PracticeUpdate Diabetes June 2019

CONFERENCE COVERAGE 18

More Than One-Third of PatientsWith Type 2 Diabetes Reach HbA1c TargetWith Sitagliptin More patients who reached target HbA1c <7% took sitagliptin + other oral antidiabetics rather than sitagliptin + insulin. C onsiderable reduction in HbA1c has been observed with sit- agliptin for type 2 diabetes: more than one-third of patients reached target. More patients reached target HbA1c <7% who took sitagliptin + other oral antidiabetic drugs than those who received sitagliptin + insulin, reports a multicenter, retrospective data analysis. glucose were 184 and 271 mg/dL, respectively. Mean body mass index was 27.5 kg/m 2 . At follow-up, mean HbA1c was 8.1%, a mean change of 0.5%. Fast- ing and postprandial blood glucose dropped to 165 and 244 mg/ dL, respectively.

Among these, 336 (44%) patients had reached target HbA1c. The percentage of patients at target HbA1c <7%was greater with sitaglip- tin + other oral antidiabetics (37%) than with sitagliptin + insulin (15%). Sitagliptin could be an optimal treatment choice. A clinically con- siderable reduction in HbA1c was observed: more than one-third of patients with type 2 diabetes reached target HbA1c with sitagliptin.

R.M. Manikandan, MD, of the Apollo Sugar Clinics, Apollo Hospi- tals in India, and colleagues set out to evaluate clinical outcomes with sitagliptin in patients with type 2 diabetes mellitus. The dipeptidyl peptidase-4 (DPP4) inhibitor sitagliptin was eval- uated as an add-on to other antidiabetic drugs. A total of 6762 patients initiated on DPP4 inhibitor therapy registered in electronic medical records formed the basis of the analysis. Demographics and baseline characteristics were captured in the database. Descriptive statistics were applied to calculate mean continuous and discrete variables. Of the 6762 DPP4 inhibitor prescriptions, 2248 (33%) were for sitagliptin, 1146 of which contained adequate follow-up data and were included in the analysis. Mean patient age was 53.7 years. A total of 737 (64%) were males and 409 (36%) were females. A total of 759 (66%) of these prescriptions were in combination with other oral drugs and 387 (34%) were in combination with insulin. At initiation, mean HbA1c was 8.6%. Fasting and postprandial blood

DulaglutideMonotherapy Improves Glycemic Outcomes and Helps Control BodyWeight in Obese AdultsWith Prediabetes The therapy was well tolerated with no serious adverse events.

I n a real-world setting, dulaglutide monotherapy was well tolerated and demonstrated a significant improvement in glycemic outcomes and body weight in obese Indian adults with prediabetes. The therapy demonstrated a potential to reduce the risk of diabetes in obese adults with prediabetes. This outcome of a retrospective, single- center study was reported at AACE 2019. Supratik Bhattacharyya, MD, MBBS, MS, of the Advanced Medical & Research Institute (AMRI) Hospital in Kolkata, India, set out to evaluate the real-world clinical effective- ness of dulaglutide monotherapy in obese adults with prediabetes. Overall, 11 obese adults (body mass index ≥30 kg/m 2 ) with prediabetes (8 were males whose mean age was 38.18 ± 6.60 years) were included in the study. Mean HbA1c was 6.34% ± 0.08%. Mean body weight was

101.09 ± 8.04 kg. Mean body mass index was 36.16 ± 2.92 kg/m 2 . Data were retrieved from the electronic database of a hospital in Kolkata, India. Patients received once-weekly dulaglu- tide as monotherapy for 6 months. Changes in fasting blood glucose, post- prandial blood glucose, HbA1c, body weight, and corresponding body mass index were recorded. Outcomes were analyzed using the paired t -test. Adverse events were also recorded. After 6 months, significant reductions (P < .001) from baseline were demonstrated in fasting blood glucose, postprandial blood glucose, and HbA1c. Mean reductions were 28 (95% confidence interval 19.94–36.06) mg/dL, 39.64 (95% CI 27.45–51.83) mg/ dL, and 0.69% (95% CI 0.57% to 0.81%), respectively. Significant reductions (P < .001) in body

weight and body mass index were also demonstrated with mean reductions of 14.91 (95% CI 11.32–18.50) kg and 5.25 (95% CI 4.09–6.40) kg/m 2 , respectively. Mild nausea was reported in 1 patient, which was managed with domperidone and ondansetron. In all, 3 patients reported a decrease in appetite. Dulaglutide monotherapy for 6 months improved glycemic parameters and body weight significantly in this cohort of obese adults with prediabetes. An HbA1c target of <5.7% was achieved in 54.55% of patients. The therapy was well tolerated with no serious adverse events. No patients dis- continued therapy. Small sample size and lack of a comparator arm limited the study. Dulaglutide is a glucagon-like peptide-1 receptor agonist. It is composed of gluca- gon-like peptide-1 (7–37) linked covalently to an Fc fragment of human immune

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