available in the USA and the EU: insulin glargine + lixisenatide (iGlarLixi) and insulin degludec + liraglutide (IDegLira). Titratable FRCs are suitable for most patients with T2D and can help to simplify treatment regimens into one daily injection, potentially aiding in patient adherence. The complementary modes of action of the two components target seven of the many known pathophysiologic defects in T2D. FRCs have demonstrated enhanced glycemic control compared with their constituent components alone, comparable risk of hypoglycemia compared with basal insulin alone, and better tolerability compared with the GLP-1RA component alone due to the slower titration. In this article, we discuss the advantages of FRCs over multiple daily injections, present case studies of typical patients who could benefit from FRC therapy, and outline practical considerations for the initiation of FRC therapy in clinical practice.Funding Sanofi.
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Affiliation(s)
- Leigh Perreault
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | | | | | - Eric Johnson
- Department of Family and Community Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
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Dandona P, Mathieu C, Phillip M, Hansen L, Tschöpe D, Thorén F, Xu J, Langkilde AM, Proietto J, Stranks S, Chen R, O'Neal D, Pape A, Forbes M, Morbey C, Luger A, Hanusch U, Schnack C, Fliesser-Goerzer E, Hoelzl B, Ebenbichler C, Prager R, Van Gaal L, Vercammen C, Scheen A, Mathieu C, Duyck F, Nobels F, Ruige J, Aggarwal N, Woo V, St-Pierre B, Dumas R, Hramiak I, Elliott T, Hansen TK, Henriksen JE, Gram J, Lihn A, Bruun J, Saltevo J, Taurio J, Strand J, Valle T, Nieminen S, Pietilainen K, Guerci B, Hadjadj S, Cariou B, Verges B, Borot S, Penfornis A, Tschöpe D, Schaum T, Marck C, Horacek T, Rose L, Klausmann G, Luedemann J, Appelt S, Aigner U, Goebel R, Behnke T, Ziegler AG, Peterfai E, Kerenyi Z, Oroszlan T, Kiss GG, Konyves L, Piros G, Phillip M, Mosenzon O, Shehadeh N, Adawi F, Wainstein J, Dotta F, Piatti P, Genovese S, Consoli A, Di Bartolo P, Mannucci E, Giordano C, Lapolla A, Aguilar C, Bazzoni Ruiz AE, Mondragon Ramirez G, Orozco EP, Stobschinski de Alba CA, Medina Pech CE, Garza Ruiz J, Sauque Reyna L, Llamas Esperon G, Nevarez Ruiz LA, Velazquez MV, Flores Lozano F, Gonzalez Gonzalez JG, Garcia-Hernandez PA, Araujo Silva R, Villeda-Espinosa E, Mistodie C, Popescu D, Constantin C, Nicolau A, Popa B, Timar R, Serafinceanu C, Pintilei E, Soto A, Gimenez M, Merino J, Morales C, Mezquita P, Jendle J, Tengmark BO, Eriksson J, Londahl M, Eliasson B, Gunstone A, Heller SR, Darzy K, Mansell P, Davies M, Reed R, Browne D, Courtney H, Turner W, Blagden M, McCrimmon R, Dandona P, Bergenstal R, Lane W, Lucas K, White A, Bao S, White J, Jantzi C, Rasouli N, Ervin W, Lewy-Alterbaum L, Handelsman Y, Miranda-Palma B, Cleland A, Fink R, Rodbard H, Nakhle S, Greenberg C, Schorr A, Bays H, Simmons D, Klein E, Kane L, Fishman N, Ipp E, Garg S, Bhargava A, Singh MZ, Rosenstock J, Thrasher J, Warren M, Young L, Aroda V, Pettus J, Liljenquist D, Busch R, Wise J, Kayne D, Biggs W. Efficacy and Safety of Dapagliflozin in Patients With Inadequately Controlled Type 1 Diabetes: The DEPICT-1 52-Week Study. Diabetes Care 2018; 41:2552-2559. [PMID: 30352894 DOI: 10.2337/dc18-1087] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study evaluated the long-term safety and efficacy of dapagliflozin as an adjunct to adjustable insulin in patients with type 1 diabetes and inadequate glycemic control. RESEARCH DESIGN AND METHODS DEPICT-1 (Dapagliflozin Evaluation in Patients With Inadequately Controlled Type 1 Diabetes) was a randomized (1:1:1), double-blind, placebo-controlled phase 3 study of dapagliflozin 5 mg and 10 mg in patients with type 1 diabetes (HbA1c 7.5-10.5% [58-91 mmol/mol]) (NCT02268214). The results of the 52-week study, consisting of the 24-week short-term and 28-week extension period, are reported here. RESULTS Of the 833 patients randomized into the study, 708 (85%) completed the 52-week study. Over 52 weeks, dapagliflozin 5 mg and 10 mg led to clinically significant reductions in HbA1c (difference vs. placebo [95% CI] -0.33% [-0.49, -0.17] [-3.6 mmol/mol (-5.4, -1.9)] and -0.36% [-0.53, -0.20] [-3.9 mmol/mol (-5.8, -2.2)], respectively) and body weight (difference vs. placebo [95% CI] -2.95% [-3.83, -2.06] and -4.54% [-5.40, -3.66], respectively). Serious adverse events were reported in 13.4%, 13.5%, and 11.5% of patients in the dapagliflozin 5 mg, 10 mg, and placebo groups, respectively. Although hypoglycemia events were comparable across treatment groups, more patients in the dapagliflozin groups had events adjudicated as definite diabetic ketoacidosis (DKA; 4.0%, 3.4%, and 1.9% in dapagliflozin 5 mg, 10 mg, and placebo groups, respectively). CONCLUSIONS Over 52 weeks, dapagliflozin led to improvements in glycemic control and weight loss in patients with type 1 diabetes, while increasing the risk of DKA.
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Affiliation(s)
- Paresh Dandona
- Department of Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, Universitair Ziekenhuis (UZ) Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Moshe Phillip
- Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Diethelm Tschöpe
- Department for Endocrinology, Diabetology and Gastroenterology, Heart and Diabetes Centre, Bad Oeynhausen, Germany, and Ruhr University Bochum, Bochum, Germany
| | | | - John Xu
- AstraZeneca, Gaithersburg, MD
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Wizemann E, Rodbard H, Tripathy D, Vidrio Velazquez M, Demissie M, Tamer SC, Piletic M. Die Hinzunahme von schnell wirksamem Insulin aspart (Faster aspart) zu Basalinsulin bewirkte eine signifikant verbesserte Blutzuckereinstellung bei Erwachsenen mit Typ 2 Diabetes: die onset® 3-Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E Wizemann
- Gemeinschaftspraxis Herrenberg, Herrenberg, Germany
| | - H Rodbard
- Endocrine and Metabolic Consultants, Rockville, Maryland, United States
| | - D Tripathy
- School of Medicine, University of Texas Health Science Center, San Antonio, Texas, United States
| | - M Vidrio Velazquez
- Endocrinology, Metabolism and Nutrition, Hospital General Regional 110, Guadalajara, Mexico
| | - M Demissie
- Insulin and Devices, Global Development, Novo Nordisk A/S, Søborg, Denmark
| | - SC Tamer
- Insulin and Devices, Global Development, Novo Nordisk A/S, Søborg, Denmark
| | - M Piletic
- Department of Diabetes and Metabolic Diseases, General Hospital, Novo Mesto, Slovenia
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Seufert J, Rodbard H, Aggarwal N, Vijapurkar U, Fung A, Sikes C, Crean J, Pfeifer M, Alba M. Achievement of Composite Endpoint of HbA1c, Weight and Blood Pressure Reduction with Titrated Canagliflozin Added to Metformin+Sitagliptin in Patients with Type 2 Diabetes. Can J Diabetes 2016. [DOI: 10.1016/j.jcjd.2016.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kaiser M, Gough S, Woo V, Rodbard H, Linjawi S, Poulsen P, Korsholm L, Bode B. IDegLira bei Patienten mit Typ 2 Diabetes: Wirksamkeit und Sicherheit nach 1 Jahr. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nauck M, Lahtela J, Ahmann A, Rodbard H, Rosenstock J, de Loredo L, Kienhöfer J, Kretzschmar Y, Tornøe K. Wirksamkeit und Sicherheit von Liraglutid im Vergleich zu Placebo bei additiver Anwendung zu bestehenden Therapien mit Basalinsulinanaloga bei Patienten mit Typ 2 Diabetes (LIRA-ADD2BASAL): eine randomisierte, placebokontrollierte Studie. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Blüher M, Rodbard H, Woo V, Vilsbøll T, Korsholm L, Gough S. Einfluss des Body Mass Index auf HbA1c-Reduktion, Hypoglykämieraten und Insulinbedarf unter IDegLira bei Patienten mit Typ 2 Diabetes. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lüdemann J, Holst J, Gough S, Rodbard H, Woo V, Linjawi S, Poulsen P, Damgaard L, Bode B. Verbesserte postprandiale Blutzuckereinstellung bei Typ 2 Diabetes mit einer Fikombination von Insulin degludec und Liraglutid: Ergebnisse eines Mahlzeitentests. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Grundner M, Vora J, Rodbard H, Mersebach H, Kapur R, Harris S. Geringeres Hypoglykämierisiko mit Insulin degludec vs. Insulin glargin bei Patienten mit einer Diabetesdauer von mehr als 10 Jahren: eine Metaanalyse über fünf randomisierte Studien. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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