This year's American Diabetes Association scientific sessions and the recent scare over Lantus and cancer
After this year's American Diabetes Association Scientific Sessions (June 5-9), I can say with confidence that the future is looking bright for diabetes. Over the last couple of years, the diaTribe team and I have been pleased and surprised by the volume of research going on to improve the lives of people with both type 1 and type 2, and this year was absolutely no exception. The meeting was a thoroughly impressive showcase of new developments in therapies, clinical practice, and management techniques, and there are a lot of interesting things on the horizon!
The first thing that I was so happy to see at the meeting was INCREDIBLE enthusiasm about continuous glucose monitoring (CGM). To me, it really seems that the latest new generations of CGM systems are coming into their own as a critical tool in diabetes management. We owe a lot to the work of the JDRF, which presented new one-year data at ADA from its well-respected CGM study (see this issue’s Conference Pearls). If the first half of the JDRF’s CGM results helped to push this technology onto the diabetes stage, this follow-up data really puts it in the spotlight, showing that participants continued to show lower A1cs and reduced hypoglycemia with CGM use. The utility of CGM is only increasing, because new generations of the devices are much easier to use - and this wasn't reflected in the older systems used in the trials. If you haven't tried CGM you might ask your doctor or educator whether they think you both could learn from it to improve your diabetes management. Even if you have an A1c that meets the ADA target (and 44% of people with diabetes in the US don't, so if yours isn't right where you want it, you're hardly alone), there was much more focus at the meeting on the “quality of A1c” - that's related to glycemic variability, which is a measure of how much you stay “in zone”.
Secondly, we're getting very excited about all the new long-acting GLP-1 therapies. Byetta, of course, was the first drug in this class, but there is a whole host of new, longer-lasting GLP-1s that improve on the original. The two new GLP-1s that are closest to market (around which most of the current “buzz” is centered) are Novo Nordisk's once-daily liraglutide and Amylin's exenatide once-weekly. Not only do these two drugs improve the convenience factor compared to Byetta, but results show that they provide better control too. Beyond these two, there are many other even longer-lasting GLP-1s in early development, and if they make it to market they might provide an even better and easier way to manage diabetes. Stay tuned--we'll keep you posted!
Meanwhile, on June 26 patients who use Sanofi-Aventis's Lantus insulin received the alarming news that “a possible link” may exist between the insulin and a higher risk for cancer. The European Association for the Study of Diabetes, which published the report, made a call for more research but also urged patients who are using Lantus to continue taking it. In a study of 127,000 patients from insurance databases, researchers found that one additional person out of every 100 who used Lantus for an average of 1.5 years was found to have cancer compared to those using human insulin.
We have two immediate concerns. First, we are concerned about the potential for sensational media coverage and undue fear not only among Lantus users but also among long-acting insulin users (such as Novo Nordisk's Levemir) and even, by extension, insulin analogs. Second, we note the limits in analyzing large insurance databases. There may be safety risks to assess with Lantus, but if there are, the benefits should be assessed and balanced as well. It's too early to tell for sure (see Dr. Steve Edelman in this issue's Quotable Quotes). On a personal note, I hope the report does not herald a return to human insulins, which from my experience caused far more hypoglycemia than insulin analogs (I had 24 ER visits between 1986 and 1996 for hypoglycemia and only one since then, mostly because I've gone on a pump and an insulin analog).
Finally, we're very excited about this month's giveaway, which allows us to share our excitement about CGM in a more-shall we say-physical way. For this month, DexCom has given diaTribe a $500 credit for any DexCom merchandise, which we will give to one lucky reader! Like all of our giveaways, this is open to non-readers as well--help us spread the word about CGM.
Yours truly,
Kelly L. Close
