Diabetes Update 2005

WebMD Live Events Transcript

The American Diabetes Association has held its 65th Annual Scientific Sessions, where researchers and clinicians from around the world gathered to share information. Cleveland Clinic endocrinologist S. Sethu K. Reddy, MD, joined us on June 15, 2005 to share the latest news from this important conference and answer your questions.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live Dr. Reddy. Thank you for joining us today.

REDDY:
Good morning and good afternoon to everyone. I look forward to your questions.

MODERATOR:
Let's start by discussing the highlights of the just concluded American Diabetes Association (ADA) Scientific Sessions.

REDDY:
I think the ADA concluded its meeting June 14 in San Diego and there were several highlights, including new therapies for diabetes .

Within the last three months we've had approved two new injectible therapies, which are going to start a new class of medications for diabetes. One is called Symilin, which is an analog of a hormone that is made by beta cells, the same cells that make insulin. It has been found that this hormone reduces your appetite, slows down the rise in sugar levels after eating, so in general causes weight loss along with improvement in diabetes control. The other injectible agent that has been approved is called exendin and the trade name is Byetta. This is a hormone that actually is derived from the venom of a giant lizard in the southwestern U.S.. It's called the Gila monster.

"We don't accept a high blood pressure reading once a person has been diagnosed with hypertension. Likewise, with diabetes, as we get better and safer therapies, we naturally want the sugars to be in the normal range, which means to aim for a more normal A1c."

This is a fascinating hormone that appears to improve insulin secretion, preserve beta cell life, and also result in some weight loss. These new therapies do not cause low blood sugars by themselves, and also the dosage does not have to be adjusted from day to day. They are available in a pen form so that it's convenient for patients to take it and both would improve postprandial or after-eating blood sugar levels and cause weight loss. So for many of our patients, this addresses one concern, in terms of many are worried about weight gain when they improve their diabetes. These agents actually cause weight loss. They are injectibles right now and that may be a barrier for some of our patients. As many of our readers or listeners know, you can bring your blood sugars down fairly well by targeting the fasting blood sugars, but to get the blood sugars in a better or perfect range one has to target postprandial blood sugars. These new therapies certainly fit a niche in that particular area.

The other highlight from the meeting would be changing attitudes towards the targets for control. More and more, endocrinologists would like the hemoglobin A1c to be 6.5% or lower compared to the current value of 7%. The Europeans, Japanese, and American college of Endocrinology have already said to go below 6.5%. Cholesterol levels are also being targeted. Some scientists feel that if you have diabetes your LDL cholesterol should be less than 80. There were several symposia on cardiovascular risk in diabetes, and the theme was early aggressive therapy to lower the cholesterol. Recent clinical trials were highlighted which suggest that if one has diabetes, one should almost automatically be on a lipid-lowering agent.

MEMBER QUESTION:
Why the changes in target levels?

REDDY:
We already know the normal range for hemoglobin A1c in nondiabetic individuals is 4%-6%, so in the past when we're aiming for 7%, we thought that was practical, but we knew that was not quite normal. If you look at other conditions like blood pressure or leukemia, we always try to get the patient back to normal. We don't accept a high blood pressure reading once a person has been diagnosed with hypertension. Likewise, with diabetes, as we get better and safer therapies, we naturally want the sugars to be in the normal range, which means to aim for a more normal A1c.