Value-Based Care in Cardiometabolic Health August 2012, Vol 1, No 2

Real-time continuous glucose monitoring improved glycemic control compared with self-monitoring of blood glucose at 1 year in a recent clinical trial; real-time continuous glucose monitoring was cost-effective for providing modest increases in life expectancy and improved quality of life based on 2 statistical models. Coinvestigator Stephanie J. Fonda, PhD, Walter Reed National Military Medical Center, Bethesda, MD, presented the data at the 2012 ADA annual meeting.

Philadelphia, PA—The epidemic of diabetes is like a tsunami that will strike in waves, said Geralyn R. Spollett, MSN, ANP-CS, CDE, President of Health Care & Education, American Diabetes Association (ADA), Alex­andria, VA, and Associate Director of the Yale Diabetes Center, Yale School of Medicine, New Haven, CT, at the 2012 ADA annual meeting. The result will be 380 million people worldwide in 2025 with diagnosed diabetes, with 53.1 million of them from the United States.

Reducing hemoglobin (Hb) A1c levels as soon as possible after the diagnosis of type 2 diabetes results in a reduction in the diabetes-related complications, including myo­cardial infarction (MI) and all-cause mortality.

Three incretin-based therapies—exenatide, liraglutide, and sita­gliptin—are associated with a reduction in cardiovascular (CV) risk scores, “an effect more clearly observed in patients using glucagon-like peptide-1 agonists,” said Christopher J. Smith, MD, Department of Diabetes and Endocrinology, Glasgow Royal Infirmary, Scotland, during the 2012 ADA annual meeting.

Incretin-based therapies are not simply “glucocentric” but also confer benefits with respect to weight control and possibly blood pressure (BP) reduction, Dr Smith said.

Medical expenditures for diabetes have increased over the past 2 decades, along with improvements in the management of the disease and the availability of new drugs. But the major increase seen from 1987 to 1997 slowed thereafter through 2008, said Xiaohui Zhuo, PhD, Health Economist, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, who presented results of the first study documenting the US cost trend for diabetes at the 2012 ADA annual meeting.

A 2-year open-label study of exen­atide once weekly showed that this medication was safe when combined with a thiazolidinedione (TZD) plus metformin, and that it significantly lowered hemoglobin (Hb) A1c in patients with type 2 diabetes.

Improved glycemic control in patients with type 2 diabetes lowers the risk of adverse cardiovascular (CV) events, reported Katarina Eeg-Olofsson, MD, from the University of Gothenburg in Sweden at the 2012 ADA annual meeting.

In this study by Dr Eeg-Olofsson and colleagues, patients who reduced their mean hemoglobin (Hb) A1c levels by almost 1%—from 7.8% to 7%—had a significant 45% reduction in their risk of CV death.

Cardiovascular (CV) outcomes were not improved with either omega-3 fatty acids or with insulin glargine in a 6-year study of 12,537 patients with dysglycemia and other CV risk factors. The multinational Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial showed that insulin glargine had no effect on cancer, and that it reduced the progression from dysglycemia to diabetes. Hertzel C.

Chronic kidney disease (CKD) is significantly underdiagnosed in the population of patients with type 2 diabetes, say investigators from a multisite, observational, cross-sectional study conducted by the National Kidney Foundation, which was presented by lead investigator Lynda Szczech, MD, President of the National Kidney Foundation, New York City, at the 2012 ADA annual meeting.

The prevalence of both type 1 and type 2 diabetes has increased substantially among American youth over the past decade, and, with this rise, the rates of diabetes complications have increased. This topic was discussed in a session on pediatric obesity at the 2012 ADA annual meeting.

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