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More than 1.4 million Americans were diagnosed with diabetes in 2004, the last year for which data are available.1 The number of new diagnoses of diabetes has increased each year since 1997. Overall, the estimated incidence of diabetes in the United States is 20.8 million, approximately 7% of the population.2 An estimated 73 million people are at risk for developing diabetes.3 Diabetes has been identified as a significant risk factor for stroke4 and coronary artery disease.5 With the significant health consequences associated with diabetes, there is a need to ensure that clinicians can diagnose and manage patients appropriately. In a recently published 10-year review article by Dr. Massi-Benedetti from the Universita di Perugia, A1C target levels of 6.0% to 7.5% were achieved by only one third of patients with type 2 diabetes.6 It is a clear and serious health care concern that better treatments for type 2 diabetes are needed and that clinicians must be aware of these new treatments in order to maximize outcomes for patients.
Conventional anti-hyperglycemic therapies have not been sufficient for a number of reasons, including associated weight gain, the increased risk of hypoglycemia associated with insulin and insulin secretagogue therapies, the inability of therapies to adequately control postprandial hyperglycemia, the wide glycemic fluctuations that persist despite treatment with most therapies and the inability of most therapies to maintain long-term glycemic control.7 In addition to glycemic control, current treatments for patients with type 2 diabetes should also target the progression from pre-diabetic impaired glucose tolerance to actual type 2 diabetes.
The complex development of diabetes progresses in stages that include glucose intolerance, insulin resistance, loss of insulin response, the deterioration of beta cell function and mass, and impairment of the body’s ability to regulate insulin release. The gap in diabetic management is that many treatments do not address the multifaceted nature of type 2 diabetes. The therapeutic goal should be to achieve and maintain the body’s physiology as close to normal as possible. To achieve this goal, clinicians need to be aware of newer therapies for glycemic control.
Innovative strategies for glycemic control in patients with type 2 diabetes that are being investigated include dipeptidyl peptidase IV (DPP-IV) inhibitors, which prevent the degradation of incretin hormones GLP-1 and GIP that have multiple actions on glucose homeostasis.8-10 The scientific clinical data of a DPP-IV inhibitor were published in July-Aug 2006 in the Annals of Pharmacotherapy and the results suggest that DPP-IV inhibitors show efficacy against type 2 diabetes as a mono-therapy and as adjunctive therapy with metformin without the adverse effects of weight gain or hypoglycemia.11 An educational program is necessary to prepare clinicians for the introduction of such therapies into their daily practices. A review article by Dr. Bailey et al. from Aston University, presented solid evidence that the early introduction of combination therapy (mostly with metformin as one of the therapies) allows more patients to achieve glycemic control and reduce complications and delay the progression of diabetes.12
The symposium proposed within this grant request will provide a broader understanding of the pathophysiology of type 2 diabetes and address both lifestyle and behavioral corrections that should be implemented to reduce patients' risk of developing diabetes as well as pharmacologic options for patients for whom behavior modification is not sufficient, particularly focusing on the contribution of incretin abnormalities in the progression of diabetes. The program will describe the gap in current treatments of type 2 diabetes and address present and future therapies to correct incretin abnormalities. Additionally, the program will review research studies involving agents that are members of this novel drug class and speculate on the potential role of these agents in the management of patients with type 2 diabetes, and present an interactive case study.
The American Association of Clinical Endocrinologists (AACE) provided a “Suggested Topics for 2007 Satellite Symposia” list as part of their AACE Satellite Symposia Proposal Guidelines. Within the section under Diabetes was listed “Incretins/GLP-1 exendin-4 analogs or DPP-IV inhibitors.” The AACE recognizes the need for education on this topic of interest. Education in this therapeutic area is especially important with the recent FDA approval of sitagliptin on October 16, 2006. In addition, attendee evaluations taken from a 2006 American Association of Diabetes Educators (AADE) symposium addressing DDP-IV inhibitors and other novel mechanisms in the management of type 2 diabetes indicated that physicians felt the topics were relevant to their professional practice and/or learning needs (mean score of 4.73 on a scale of 1 to 5, with 1 being strongly disagree and 5 being strongly agree). Vindico Medical Education, through the support of Merck, proposes a satellite symposium on incretin enhancers and dipeptidyl peptidase-IV (DPP-IV) inhibitors to be held at the 2007 annual meeting of the Endocrine Society.
References
1. Diabetes Public Health Resource. Available at http://www.cdc.gov/diabetes/statistics/incidence/fig1.htm. Accessed August 28, 2006.
2. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005. Available at: http://www.cdc.gov/diabetes/pubs/factsheet05.htm. Accessed August 28, 2006.
3. Cowie CC, Rust KF, Byrd-Holt DD, et al. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health And Nutrition Examination Survey 1999-2002. Diabetes Care. 2006;29(6):1263-1268.
4. Ohira T, Shahar E, Chambless LE, Rosamond WD, Mosley TH Jr, Folsom AR. Risk Factors for Ischemic Stroke Subtypes. The Atherosclerosis Risk in Communities Study. Stroke. 2006 Aug 24; [Epub ahead of print].
5. Govind S, Saha S, Brodin LA, Ramesh SS, Arvind SR, Quintana M. Impaired Myocardial Functional Reserve in Hypertension and Diabetes Mellitus Without Coronary Artery Disease: Searching for the Possible Link With Congestive Heart Failure in the Myocardial Doppler in Diabetes (MYDID) Study II. Am J Hypertens. 2006;19(8):851-857.
6. Massi-benedetti M. Changing targets in the treatment of type 2 diabetes. Curr Med Res Opinion 2006; 22 suppl 2: 5-13
7. Blonde L. AMulti?Disciplinary Approach Addressing Novel Mechanisms in the Management of Type 2 Diabetes. Presented at the annual meeting of the Americam Association of Diabetes Educators. Los Angeles, CA; August 9, 2006.
8. Toft-Nielsen MB, Damholt MB, Madsbad S, et al. Determinants of the impaired secretion of glucagon-like peptide-1 in type 2 diabetic patients. J Clin Endocrinol Metab. 2001;86(8):3717-3723.
9. Deacon CF, Nauck MA, Toft-Nielsen M, Pridal L, Willms B, Holst JJ. Both subcutaneously and intravenously administered glucagon-like peptide I are rapidly degraded from the NH2-terminus in type II diabetic patients and in healthy subjects. Diabetes. 1995;44(9):1126-1131.
10. Drucker DJ. Biological actions and therapeutic potential of the glucagon-like peptides. Gastroenterology. 2002;122(2):531-544.
11. Miller s, St Onge E, Sitagliptin: a dipeptidyl peptidase IV inhibitor for the treatment of type 2 diabetes. Ann Pharmacother 2006 July-Aug; 40 (7-8): 1336-1343
12. Bailey C, del Prato S, Eddy D et al. Earlier intervention in type 2 diabetes: the case for achieving early and sustained glycaemic control. Int J Clin Pract 2005 Nov (11): 1309-1316
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