resum ada 2012 - redgdps jornades... · estructura similar a exedin 4 2.! estructura similar a glp1...
TRANSCRIPT
Congrés ADA 2012 Highlights AP Philadelphia 8-12 Juny 2012
F . X a v i e r C o s C l a r a m u n t CAP Sant Martí de Provençals. Barcelona RedGDPS / Primary Care Diabetes Europe
Congrés ADA 2012 Highlights
Sumari
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Congrés ADA 2012 Highlights
Sumari AP
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Management of Hyperglycemia in Type
2
Diabetes: A Patient-Centered Approach
Position Statement of the American Diabetes Association (ADA) and !
the European Association for the Study of Diabetes (EASD)"
ADA-EASD Position Statement: Management of
Hyperglycemia in T2DM: A Patient-Centered
Approach&
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#*#'?EG;6?#Diabetes Care, Diabetologia. 19 April 2012 [Epub ahead of print]!
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ADA-EASD Position Statement: Management of
Hyperglycemia in T2DM: A Patient-Centered
Approach&
Diabetes Care, Diabetologia. 19 April 2012 [Epub ahead of print]!
Initial drug monotherapy
Efficacy (! HbA1c)
Hypoglycemia
Weight
Side effects
Costs
Healthy eating, weight control, increased physical activity
Metformin
high
low risk
neutral/loss
GI / lactic acidosis
low
If needed to reach individualized HbA1c target after ~3 months, proceed to 2-drug combination (order not meant to denote any specific preference):
Metformin +
Metformin +
Metformin +
Metformin +
Metformin +
Efficacy (! HbA1c)
Hypoglycemia
Weight
Major side effect(s)
Costs
high
low risk
gain
edema, HF, fx’s‡
high
Thiazolidine- dione
intermediate
low risk
neutral
rare‡
high
DPP-4 Inhibitor
highest
high risk
gain
hypoglycemia‡
variable
Insulin (usually basal)
Two drug combinations*
Sulfonylurea†
+
Thiazolidine-dione
+
DPP-4 Inhibitor
+
GLP-1 receptor agonist
+
Insulin (usually basal)
+
Metformin +
Metformin +
Metformin +
Metformin +
Metformin +
TZD
DPP-4-i
GLP-1-RA
Insulin§
SU†
DPP-4-i
GLP-1-RA
Insulin§
SU† SU†
TZD TZD
TZD
DPP-4-i
Insulin§ Insulin§
If combination therapy that includes basal insulin has failed to achieve HbA1c target after 3-6 months, proceed to a more complex insulin strategy, usually in combination with 1-2 non-insulin agents:
Insulin# (multiple daily doses)
Three drug combinations
More complex insulin strategies
or
or
or
or
or
or
or
or
or
or
or
or GLP-1-RA
high
low risk
loss
GI‡
high
GLP-1 receptor agonist
Sulfonylurea†
high
moderate risk
gain
hypoglycemia‡
low
If needed to reach individualized HbA1c target after ~3 months, proceed to 3-drug combination (order not meant to denote any specific preference):
&0-N#%?D@=58C<;=B896B#&@8C>5=Y#38?8C>;#,8B:998?7>D:?E#Diabetes Care, Diabetologia. 19 April 2012 !
[Epub ahead of print]!
Initial drug monotherapy
Efficacy (! HbA1c)
Hypoglycemia
Weight
Side effects
Costs
Healthy eating, weight control, increased physical activity
Metformin
high
low risk
neutral/loss
GI / lactic acidosis
low
If needed to reach individualized HbA1c target after ~3 months, proceed to 2-drug combination (order not meant to denote any specific preference):
Metformin +
Metformin +
Metformin +
Metformin +
Metformin +
Efficacy (! HbA1c)
Hypoglycemia
Weight
Major side effect(s)
Costs
high
low risk
gain
edema, HF, fx’s‡
high
Thiazolidine- dione
intermediate
low risk
neutral
rare‡
high
DPP-4 Inhibitor
highest
high risk
gain
hypoglycemia‡
variable
Insulin (usually basal)
Two drug combinations*
Sulfonylurea†
+
Thiazolidine-dione
+
DPP-4 Inhibitor
+
GLP-1 receptor agonist
+
Insulin (usually basal)
+
Metformin +
Metformin +
Metformin +
Metformin +
Metformin +
TZD
DPP-4-i
GLP-1-RA
Insulin§
SU†
DPP-4-i
GLP-1-RA
Insulin§
SU† SU†
TZD TZD
TZD
DPP-4-i
Insulin§ Insulin§
If combination therapy that includes basal insulin has failed to achieve HbA1c target after 3-6 months, proceed to a more complex insulin strategy, usually in combination with 1-2 non-insulin agents:
Insulin# (multiple daily doses)
Three drug combinations
More complex insulin strategies
or
or
or
or
or
or
or
or
or
or
or
or GLP-1-RA
high
low risk
loss
GI‡
high
GLP-1 receptor agonist
Sulfonylurea†
high
moderate risk
gain
hypoglycemia‡
low
If needed to reach individualized HbA1c target after ~3 months, proceed to 3-drug combination (order not meant to denote any specific preference):
&0-N#%?D@=58C<;=B896B#&@8C>5=Y#38?8C>;#,8B:998?7>D:?E#Diabetes Care, Diabetologia. 19 April 2012 !
[Epub ahead of print]!
Initial drug monotherapy
Efficacy (! HbA1c)
Hypoglycemia
Weight
Side effects
Costs
Healthy eating, weight control, increased physical activity
Metformin
high
low risk
neutral/loss
GI / lactic acidosis
low
If needed to reach individualized HbA1c target after ~3 months, proceed to 2-drug combination (order not meant to denote any specific preference):
Metformin +
Metformin +
Metformin +
Metformin +
Metformin +
Efficacy (! HbA1c)
Hypoglycemia
Weight
Major side effect(s)
Costs
high
low risk
gain
edema, HF, fx’s‡
high
Thiazolidine- dione
intermediate
low risk
neutral
rare‡
high
DPP-4 Inhibitor
highest
high risk
gain
hypoglycemia‡
variable
Insulin (usually basal)
Two drug combinations*
Sulfonylurea†
+
Thiazolidine-dione
+
DPP-4 Inhibitor
+
GLP-1 receptor agonist
+
Insulin (usually basal)
+
Metformin +
Metformin +
Metformin +
Metformin +
Metformin +
TZD
DPP-4-i
GLP-1-RA
Insulin§
SU†
DPP-4-i
GLP-1-RA
Insulin§
SU† SU†
TZD TZD
TZD
DPP-4-i
Insulin§ Insulin§
If combination therapy that includes basal insulin has failed to achieve HbA1c target after 3-6 months, proceed to a more complex insulin strategy, usually in combination with 1-2 non-insulin agents:
Insulin# (multiple daily doses)
Three drug combinations
More complex insulin strategies
or
or
or
or
or
or
or
or
or
or
or
or GLP-1-RA
high
low risk
loss
GI‡
high
GLP-1 receptor agonist
Sulfonylurea†
high
moderate risk
gain
hypoglycemia‡
low
If needed to reach individualized HbA1c target after ~3 months, proceed to 3-drug combination (order not meant to denote any specific preference):
&0-N#%?D@=58C<;=B896B#&@8C>5=Y#38?8C>;#,8B:998?7>D:?E#Diabetes Care, Diabetologia. 19 April 2012 !
[Epub ahead of print]!
Initial drug monotherapy
Efficacy (! HbA1c)
Hypoglycemia
Weight
Side effects
Costs
Healthy eating, weight control, increased physical activity
Metformin
high
low risk
neutral/loss
GI / lactic acidosis
low
If needed to reach individualized HbA1c target after ~3 months, proceed to 2-drug combination (order not meant to denote any specific preference):
Metformin +
Metformin +
Metformin +
Metformin +
Metformin +
Efficacy (! HbA1c)
Hypoglycemia
Weight
Major side effect(s)
Costs
high
low risk
gain
edema, HF, fx’s‡
high
Thiazolidine- dione
intermediate
low risk
neutral
rare‡
high
DPP-4 Inhibitor
highest
high risk
gain
hypoglycemia‡
variable
Insulin (usually basal)
Two drug combinations*
Sulfonylurea†
+
Thiazolidine-dione
+
DPP-4 Inhibitor
+
GLP-1 receptor agonist
+
Insulin (usually basal)
+
Metformin +
Metformin +
Metformin +
Metformin +
Metformin +
TZD
DPP-4-i
GLP-1-RA
Insulin§
SU†
DPP-4-i
GLP-1-RA
Insulin§
SU† SU†
TZD TZD
TZD
DPP-4-i
Insulin§ Insulin§
If combination therapy that includes basal insulin has failed to achieve HbA1c target after 3-6 months, proceed to a more complex insulin strategy, usually in combination with 1-2 non-insulin agents:
Insulin# (multiple daily doses)
Three drug combinations
More complex insulin strategies
or
or
or
or
or
or
or
or
or
or
or
or GLP-1-RA
high
low risk
loss
GI‡
high
GLP-1 receptor agonist
Sulfonylurea†
high
moderate risk
gain
hypoglycemia‡
low
If needed to reach individualized HbA1c target after ~3 months, proceed to 3-drug combination (order not meant to denote any specific preference):
Diabetes Care, Diabetologia. !
19 April 2012 [Epub ahead of print]!
Basal insulin only (usually with oral agents)
Basal insulin
+ 1 (meal-time)
rapid-acting insulin injection
Basal insulin
+ !2 (meal-time)
rapid-acting insulin injections
Premixed insulin
twice daily
less flexible
Number of
injections
1
Flexibility
Regimen
complexity
low
mod.
Non-insulin regimens
Sequential Insulin Strategies in T2DM Diabetes Care, Diabetologia. 19 April 2012 [Epub ahead of print]!
Congrés ADA 2012 Highlights
Nou consens ADA/EASD del tractament de la hiperglicemia en la Diabetes tipus 2
State of the art lecture Dr. Silvio Inzucchi
Cal individualitzar el tractament hipoglicemiant i els objectius terapeutics
Alimentació, activitat fisica i educació són la base del tractament
Metformina és el farmac de primera elecció si no està contraindicat
Després de Metformina cal valorar tractament combinat 1-2 FFOO/ SC.
Prioritzar minimitzar Efectes secundaris
Caldria plantejar-se decisions terapeutiques compartides
(preferències,necesitats i valors)
La reducció de RCV hauria de ser la prioritat en el tractament
Congrés ADA 2012 Highlights
IN CRE TINES
Actividad GLP-1 y GIP
Secreción de incretinas
Tracto GI
Comida
Pancreas
Cel Beta Cel Alfa
Reducción de la glucemia
! Captación de glucosa por Musculo y Tejido adiposo
! Insulina Cel beta
(GLP-1 y GIP) Glucosa dependiente
metabolitos
GLP-1 y GIP
X Inhibidor DPP-4
Incretin miméticos
Enzima DPP-4
Drucker DJ. Diabetes Care. 2003;26:2929–40.
!! Glucagon Cel alfa (GLP-1) Glucosa
dependiente
!! Producción hepática de glucosa
Us clínic de les Incretines
Congrés ADA 2012 Highlights
IN CRE TINES Anàlegs receptor GLP-1 Incretin miméticos
Congrés ADA 2012 Highlights
A C multicentric aleatoritzat Glimepiride vs Exenatide en pacients DM2 mal controlats en monoterapia amb Metformina
Avaluació: HbA1c > 9% els primers 3 mesos o >7% en dues ocasions passats 6 mesos
N= 1029 DM2 mal control MET Edat: 56 (10) anys Sexe: 56% homes IMC: 32.6 kg/m2 HbA1c: 7.5 %
EUREXA trial ADA/Lancet Dr. Schernthaner
Congrés ADA 2012 Highlights
EUREXA trial ADA/Lancet Dr. Schernthaner
1.! AC més llarg amb Anàleg GLP1 (4.5 anys) 2.! Millor control HbA1c, reducció de pes i menys Hipoglucemies en
el grup Exenatide. 3.! 4-5 de cada 10 pacients van necesitar afegir un altre farmac per
mantenir el control metabolic
Congrés ADA 2012 Highlights
Analegs del GLP 1 Are they all the same? Dr. Filip Knop Dinamarca
•! Categoritzacio per:
•! FK
•! Estructura
•! Tamany
FK Curta durada Llarga durada
Molecules Exenatide1 Lixisenatide1
Exenatide LAR1 Liraglutide2 Albuglutide2
Impacte glicèmic G. Post prandial G. Basal
Nausea +++ ++ 1.! Estructura similar a Exedin 4 2.! Estructura similar a GLP1
No són similars
Congrés ADA 2012 Highlights
Analegs del GLP 1 Tenen impacte CV?? Dr. Steven Marso . Cardioleg (Kansas)
Existencia de receptors GLP1 pancrees endocrí, cardiomiocit i
endoteli vascular
Recerca en models animals i humans
Beneficis en xifres PA i lipids
Models experimentals en IAM i I Cardiaca
Congrés ADA 2012 Highlights
EASIE trial ADA/Lancet Dr. Pablo Aschner ( Colombia)
A C multicentric aleatoritzat obert I. Glargine I Sitagliptina en pacients DM2 mal controlats en monoterapia amb Metformina
Objectiu: comparar eficacia (HbA1c), tolerabilitat i seguretat d’ambdos molecules
N = I. Glargina: 250 Sitagliptina: 265 Duració: 24 setmanes
Edat: 53.6 (9) anys Sexe: 51% homes IMC: 31.1 kg/m2 Duració DM2: 4.5 anys HbA1c: 8.5 %
Dosis Sitagliptina 100 mg/d
Dosis insulina final del estudi 0.5UI/kg/dia
Congrés ADA 2012 Highlights
EASIE trial ADA/Lancet Dr. Pablo Aschner ( Colombia)
Despres de 24 setmanes
I. Glargina Sitagliptina
HbA1c < 7% 68% 42% p< 0.0001
Hipoglucemia (pacient/any) 4.21 0.50 p< 0.0001
Congrés ADA 2012 Highlights
DPP4 Inh Are they all the same? Dr. Adrian Vella ( Mayo Clinic) USA
Tenen estructures quimiques diferents
Comparteixen el mateix mecanisme d’acció amb similar inh
enzimatica ( 80%)
Existeixen diferencies en la seva FK
Reduccio HbA1c 0.7% aprox
Baix risc Hipoglicemia
No increment de pes
Efectes adversos similars Si, són similars
Congrés ADA 2012 Highlights
Debat: AGC si o no????
Pro Dr. Lutz Heinemann (Germany)
-! MA i RS AGC es relaciona reduc. de HbA1c de 0.2 a 0.4
-! Estudis amb limitacions (randomització, entrenament ,…)
-! M. Franciosi et al. Diabetic Med 2011;28:798 reduc.
HbA1c 0.5%
-! Eina d’empoderament del pacient en l’autocontrol
Congrés ADA 2012 Highlights
Debat: AGC si o no????
Contra Dr. Jeffrey Stephens (UK)
-! Argumenta que les reduccions d’HbA1c observades no
són clinicament rellevants.
-! Excepció per els diabètics de recent diagnostic amb valors
HbA1c més elevats
-! Importancia en que cal saber fer la tecnica i tambe
ENTENDRE els resultats i actuar en consequencia
-! Apropiat en pacients amb risc de HIPOS i de forma
transitoria (canvi de tractament o malaltia intercorrent)
Delay in Progression to Type 2 Diabetes among High-Risk Spanish Individuals DE-PLAN-CAT study
Delay in Progression to Type 2 Diabetes among High-Risk Spanish Individuals Following Lifestyle Intervention in Real-Life Primary Care
DE-PLAN CAT #4$,W&Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional intervention
XAVIER COS1, BERNADO COSTA1, FRANCISCO BARRIO1, JOAN J. CABRÉ1, JOSEP LLUIS PIÑOL1, SONIA SARRET1, CLAUSTRE SOLÉ1, XAVIER MUNDET1, TERESA MUR1, MONTSERRAT COT1, JACINT CAULA1, FRANCESC PUJOL1, JAANA LINDSTRÖM2, JAAKKO TUOMILEHTO2, DE-PLAN-CAT RESEARCH GROUP1
1Primary Care University reasearch institute. IDIAP Jordi Gol. Barcelona, Spain 2Department of Public Health, University of Helsinki, Finland
Área de Investigación en Diabetes y Enfermedades Endocrino-Metabólicas Prevencion de Diabetes Research Agenda (IDIAP Jordi Gol) .
The DE-PLAN study (2004) DE - PLAN CAT (2005) Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional intervention Financiacion de la UE (DG SANCO), FIS (Instituto de Salud Carlos III) y Departamento de Salut Publica de la Generalitat de Catalunya
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
DE PLAN
DE PLAN-CAT
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Metodos 1
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Performed OGTT n=591 (44.2%)
Performed OGTT n=601 (83.9%)
Low-Moderate Risk at FINDRISC n=1338 (65.1%)
High-Very High Risk at FINDRISC n=716 (34.9%)
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Resultados 1
0
5
10
15
20
25
30
35
Year 1 Year 2 Year 3 Year 4
Standard care Group
Intensive Group
Complete Group
Años 1 2 3 4 Grupo Standard 20 (6) 41 (12.3) 53 (15.9) 61 (18.3) Standard-Care Intervention Group 17 (7.8) 37 (16.9) 51 (23.3) 63 (28.8) No acumulado de diabetes 37 (6.7) 78 (14.1) 104 (18.8) 124 (22.5)
'?B678?B6>#>BG9G;>7>#78#-6>J8A8E#
La incidencia de diabetes tras una mediana de 4,2 años fue 7,2 y 4,6 casos-100 personas-año (RRR=36,5%; p<0,005)
Resultados 2
Participantes a riesgo Año 1 Año 2 Año 3 Año 4 Total no. 514 476 453 430 N. Acumulado de pacientes diabetes 37 78 104 124 Grupo Intensivo 20 41 53 61 Grupo Standard 17 37 51 63
Y&6&:&5&7&
71a&
71H&
719&
7&
517&
Follow-up time (years) p = 0.005 (Log Rank)
Cum
ula
tive p
robabili
ty o
f re
main
ing d
iabete
s-fr
ee
NNT = 9.5
El número necesario de participantes a tratar durante 4 años para reducir un caso de diabetes fue 9,5.
Resultados 3
1.! Se observa una reduccion del 36% en la incidencia de in
Diabetes
2.! Todos los participantes mostraron beneficios de la Intervencion en
estilos de vida, independientemente de la edad y el sexo.
3.! Es necesario tratar 10 individuos de alto riesgo durante 4 años
con un programa de educacion de 6 horas para evitar (prevenir or
retrasar) 1 caso de diabetes.
4.! Es posible conseguir una reduccion de la incidencia de
Diabetes en sujetos de alto riesgo con intervenciones de estilos de
vida en el ambito de la Atencion Primaria.
F.(-+$#2.("#&
Congrés ADA 2012 Highlights
TINSAL trial Dr. Allison Goldfine (Joslin Diabetes Center)
Congrés ADA 2012 Highlights
TINSAL trial Dr. Allison Goldfine (Joslin Diabetes Center)
A C multicentric aleatoritzat salsalat 3.5 gr/d o PCB 48 set
Objectiu: Canvi de la HbA1c
Criteris inclusió Edat 18 a 75 anys DM2 en FFOO A1c 7-9.5%
Criteris Exclusió Tt. Amb Glitazones, Insulina o Analegs GLP 1 Tt. Crònic amb AINES FG< 60 ml/min
N= 286 DM2 no controlada
Congrés ADA 2012 Highlights
TINSAL trial resultats Dr. Allison Goldfine (Joslin Diabetes Center)
N= 286 Edat: 56(10) anys Sexe: 55% homes IMC: 33.3 kg/m2 HbA1c: 7.7(0.7) %
Met 88% Secretagog 82% (mono 41% bi 49% tri 6%)
Aspirina 41% Estatines 60%
Despres de 48 setmanes
Reducció HBA1C 0.24% (Salsalat vs PCB) p< 0.001
Reducció de Leucocits (Neutròfils i Limfòcits)
No canvis Prot C Reactiva
Reducció del aclariment insulina hepàtic
Canvis perfil lipidic (! Col total i LDL c, " TG ) p< 0.02
1.! Aquest estudi permet afirmar que la hipotesis inflamatoria pot tenir un paper en la fisiopatologia de la DM2
2.! El Salsalat no es pot considerar un tractament per la DM2
Congrés ADA 2012 Highlights
TODAY trial Dr. Philip Zeitler (University of Colorado)
Opcions terapeutiques en pacients diabetics tipus 2 adolescents o joves
Criteris inclusió Edat 10 a 17 anys DM2 < 2 anys evolució IMC > percentil 85 Ac’s antipancreàtics neg /C peptit > 0.6 ng/ml
15 centres
N= 699 (Edat 14 anys, IMC 34.9 kg/m2, 7.8 mesos desde Dx DM2)
3 grups de intervenció: Met, Met + Rosigli i Met+SV
Congrés ADA 2012 Highlights
TODAY trial resultats Dr. Philip Zeitler (University of Colorado)
Inici del estudi - 26% HTA - 13% mircoalbuminuria - 80% HDL-c baixa - 10% TG elevats - nivell SE i educacio pares baix
End point A1c > 8% 6 mesos o descompensacio metabolica persistent
Seguiment 3.9 anys
Raons per End point similars a tots els grups.
IMC no va influenciar en els resultats
-! Metformina menys efectiva en pacients de color
-! > 50% no van aconseguir control glicemic amb Met
-! Important deteriorament funcionalisme !
The Big Picture - ORIGIN
•! A large international RCT in people with new or recently diagnosed diabetes, IFG or IGT & additional CV risk factors lasting > 6 years
•! Assessed the effect of 2 independent therapies on serious CV outcomes in > 12,500 people:
a)! titrated basal insulin using insulin glargine b)! 1 g of omega 3 FA
ORIGIN Research Questions
Participants (Key Inclusion Criteria)
Glargine Standard Care
Omega 3 FA* Glargine + Omega 3 Omega 3
Placebo Glargine + Placebo Placebo
Recruitment: Sept ‘03 – Dec’05 Final Visit: Q4 2011
Median (IQR) Follow-up: 6.2 y (5.8-6.6)
Glargine (Lantus): open vs. standard care
Omega 3 FA (Omacor): double-blind; 1 cap/day*
*Omacor contains EPA 465 mg & DHA 375 mg
Major Outcomes: Glargine Trial Primary
•! CV death OR MI OR stroke
•! CV death OR MI OR stroke OR revasc OR CHF hosp’n
Secondary
•! Microvascular composite
(i.e. doubling of serum Cr, progression of albuminuria category, dialysis/renal transplant, laser Rx/vitrectomy for retinopathy)
•! New type 2 diabetes (in those without baseline diabetes)
•! All cause death
•! Cancers
•! Angina, amputation for ischemia,
•! CV & other hospitalizations
•! Hypoglycemia, weight
•! Cognition
•! Erectile dysfunction
Other Outcomes & Measures
Randomized By Region N=12537 from 573 sites in 40 countries
N. America 1314 (11%) Europe/Africa 6060 (48%) Australia 202 (2%)
S. America 3853 (31%) Asia 1108 (9%)
Characteristic % Drug Use %
Smoking 12 Statin 54
Hypertension 80 ACE-I/ARB 69
Any Albuminuria 15 Thiazide 19
Previous CVD 59 Beta Blocker 53
Other BP Drug 41
Antiplatelet 69
Baseline Characteristics Mean Age = 63.5 yrs; Females = 35%
Conventional Units
SI Units
BMI (kg/m2) 29.8 29.8
Blood Pressure (mm) 146/84 146/84
Cholesterol (mg/dl or mM) 190 4.9
LDL (mg/dl or mM) 112 2.90
HDL (mg/dl or mM) 46 1.19
TG (Median mg/dl or mM) 140 1.58
Baseline Characteristics (Mean Level)
Median A1C Levels
IQR 5.5 – 6.5
IQR 5.8 – 6.9
Insulin Glargine
Standard Care
P
Cholesterol (mg/dl) 175 177 0.09
LDL (mg/dl) 102 102 0.51
HDL (mg/dl) 45 46 <0.001
Triglyceride (mg/dl) 124 128 <0.001
HR 69.2 69.7 0.08
SBP/DBP 141/79 141/79 0.4
Final CV Risk Factors ConventionaI Units
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1st Co-primary: MI, Stroke, or CV Death
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2nd Co-Primary: MI, Stroke, CV Death, Revascularization, Heart Failure
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All-cause Death
Summary of Findings
•! 1st CV Composite: HR = 1.02 (0.94, 1.11)
•! 2nd CV Composite: HR = 1.04 (0.97, 1.11)
•! Microvascular Composite: HR = 0.97 (0.90, 1.05)
•! Death: HR = 0.98 (0.90, 1.08)
•! Cancer: HR = 1.00 (0.88, 1.13)
•! Conversion IFG/IGT to DM: HR = 0.72 (0.58, 0.91) P=0.006
ORIGIN clearly assessed the effect of basal insulin
glargine on important health outcomes:
Summary of Findings
Congrés ADA 2012 Highlights
Congrés ADA 2012 Highlights
Abstrats deadline 3 Setembre www.pcdeurope.org http://pcdeurope2012.semfyccongresos.com/registration
Congrés ADA 2012 Highlights
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