Two Diabetes Studies Paint Comprehensive Picture of the Disease

Drugs used to treat type 2 diabetes perform as expected, while estimates of the prevalence of diabetes in adolescents are higher than previously reported, according to two studies published July 19 in the Journal of the American Medical Association.

In “Comparison of Clinical Outcomes and Adverse Events Associated With Glucose-Lowering Drugs in Patients With Type 2 Diabetes,” by Suetonia C. Palmer, PhD, et al., a meta-analysis of 301 clinical trials revealed that there were no substantial differences in associations between any drug class as monotherapy, dual therapy or triple therapy with odds of cardiovascular or all-cause mortality. The authors conducted a systematic review of randomized clinical trials in which treatment was given for 24 weeks or longer. Comparisons of the following drug classes were studied: metformin, sulfonylurea, thiazolidinedione, DPP-4 inhibitor, SGLT2 inhibitor, GLP-1 receptor agonist, basal insulin, meglitinide and a-glucosidase inhibitor. Drugs were given as monotherapy in 177 of the selected trials, as dual therapy (added to metformin) in 109 trials and as triple therapy (added to metformin and sulfonylurea) in 29 trials.

The analysis found no evidence of an association of any drug class with cardiovascular mortality – the primary end point – in the monotherapy, dual therapy or triple therapy trials. All of the monotherapy studies showed uncertain comparative associations with all-cause mortality, serious adverse events, myocardial infarction and stroke (secondary end points), while the dual therapy and triple therapy trials showed no significant differences between any drug class and those secondary end points.

The authors concluded that among adults with type 2 diabetes, there were no significant differences in the associations between any of the classes of glucose-lowering drugs (alone or in combination) and the risk of cardiovascular or all-cause mortality. All drugs were estimated to be effective when added to metformin. Palmer, et al., stated that “these findings are consistent with American Diabetes Association (ADA) recommendations for using metformin monotherapy as initial treatment for patients with type 2 diabetes and selection of additional therapies based on patient-specific considerations.”

Many adolescents who have diabetes are unaware of their condition, according to “Prevalence of Diabetes in Adolescents Aged 12 to 19 Years in the United States, 2005-2014,” a research letter authored by Andy Menke, PhD, et al. Using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014, the authors looked at responses from adolescents 12 to 19 years old. In addition to being asked if they had ever been diagnosed with diabetes, patients’ hemoglobin A1C and fasting plasma glucose were measured, and an oral glucose tolerance test was administered.

Of the 2606 patients included, 62 had diabetes, 20 were undiagnosed and 512 had prediabetes. Prediabetes was more common in males than females; the percentage of undiagnosed patients and the prediabetes prevalence were higher in non-Hispanic black participants.

“To our knowledge, these are the first estimates of diabetes in a nationally representative sample of US adolescents using all three ADA recommended biomarkers,” stated Menke, et al. “The estimates are higher than previously reported.” The fact that a relatively large proportion of patients were unaware of the condition indicates a need for an improved diabetes screening process among adolescents.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Heart Failure and Cardiac Biomarkers, Diet

Keywords: Adolescent, American Medical Association, Benzamides, Biomarkers, Pharmacological, Blood Glucose, Diabetes Mellitus, Type 2, Fasting, Glucose, Glucose Tolerance Test, Glucosidases, Hemoglobin A, Glycosylated, Hypoglycemic Agents, Insulins, Metformin, Myocardial Infarction, Nutrition Surveys, Prediabetic State, Stroke, Sulfonylurea Compounds, Thiazolidinediones, Metabolic Syndrome X

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