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Clinical Updates in Type 2 Diabetes

An Evolving Role for Combinations of Injectable Antihyperglycemic Therapies

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Guidelines

Standards of medical care in diabetes—2017.

The ADA’s Standards of Care provide clinicians, patients, researchers, payers, and other interested individuals with the components of good diabetes management, general treatment goals, and tools to evaluate the quality of care. Importantly, these recommendations should be adjusted based on individual preferences, comorbidities, and other patient-related factors. 

American Diabetes Association. Diabetes Care. 2017;40(suppl 1):S1-S135.

AACE/ACE Comprehensive Diabetes Management Algorithm 2017. 

The AACE/ACE algorithm provides recommendations on evaluating the whole patient, outlines potential risks and complications, and highlights evidence-based treatment approaches for diabetes. The document contains sections on lifestyle changes, considerations for obese individuals, prediabetes, glycemic goals, antihyperglycemic therapies, treatment algorithms, modifications for atherosclerotic cardiovascular disease risk factors, and overall principles of diabetes management. 

Garber AJ, et al. Endocr Pract. 2017;23(2):207-238.

Patient and Caregiver Resources

Diabetes HealthSense

Created as part of the National Diabetes Education Program, Diabetes HealthSense includes easily accessible resources that can help patients live well and meet their goals—whether they have diabetes or are at risk for the disease. 

Decision Aids for T2DM

To facilitate shared decision making, these examples of medication choice decision aids from the Mayo Clinic are organized into 7 issues that may be of interest to patients with T2DM. A video demonstrating the use of these cards can be found at: www.youtube.com/watch?v=SYTPqceFgSw.

Suggested Readings

Efficacy and Safety of LixiLan, a Titratable Fixed-Ratio Combination of Insulin Glargine Plus Lixisenatide in Type 2 Diabetes Inadequately Controlled on Basal Insulin and Metformin: The LixiLan-L Randomized Trial.

Aroda VR, et al. Diabetes Care. 2016;39(11):1972-1980.

Pharmacology, physiology, and mechanisms of incretin hormone action.

Campbell JE, Drucker DJ. Cell Metab. 2013;17:819-837.

From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus.

Defronzo RA. Diabetes. 2009;58(4):773-795.

Minimizing hypoglycemia in diabetes.

International Hypoglycemia Study Group. Diabetes Care. 2015;38(8):1583-1591. 

Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes.

Inzucchi SE, et al. Diabetes Care. 2015;38(1):140-149.

Effect of Insulin Glargine Up-titration vs Insulin Degludec/Liraglutide on Glycated Hemoglobin Levels in Patients With Uncontrolled Type 2 Diabetes: The DUAL V Randomized Clinical Trial.

Lingvay I, et al. JAMA. 2016;315(9):898-907; requires registration for a free personal account.

The Efficacy of IDegLira (Insulin Degludec/Liraglutide Combination) in Adults with Type 2 Diabetes Inadequately Controlled with a GLP-1 Receptor Agonist and Oral Therapy: DUAL III Randomized Clinical Trial.

Linjawi S, et al. Diabetes Ther. 2017;8(1):101-114

Liraglutide and renal outcomes in type 2 diabetes.

Mann JFE, et al. N Engl J Med. 2017;377(9):839-848.

Liraglutide and cardiovascular outcomes in Type 2 diabetes.

Marso SP, et al. N Engl J Med. 2016;375(4): 311-322.

Semaglutide and cardiovascular outcomes in patients with type 2 diabetes.

Marso SP, et al. N Engl J Med. 2016;375(19):1834-1844

Efficacy and safety of degludec versus glargine in type 2 diabetes.

Marso SP, et al. N Engl J Med. 2017;377(8):723-732.

Lixisenatide in patients with type 2 diabetes and acute coronary syndrome.

Pfeffer MA, et al. N Engl J Med. 2015;373(23):2247-2257.

Benefits of combination of insulin degludec and liraglutide are independent of baseline glycated haemoglobin level and duration of type 2 diabetes.

Rodbard HW, et al. Diabetes Obes Metab. 2016;18(1):40-48.

Benefits of LixiLan, a Titratable Fixed-Ratio Combination of Insulin Glargine Plus Lixisenatide, Versus Insulin Glargine and Lixisenatide Monocomponents in Type 2 Diabetes Inadequately Controlled on Oral Agents: The LixiLan-O Randomized Trial.

Rosenstock J, et al. Diabetes Care. 2016;39(11):2026-2035.

Type 2 diabetes patients reach target glycemic control faster using IDegLira than either insulin degludec or liraglutide given alone.

Vilsbøll T, et al. Clin Drug Investig. 2016;36(4):293-303.

Activity
Clinical Updates in Type 2 Diabetes

An Evolving Role for Combinations of Injectable Antihyperglycemic Therapies

Relevant Resources

Incretin-Based Therapies for Type 2 Diabetes

Mechanism-Based Strategies to Achieve Patient-Centered Care

Insulin Replacement Therapy for Type 2 Diabetes

Patient-Centered Management of Hyperglycemia in Primary Care

Improving Outcomes in Type 2 Diabetes

Integrating GLP-1 Receptor Agonists Into Multimodal Treatment Regimens

A Focus on Bipolar Depression

Overcoming Diagnostic Barriers and Optimizing Long-Term Patient Outcomes

Clinical Issues in Type 2 Diabetes

Discussions and Debates Around GLP-1 Receptor Agonists

Clinical Issues in Type 2 Diabetes

Evolving Roles of GLP-1 Receptor Agonists

Improving Outcomes for Women with Type 2 Diabetes

Individualizing Evidence-Based Care

Noninsulin Approaches to Managing Type 2 Diabetes

Best Practices in Combination Therapy

Hitting the Target in Type 2 Diabetes

Evolving Approaches to Insulin Based Therapy

Improving Outcomes in Congenital and Acquired Lipodystrophy

Best Practices in Diagnosis and Management

Clinical Updates in Type 2 Diabetes

New Strategies for Insulin Replacement Therapy

Clinical Issues in Type 2 Diabetes

Consensus and Controversies Around Intensifying Noninsulin Therapy

How Low Do You Go?

Clinical Updates in LDL-C Management

Incretin-Based Therapies For Type 2 Diabetes

Improving Comprehensive Patient Care

Raising the Bar by Lowering the Target

Integrating PCSK9 Inhibitors Into Hypercholesterolemia Management

Injecting New Ideas into Managing Type 2 Diabetes

Evolving Roles of GLP-1 Receptor Agonists

Multidimensional Issues in Type 2 Diabetes

Looking Beyond Hemoglobin A1c

GLP-1 Receptors Agonists in Type 2 Diabetes

Mechanistic Insights and Evolving Treatment Options

Pharmaceutical Economics and LDL-C Management

Implications for PCSK9 Inhibitors in Clinical Practice

Assimilating the Evidence in T2DM

Cardiovascular and Renal Outcomes With SGLT2 Inhibitors

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SHOW CREATE TABLE `resources`
1 0.000307 0.000307 0.000307 0.000307
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
1 0.000290 0.000290 0.000290 0.000290
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000319
1
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000233
2
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000289
3
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000255
4
SHOW COLUMNS FROM `resources`
0.001483
5
SHOW CREATE TABLE `resources`
0.000307
6
SELECT * FROM `resources` `t` WHERE `t`.`id`=73 LIMIT 1
0.000380
7
SHOW COLUMNS FROM `resource_videos`
0.001065
8
SHOW CREATE TABLE `resource_videos`
0.001703
9
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
0.002824
10
SHOW COLUMNS FROM `activities`
0.001432
11
SHOW CREATE TABLE `activities`
0.000320
12
SHOW COLUMNS FROM `users`
0.001212
13
SHOW CREATE TABLE `users`
0.000316
14
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000821
15
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003922
16
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000457
17
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2540007
0.003796
18
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
0.000330
19
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
0.000290
20
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (143, 132, 129, 122, 118, 109, 89, 81, 51, 50, 49, 48, 45, 42, 38, 33, 30, 29, 20, 18, 16, 14, 13, 9, 11, 4)
0.000618
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