PracticeUpdate Diabetes Best of 2018

EASD 2018 23

European Association for the Study of Diabetes 54th Annual Meeting 1–5 OCTOBER 2018 • BERLIN, GERMANY By the PracticeUpdate Editorial Team DISCOVER Study Finds High Complication Rate in Type 2 Diabetes Patients woefully undertreated worldwide T he high rate of microvascular and macrovascular complica- tions among patients with type 2 diabetes who have been initiated on second-line therapy is a wake-up call for diabetes experts globally, according to a presentation made at EASD 2018. they follow the guidelines and nobody does,” he told Elsevier’s PracticeUpdate.

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He noted that all guidelines recommend initiating second-line treatment around an HbA1c of 6.5% to 7.0%, but initiation world- wide happens at a median of 8.3%. The lag time between the diagnosis and the initiation of second-line treatment is 5 years, yet most diabetes guidelines recommend only 3 to 12 months. This undertreatment is a global issue and occurs in relatively wealthy countries with comprehensive drug-reimbursement programs. “The main predictive factor for having micro- or macrovascu- lar complications at 1-year is having a micro- or macrovascular complication before,” Dr. Surmont said. “So the people who are treated badly are those patients who are prone to get a second complication.” Another surprise finding of the study, he said, was that “even the most basic measurements are not taken. Around the world, [about] 80% get an HbA1c to make a decision for second-line treatment, and maybe 90% get a fasting glucose. But 10% do not get even a glucose measurement when taking the decision to change a treatment.” Other important parameters, such as kidney function testing and lipid levels, are evaluated far less frequently. AstraZeneca is building a global registry to collect key perfor- mance indicators worldwide based on 15 datapoint measurements, including serum blood glucose levels, blood pressure, and albumin levels, Dr. Surmont said. He noted that while diabetes manage- ment is currently very “sugar focused” other important parameters to monitor are outcomes, such as kidney function, that have an impact on mortality. AstraZeneca is working to collaborate with organizations such as the International Diabetes Federation, European Medical Asso- ciation, and European Association for the Study of Diabetes to enable the registry to be as broad as possible. www.practiceupdate.com/c/74355

The global, observational DISCOVER study, a 3-year, non-interventional investigation, is following patients from 37 countries with type 2 diabetes initiated on second-line glu- cose-lowering therapy. Rates of microvascular and macrovascular complications continue to be collected. Microvascular complications comprised new diagnoses or procedures related to retinopathy, neuropathy, nephrop- athy, or erectile dysfunction. Macrovascular

Dr. Filip Surmont

complications comprised new diagnoses or procedures related to coronary or peripheral artery disease or heart failure. The DIS- COVER study is supported by AstraZeneca. Filip Surmont, MD, of AstraZeneca in Luton, United Kingdom, pre- sented the 1-year interim results. This analysis included 11,430 patients from 34 countries for whom 6-month or 12-month data were available. Overall, the rate of new microvascular complica- tions was 6.6%, and the rate of new macrovascular complications was 4.7%. There were substantial variations across countries, with the highest rates seen in Russia and, to a lesser extent, Canada, China, Australia, and parts of Europe. The proportion of patients with new microvascular complications was higher in those with microvascular disease at baseline (9.8%) than those without (5.9%; P < .001). Similarly, new macrovascular complications occurred more commonly in patients with macro- vascular disease at baseline (16.9% vs 2.9%; P < .001). These findings indicate that globally patients with type 2 diabe- tes are being undertreated, said Dr. Surmont. “Physicians tell us

VOL. 2 • NO. 4 • 2018