Congrés ADA 2012 Highlights APprojectes.camfic.cat/CAMFiC/Seccions/Formacio/Docs... · Estructura similar a Exedin 4 2. Estructura similar a GLP1 No són similars . Congrés ADA

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

Resum general del congrés www.diabetes.org

130 sessions (72 simposium) EADS/ADA, Lancet/ADA, IDF/ADA 377 Comunicacions orals 2578 Posters (presentats/publicats)


Sumari AP

State of the art ADA/EASD consensus Tractament

Anàlegs GLP-‐1 IDPPIV

Autoanalisis (si o no? !!!) Resultats finals dels estudis

-‐ DE-‐PLAN-‐CAT -‐ TINSAL -‐ TODAY -‐ ORIGIN

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

1.   PATIENT-‐CENTERED APPROACH

2. BACKGROUND •  Epidemiology and health care impact •  RelaDonship of glycemic control to outcomes •  Overview of the pathogenesis of Type 2 diabetes

3. ANTI-‐HYPERGLYCEMIC THERAPY •  Glycemic targets •  TherapeuDc opDons

-‐ Lifestyle -‐ Oral agents & non-‐insulin injectables -‐ Insulin

Diabetes Care, Diabetologia. 19 April 2012 [Epub ahead of print]

3. ANTIHYPERGLYCEMIC THERAPY •  ImplementaDon Strategies

-‐ IniDal drug therapy -‐ Advancing to dual combinaDon therapy -‐ Advancing to triple combinaDon therapy -‐ TransiDons to and DtraDons of insulin

4. OTHER CONSIDERATIONS •  Age •  Weight •  Sex/racial/ethnic/geneDc differences •  ComorbidiDes (Coronary artery disease, Heart failure,

Chronic kidney disease, Liver dysfunc8on, Hypoglycemia)

5. FUTURE DIRECTIONS / RESEARCH NEEDS

ADA-EASD Position Statement: Management of Hyperglycemia in T2DM: A Patient-Centered

Approach


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


T2DM AnDhyperglycemic Therapy: General RecommendaDons







Metformin +

Metformin +

Metformin +

Metformin +

Metformin +



Thiazolidine- dione


high

DPP-4 Inhibitor


variable



Sulfonylurea† +


DPP-4 Inhibitor +



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§





or

or

or

or

or

or

or

or

or

or

or

or GLP-1-RA



Sulfonylurea†



T2DM AnDhyperglycemic Therapy: General RecommendaDons Diabetes Care, Diabetologia. 19 April 2012 [Epub ahead of print]






Metformin +

Metformin +

Metformin +

Metformin +

Metformin +



Thiazolidine- dione


high

DPP-4 Inhibitor


variable



Sulfonylurea† +


DPP-4 Inhibitor +



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§





or

or

or

or

or

or

or

or

or

or

or

or GLP-1-RA



Sulfonylurea†



T2DM AnDhyperglycemic Therapy: General RecommendaDons Diabetes Care, Diabetologia. 19 April 2012 [Epub ahead of print]






Metformin +

Metformin +

Metformin +

Metformin +

Metformin +



Thiazolidine- dione


high

DPP-4 Inhibitor


variable



Sulfonylurea† +


DPP-4 Inhibitor +



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§





or

or

or

or

or

or

or

or

or

or

or

or GLP-1-RA



Sulfonylurea†




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]

Congrès ADA 2012 Highlights

http://www.diabetes.conference-companion.com


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


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.

ä  Glucagon Cel alfa (GLP-1) Glucosa

dependiente

ä  Producción hepática de glucosa

Us clínic de les Incretines


IN CRE TINES Anàlegs receptor GLP-1 Incretin miméticos


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


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


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


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


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


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


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


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


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 study 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

0

5

10

15

20

25

30

35

Year 1 Year 2 Year 3 Year 4

Standard care GroupIntensive GroupComplete 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)

Incidencia acumulada de Diabetes

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

4 3 2 1 0

0.9

0.8

0.7

0

1.0

Follow-up time (years) p = 0.005 (Log Rank)

Cum

ulat

ive

prob

abili

ty o

f rem

aini

ng d

iabe

tes-

free

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.

Conclusiones


TINSAL trial Dr. Allison Goldfine (Joslin Diabetes Center)


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


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 (é Col total i LDL c, ê 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


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


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 β

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

In high risk people with IFG, IGT or early diabetes,

a)  does insulin replacement therapy targeting fasting normoglycemia (< 5.3 mM or 95 mg/dl) with insulin glargine, reduce CV outcomes more than standard approaches to dysglycemia?

b)  does adding omega 3 FA reduce CV death?

Participants (Key Inclusion Criteria) •  Age > 50 yrs AND

•  Dysglycemia AND –  EITHER IFG or IGT or new type 2 DM by OGTT

[i.e. FPG > 110 (6.1); or 2 Hr PG > 140 (7.8)] –  OR prior type 2 DM @ stable dose > 10 wks & …

•  on no OADs … + HbA1c < 9.0% •  < half-max 1 OAD + HbA1c < 8.5% •  > half-max 1 OAD + HbA1c < 8.0%

•  High CV Risk –  EITHER Prior MI, stroke, revasc, angina + doc. ischemia –  OR MA, proteinuria, LVH, 50% art. stenosis, ABI < 0.9

Glargine Standard Care Omega 3 FA* Glargine + Omega 3 Omega 3

Placebo Glargine + Placebo Placebo

ORIGIN Factorial Design N=12,537; 573 sites; 40 countries; 2 Comparisons

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

Spain

Norway

PortugalTurkey

Ukraine

Greece

Ireland

Greenland

Iceland

United States

Canada

MexicoThe Bahamas

Cuba

Panama

El Salvador Nicaragua

Costa Rica

JamaicaHaiti

Dom. Rep.

Argentina

Bolivia

Colombia

Venezuela

Peru

Brazil

Guyana

Chile

EcuadorKenya

Ethiopia

EritreaSudan

Egypt

NigerMauritania

Mali

Nigeria

Somalia

Namibia

Libya

Chad

TanzaniaDem. Rep.Of Congo

Angola

Algeria

Madagascar

Zambia

Gabon

Tunisia

Morocco

SwazilandLesotho

Liberia

Sierra Leone

GuineaGambia

Congo

Senegal

Guinea Bissau

IsraelLebanon

Georgia Kyrgyzstan

Yemen

IraqIran

Oman

Saudi Arabia

Russia

India

China

Kazakhstan

Nepal

Vietnam

Sri Lanka

PapuaNew

Guinea

Brunei

Philippines

Malaysia

Indonesia

Japan

Mongolia

S. KoreaN. Korea

Australia

New Zealand

United Kingdom

FijiZimbabwe

Vanuatu

Uzbekistan

Uruguay

U.A.E.

Uganda

Turkmenistan

Togo

Thailand

Tajikistan

Syria

Sweden

Suriname

South Africa

Antarctica

Solomon Islands

Sao Tome & Principe

Rwanda

Qatar

Poland

Paraguay

Pakistan

Neth.

Mozambique

Laos

Kuwait

HondurasGuatemala

Ghana

Germany

French Guiana

France

Finland

Equatorial Guinea

Dijbouti

Denmark

Cyprus

Coted'Ivoire Central African Republic

Cape Verde

Cameroon

Cambodia

Burundi

Burkina Faso

Bulgaria

Botswana

Bhutan

Benin

Belize

Bangla-desh

Azerb.

Afghanistan

Western Sahara(Occupied by Morocco)

Timor Leste (East Timor)

Myanmar(Burma)

ATLANTIC

PACIFIC

PACIFIC

INDIAN

OCEAN

OCEAN

OCEAN

OCEAN

Bel.Belarus

HungaryRomaniaSwitz.

Italy

Jordan

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)

Interventions (Added to Lifestyle) •  Insulin Glargine Group

–  Same approach for people with/without DM –  Add evening glargine to 0 or 1 oral agent –  Self-titrate @ 1-2 units, 2/wk; target capillary FPG < 95

mg/dl (5.3 mM) –  Metformin could be added to mitigate hypoglycemia

•  Standard Care Group –  Non-DM Screen for DM yearly –  DM Guideline-based + MD’s judgment

No insulin until > 2 OADs & no glargine

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

Years of Follow-up

Prop

ortio

n w

ith e

vent

s

0.0

0.1

0.2

0.3

0.4

0.5

0 1 2 3 4 5 6 7

GlargineStandard Care

# at Risk 1 2 3 4 5 6 7

G

SC

6264 6057 5850 5619 5379 5151 3611 766

6273 6043 5847 5632 5415 5156 3639 800

Time to Adjudicated Primary Outcome 1 - CV Death MI Stroke

Adj. HR 1.02 (0.94, 1.11) Log Rank P = 0.63

1st Co-primary: MI, Stroke, or CV Death

Years of Follow-up

Prop

ortio

n w

ith e

vent

s

0.0

0.1

0.2

0.3

0.4

0.5

0 1 2 3 4 5 6 7


# at Risk 1 2 3 4 5 6 7

G

SC

6264 5827 5474 5153 4835 4523 3076 631

6273 5833 5493 5186 4880 4555 3142 663

Time to Adjudicated Primary Outcome 2 - CV Death-MI-Stroke-HF Hosp-Revasc

Adj. HR 1.04 (0.97, 1.11) Log Rank P = 0.27

2nd Co-Primary: MI, Stroke, CV Death, Revascularization, Heart Failure

Years of Follow-up

Prop

ortio

n w

ith e

vent

s

0.0

0.1

0.2

0.3

0.4

0.5

0 1 2 3 4 5 6 7


# at Risk 1 2 3 4 5 6 7

G

SC

6264 6150 6024 5857 5687 5508 3906 847

6273 6159 6029 5878 5710 5501 3931 878

Time to Adjudicated All Death

Adj. HR 0.98 (0.90, 1.08) Log Rank P = 0.70

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 Compared to standard glycemic care of people with early diabetes, IGT &/or IFG … using once daily basal insulin glargine to target a FPG < 95 mg/dl (5.3 mmol/l) for a median of 6.2 years ...

•  Maintains near-normal glycemic control

•  Has a neutral effect on CV outcomes & on cancers

•  Slows progression of dysglycemia

•  Modestly increases hypoglycemia

•  Modestly increases weight


http://www.diabetes.conference-companion.com



Abstrats deadline 3 Setembre www.pcdeurope.org http://pcdeurope2012.semfyccongresos.com/registration

Documents

Congrés ADA 2012 Highlights APprojectes.camfic.cat/CAMFiC/Seccions/Formacio/Docs... · Estructura similar a Exedin 4 2. Estructura similar a GLP1 No són similars . Congrés ADA