Dr. Anne Peters is one of our favorite endocrinologists in the limelight. She's director of the Diabetes Program at the University of Southern California (USC), head of the nation's largest outreach program for community-based diabetes prevention and treatment in Los Angeles, and author of the best-selling book Conquering Diabetes. She does a series of regular videos on diabetes for Medscape and other sites, and we've interviewed her and featured her here several times in the past.
The other day, while working on compiling an overview of our own year in diabetes, I ran into Anne's 2013 year-end assessment on Medscape, and was kind of blown away. How does such a busy practicing endo have time to also vlog and blog so eloquently?! In any case, it hit me that Anne has a great "broad" view of the diabetes world, including insights on oral drugs for type 2's that we don't generally focus on.
I thought it was totally worth recapping Anne's insights here, for all our enrichment:
First off, she calls 2013 "another year of small steps." Aren't they all? As Anne says: "changes in diabetes never happen as quickly as we would like."
Still, here's her list of 12 BIG THINGS that happened in diabetes this year:
1) New Cholesterol Guidelines
This is all about controversial statin therapy: who should be taking these pills regularly? Certainly anyone with high cardiovascular risk -- but Anne isn't sure whether PWDs with type 1 and type 2 should be lumped together when it comes to considering this treatment.
2) Mediterranean Diet Proven Awesome
We all kind of knew this, but a "large and rigorous" study this year among PWDs showed that a diet rich in olive oil, nuts, beans, fish, fruits and vegetables can reduce risk for heart attacks, strokes, or deaths from heart disease by 30%. The question now is whether we can get the U.S. population at large to eat this way.
3) Low Glucose Suspend Arrives!
Medtronic's new 530G brought to market "the first step in the Artificial Pancreas" with a sensor-augmented insulin pump that can automatically shut down overnight if low blood sugar is detected. That's right, Medtronic et al, this is a FIRST STEP toward an automated diabetes management system...
4) Obamacare (She "Doesn't Hate It")
The Affordable Care Act (ACA), aka Obamacare, brought the elimination of discrimination on the basis of preexisting conditions -- great news for PWDs.
• Young adults are able to stay on their parents' insurance plans until the age of 26;
• A limit on out-of-pocket costs for seniors; and
• Free coverage for preventive care, including yearly physical exams.
She's "cautiously optimistic" that for her patients in low-income areas of Los Angeles who don't have insurance from their employers, the new Exchange plans "will mitigate issues around affording healthcare."
5) Teens with Diabetes = Problematic
The epidemic of teens presenting with type 2 diabetes is truly disturbing. And: "the most recent news is that developing young-onset type 2 diabetes is more lethal and is associated with more complications than developing type 1 diabetes at the same age," Anne points out.
6) Obesity Rates Soar
This year saw obesity rates in the U.S. racking up the largest year-over-year increase since 2009, bringing the rate up to 27.2%. Yikes!
"I hope that the American Medical Association will prompt physicians to treat obesity more seriously and provide more counseling to their patients," Anne writes.
7) DPP-4 Inhibitors Triumph
The two newest DPP-4 inhibitor drugs (pills that lower blood sugar by inhibiting glucagon release) each underwent a huge clinical trial among type 2 patients at high risk for cardiovascular disease, and proved not to increase the risk for cardiovascular events.
The bad news is that neither drug reduced the risk either. In fact, "there was a slight increase in congestive heart failure requiring hospitalization in the patients on saxagliptin." Ugh.
More. Research. Necessary. (as Anne says)
8) SGLT-2 inhibitors Debut
The new class of oral drug called SGLT-2 (sodium glucose cotransporter) inhibitors are possibly the weirdest diabetes treatment to hit market in recent years. As we reported, they essentially let patients "pee down their blood sugar levels" by spilling off glucose in the urine.
They seem to work well lowering glucose, but side effects include yeast infections for women and urinary tract infections, and other side effects may be yet to be detected. Oy...
9) "Triple Therapy" for Prevention
Authorities are now saying there are a whopping 79 million Americans with prediabetes -- and only 11% currently know they have the condition. Wow! So prevention is HUGE.
Instead of just struggling to get people to lose weight and be more active, one doctor in Texas is advocating for a triple therapy approach, simultaneously starting patients on metformin, pioglitazone, and exenatide. 3x the drugs is better than one, right? Only time will tell...
10) Bariatric Surgery Best When Done Early
Did you know there was an event (in November over World Diabetes Day) called Obesity Week 2013, the joint annual scientific meeting of the American Society for Metabolic and Bariatric Surgery and The Obesity Society? No kidding.
New evidence was unveiled that newly diagnosed patients (with diabetes < 3 years) had better long-term outcomes after undergoing bariatric surgery. That is, the glucose-related benefits of surgery were more significant and lasted longer than among long-time obese PWDs. More bad news for the latter.
11) Look AHEAD Trial Stopped (But Still a Success)
The long-term Look AHEAD trial examined the benefits of weight loss and exercise in the treatment of type 2 diabetes. The trial was halted because "the intervention did not reduce rates of cardiovascular events in overweight or obese adults with type 2 diabetes after 11 years."
But the intensive lifestyle group had an 8.6% reduction in body weight in the first year, and continued weight loss of about 5% after that. There were other benefits from becoming fit and eating well too, like reductions in sleep apnea, depression, and medication use, and "improvements in quality of life, physical functioning, and mobility." Anne was one of the principal investigators in this trial, and says her take-away advice for patients is: that there are real benefits to lifestyle change, and we now know that we can create intensive diet and exercise interventions that do no harm and can safely reduce the burden of diabetes.
12) "Insulin on Steroids" Could Work!
For people with type 2 diabetes, researchers have been experimenting with the use of long-acting insulin alongside an injectable GLP-1 (glucagon-like peptide) drug to bring down post-meal glucose levels. A recent trial of Novo Nordisk's experimental IDegLira, a fixed-dose combination of the long-acting insulin degludec and liraglutide, showed good results in type 2's.
Dr. John Buse of the University of North Carolina, Chapel Hill, called it "a sort-of souped-up insulin -- I hate to say it, but 'insulin on steroids.'"
He probably only hates to say it because the new combo drug is still awaiting approval in Europe, and has not yet even been submitted to FDA. It's one to watch, I suppose.
Many thanks to Anne Peters for these highlights. Read the full article for a lot more detail and insight from this very awesome endo.
All in all, not such a bad year as it may have seemed ...