The introduction of insulin glar­gine in 2000 and of insulin detemir in 2004 responded to some of the problems associated with neutral protamine Hagedorn (NPH) insulin, introduced 90 years ago. Continuous subcutaneous insulin infusion (CSII) delivered through an insulin pump became the gold standard replacement of insulin for type 1 diabetes in 1978. Yet, improved basal insulins are needed, said Geremia B. Bolli, MD, University of Perugia, Italy, in a session providing an update on insulin therapy at the 2012 ADA annual meeting.

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 number of promising oral and injectable agents for diabetes are currently in late-stage development and were featured in posters, oral abstract presentations, and symposia during the 2012 ADA annual meeting. The following is a sampling of new medications with potentially important implications for the treatment of patients with diabetes.

The investigational ultra–long-acting insulin degludec improves long-term glycemic control in patients with type 2 diabetes similar to insulin glargine but with a reduced rate of nocturnal and severe hypoglycemia, and greater weight loss, said Bernard Zinman, MD, Director of the Diabetes Center at Mount Sinai Hospital, Professor of Medicine, University of Toronto, and lead investigator of a randomized head-to-head comparison.

The anti-inflammatory agent salsalate, used for decades as a treatment for rheumatoid arthritis, also has glucose-lowering properties, said Steven Shoelson, MD, PhD, Associate Director of Research at the Joslin Diabetes Center, Boston, and principal investigator of a placebo-controlled study of salsalate in patients with type 2 diabetes.

Salsalate lacks many of the side effects of aspirin; however, in the current study, this drug was associated with weight gain and an increase in low-density lipoprotein cholesterol (LDL-C), said Dr Shoelson.

Several studies related to the GetGoal Program involving the investigational glucagon-like peptide (GLP)-1 agonist lixisenatide were presented at the 2012 ADA annual meeting. Glycemic control was improved in patients with type 2 diabetes with once-daily lixisenatide added to various antidiabetes medications, including basal insulin in the GetGoal-L study, pioglitazone in the GetGoal-P study, and insulin glargine and oral agents in the GetGoal Duo 1 study.

Intensive therapy initiated in newly diagnosed patients with type 2 diabetes can preserve beta-cell function, according to data released by Ildiko Lingvay, MD, Assistant Professor of Internal Medicine at the University of Texas Southwestern Medical Center, Dallas, at the 2012 ADA annual meeting.

Progression of type 2 diabetes hinges on a progressive decline in beta-cell function over time, and Dr Lingvay recommended that “we try to achieve glycemic normalization as quickly as possible after diagnosis. In addition, I recommend we maintain glycemic control long-term.”

Data presented from a phase 2b study with empagliflozin, a sodium glucose cotransporter-2, which increases renal glucose excretion, showed reductions in hemoglobin (Hb) A1c, fasting plasma glucose (FPG), and body weight in patients with type 2 diabetes at 90 weeks. Hans-Juergen Woerle, MD, Vice President, Boehringer Ingelheim, Germany, presented this randomized, multinational, open-label extension study in a late-breaking abstract session at the 2012 ADA annual meeting.

Reversing prediabetes and returning to a normal state of glucose regulation, even transiently, significantly reduces future risk of developing diabetes, reported investigators from the Diabetes Prevention Program Research Group at the 2012 ADA annual meeting.

The rise of diabetes in American youth was the focus of a session at the 2012 ADA annual meeting that was devoted to the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Philip S. Zeitler, MD, PhD, Section Head, Endocrinology, University of Colorado, Denver, presented updated data from new analyses released after the publication of the key results in April 2012.

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