American Diabetes Association 66th Annual Scientific Sessions

Diabetes and Primary Care, Summer, 2006

Washington DC, USA, 9-13 June 2006

Sitagliptin gives same glucose-lowering effect as glipizide

Study results released at the American Diabetes Association (ADA) 66th Annual Scientific Sessions show that sitagliptin (Januvia; Merck Sharp & Dohme, Hoddesdon) was non-inferior to glipizide in reducing blood glucose levels when added to metformin monotherapy in people with inadequately controlled type 2 diabetes. The data presented were based on a 52-week study period, with the trial due to continue for another 52 weeks.

This double-blind study randomised 1172 people to receive either once-daily 100mg sitagliptin (an investigational dipeptidyl peptidase-4 [DPP-4] inhibitor) or glipizide at the maximum titrated dose. Hb[A.sub.1c] was observed to decrease by 0.67 percentage points versus baseline in each study arm (P<0.001) and similar proportions of participants achieved Hb[A.sub.1c] <7% in each group.

However, participants in the sitagliptin group exhibited significant weight loss (-1.5 kg) while the glipizide-treated people gained weight (+1.1 kg; P<0.001 between treatments). In addition, hypoglycaemic episodes were experienced by a smaller proportion of the sitagliptin group compared with the glipizide-treated group (4.9% versus 32.0%, respectively; P<0.001).

Phase III data demonstrate efficacy of ruboxistaurin

Analysis of data from two phase III clinical trials presented in Washington demonstrates that use of the investigational protein-kinase-C-beta inhibitor ruboxistaurin mesylate (Arxxant; Eli Lilly, Basingstoke) reduces the relative risk of sustained moderate vision loss (SMVL) compared with placebo in people with moderate-to-severe non-proliferative diabetic retinopathy.

SMVL occurred in 6.1% of people treated with ruboxistaurin over 3 years compared to 10.2% of those receiving placebo (P=0.011).

Insulin initiation delayed

Data from a study of UK patient records presented at the ADA meeting show that more than half of a group of 2501 patients delayed starting insulin for at least 4-6 years after their oral therapies failed to be effective.

A statement from Pfizer says that these findings counter the preliminary NICE opinion on inhaled insulin therapy that using injected insulin is 'not usually a concern for the majority of people with diabetes'.

Campaign for UN resolution on diabetes launched

The International Diabetes Federation (IDF) launched 'Unite for Diabetes' at the ADA meeting, a campaign aiming to highlight the alarming rise of diabetes worldwide and to secure a United Nations resolution on diabetes.

New data from the IDF suggest that more than 230 million people worldwide (nearly 6% of the population) now live with diabetes, with this figure estimated to rise to 350 million by 2025. Despite these alarming statistics, the IDF says, little political effort has been made to tackle diabetes. Reversing the current trend will require a 'whole-of-government approach and the attention of the international community'.

'The diabetes epidemic will overwhelm healthcare resources everywhere if governments do not wake up and take action now,' said Professor Martin Silink, IDF's President-Elect.

It is hoped that a UN declaration on diabetes will be declared on or around World Diabetes Day 2007.

Study examines effects of insulin detemir in routine practice

Results from the German cohort of the international PREDICTIVE (Predictable Results and Experience in Diabetes through Intensification and Control to Target: an International Variability Evaluation) study confirm that insulin detemir (Levemir; Novo Nordisk, Crawley) improves glycaemic control and reduces the risk of hypoglycaemia. The new data were released in a poster presentation at the ADA Scientific Sessions.

The results are based on data from 10276 participants taking part in the German arm of the 12-week, prospective, non-interventional, open-label observational study which was designed to evaluate the safety and efficacy of insulin detemir in routine clinical practice.

The beneficial effects of the insulin were seen regardless of the particular basal insulin treatment that participants were using before switching to insulin detemir, said the investigators. The effects were also noted in people who had not previously used insulin.

Commenting on these results, Dr Malcolm Nattrass of University Hospital Birmingham said: 'This insight into how [insulin detemir] is being used in clinical practice to manage diabetes successfully without weight gain is very positive for healthcare professionals and patients alike.'