Diabetes Core Update – July 10, 2012 Episode Summary

Episode Overview

This episode of the Diabetes Core Update discusses clinically relevant articles published in the American Diabetes Association’s journals, providing valuable insight for physicians and healthcare practitioners on how the latest research impacts clinical diabetes care. Hosts Dr. Neil Skolnik and Dr. John Russell cover five key studies released in the June 2012 issues, addressing mortality trends, physical fitness, genetic testing, new therapies, and the impact of treatment adherence.

Key Discussion Points & Insights

1. Trends in Mortality Among US Adults With and Without Diabetes (1997-2006)

• Article Source: Diabetes Care, June 2012
• Summary:
  • Among adults with diabetes, cardiovascular death rates declined by 40% and overall mortality by 23% over a decade.
  • The rate of decline was similar for both men and women with diabetes.
  • Excess cardiovascular mortality linked to diabetes dropped by 60%, all-cause by 44%.
  • By comparison, non-diabetic individuals saw only a small decline in mortality.
• Analysis:
  • The reduction is attributed to advances in cardiovascular care and a more aggressive approach to managing LDL cholesterol in diabetics, possibly stemming from ATP3 and subsequent guideline updates (2003-2004).
  • Recognizing diabetes as a “cardiac equivalent” led to tighter LDL targets and better risk management for this population.
• Quote:

  "We are much more enlightened with regard to diabetes being a cardiac equivalent, and we are much more aggressive now... If we get people's LDLs lower, we can certainly have a decrease in cardiovascular events."
  — Dr. John Russell (03:22)

• Timestamp: [00:57]–[03:22]

2. Physical Fitness and Cardiovascular Risk in Type 2 Diabetes

• Article Source: Diabetes Care, June 2012 (Italian Diabetes and Exercise Trial)
• Summary:
  • 22 diabetes clinics in Italy conducted a 6-month trial comparing supervised exercise+education vs. education-only.
  • Supervised regimen: 150 minutes/week of mixed aerobic and resistance exercises.
  • Improvements in strength, flexibility, and overall fitness were strongly associated with better A1C, BMI, waist circumference, improved HDL, and lower cardiovascular risk—often independent of weight loss.
• Takeaway:
  • Regular exercise has direct, measurable benefits on modifiable risk factors in diabetes—in excess of just losing weight.
  • Both aerobic and resistance training provide independent and additive effects.
• Quote:

  "We need to constantly remind our patients of the importance of exercise and that a lack of exercise should be viewed simply as a modifiable risk factor, which if addressed can yield substantial improvement in outcomes."
  — Dr. Neil Skolnik (07:33)

• Memorable Point: Exercise benefits extend beyond BMI; risk factors improved even without significant weight loss.
• Timestamp: [03:22]–[07:52]

3. Genetic Testing for Maturity Onset Diabetes of the Young (MODY)

• Article Source: Diabetes Care, June 2012
• Summary:
  • Study sequenced genes in 247 type 1 and 322 type 2 young diabetic adults.
  • MODY mutations identified in ~1% of type 1 and ~4% of type 2 labeled patients.
  • Less than half of MODY cases would be detected under current testing guidelines.
  • Accurate diagnosis is critical: some MODY patients might not require lifelong insulin.
• Clinical Insight:
  • The diagnostic spectrum has blurred: young adults may have LADA, MODY, or mixtures of traditional type 1 and 2 characteristics.
  • MODY might masquerade as type 1 or 2, so genetic testing should be considered more often, especially for non-obese patients or those with a strong family history.
• Quote:

  "Really the only benefit of figuring out someone would have maturity onset diabetes of the young is there's a possibility these folks don't have to be committed to insulin for the rest of their lives."
  — Dr. John Russell (11:40)

• Timestamp: [07:52]–[11:45]

4. Lixisenatide as Monotherapy for Type 2 Diabetes

• Article Source: Diabetes Care, June 2012 (Phase 3 Clinical Trial)
• Summary:
  • Lixisenatide, a highly selective, once-daily GLP-1 receptor agonist, tested in a randomized, double-blind 12-week study in patients with type 2 diabetes not on glucose-lowering therapy.
  • Lixisenatide reduced A1C by up to 0.85%, more patients achieved target A1C compared to placebo.
  • Modest weight loss (~2 kg) observed; most common side effect was nausea (24% in treatment group vs. 4% in placebo).
  • Low risk of hypoglycemia; GI side effects led to discontinuation in some cases.
• Practical Impact:
  • Lixisenatide offers a new option for treatment-naive type 2 diabetics, with efficacy and side effect profiles similar to other GLP-1 receptor agonists.
• Quote:

  "We have a high incidence of nausea that seems to diminish over time, some weight loss and a low incidence of hypoglycemia. So it's nice to see again new drugs being studied that will likely add to our armamentarium."
  — Dr. Neil Skolnik (15:23)

• Timestamp: [11:45]–[15:23]

5. Impact of Treatment Non-Compliance on Mortality in Type 2 Diabetes

• Article Source: Diabetes Care, June 2012 (UK General Practice Database)
• Summary:
  • Over 15,000 type 2 diabetic patients reviewed; non-compliance defined as missing >1 visit or documented medication non-adherence.
  • Findings:
    • Medication non-compliance increased mortality by 57%.
    • Missing 1–2 appointments: 16% higher mortality; >2 appointments: 60% higher mortality.
    • All were independent risk factors for all-cause mortality.
• Implications for Practice:
  • Highlights significance of follow-up and adherence; maintaining regular appointments and consistent medication use can profoundly affect survival.
  • Underscores the value of medical homes and proactive follow-up in chronic care.
• Quote:

  "If we can get people to the doctors, we can get them to take their medicines, we can get them to live longer."
  — Dr. John Russell (19:08)

• Timestamp: [15:23]–[19:13]

Memorable Moments & Quotes

• On Exercise Beyond Weight Loss:

  "There were people who lost weight that didn't improve their A1Cs as much as people who had exercise."
  — Dr. Neil Skolnik (06:39)

• On Evolving Diabetes Diagnosis:

  "We certainly see the blurring [between types], so it's important ...to remember for us that there are entities like late onset autoimmune diabetes and maturity onset diabetes of the young."
  — Dr. John Russell (10:50)

• On Medical Home Model:

  "This is as great an argument for a medical home as any study I've seen lately."
  — Dr. John Russell (18:43)

Timestamps for Key Segments

• [00:57] – Trends in Diabetes-Related Mortality
• [03:22] – Fitness, Exercise, and Cardiovascular Risk
• [07:52] – MODY: Genetic Testing and Clinical Implications
• [11:45] – Lixisenatide: New GLP-1 Agonist Trial
• [15:23] – Treatment Non-Compliance and Patient Mortality

Conclusion

This episode reinforces the evolving nature of diabetes management, emphasizing mortality improvements, the independent value of increasing fitness, the expanding role of genetic testing, the promise of new pharmacotherapies, and the critical importance of patient adherence to treatment and care follow-up.

Healthcare providers are encouraged to integrate these insights—particularly exercise promotion, diagnostic vigilance, and robust follow-up—into their daily practice to optimize outcomes for people living with diabetes.