New research was presented at ADA 2020, the virtual 80th Scientific Sessions of American Diabetes Association, from June 12-16. The features below highlight some of the studies that emerged from the conference.
Sustained Glycemic Control With Intensive Telehealth Interventions
Limited access to specialty care and intensive self-management programs may perpetuate poor diabetes outcomes among patients living in rural areas. Although telehealth can allow extension of specialized diabetes care to rural areas, implementation in routine practice may be difficult. For a study, researchers examined rural implementation of an intensive telehealth intervention designed to leverage the existing Veterans Health Administration Home Telehealth (HT) infrastructure for patients with uncontrolled type 2 diabetes despite receiving routine care. The intervention combines telemonitoring, self-management support, and clinician-guided medication management, and is delivered by clinical HT nurses using standard HT equipment. Mean A1C improved from 9.25% at baseline to 7.89% at 6 months (-1.36%) with the intervention. This benefit persisted at 12 (-1.22%) and 18 months (-1.07%). Implementation at each participating site was acceptable, with an average of 8-10 or 12 scheduled calls completed. The intervention enhanced patient engagement and glycemic control awareness, while moderately increasing clinician workload.
Patients With Diabetes & Caregiver Thoughts on Psychological Care Needs
In order to characterize the need for and access to psychological care and self-care support for people with diabetes and their caregivers, investigators conducted a national survey of nearly 39,000 members of the Danish Diabetes Association. Likert items/scales and open-ended items focused on impact/daily life, access to care, technology and services, and key wishes and priorities. Among people with diabetes, 19% felt distress, or that diabetes was taking up “too much of daily life.” Overall, 18% of people with diabetes (24% of women, 12% of men) reported needing a referral for a psychologist but not having been offered one. A lack of support needed to deal with diabetes-related emotions was reported by 36% of people with diabetes and 21% of caregivers. Of all participants, 19% reported a major need for system-wide improvement in psychosocial support, with improvements needed in access to new technology, quality of care primary practice, and whole-person care beyond medicine (exercise, diet, mental health).
High Diastolic Dysfunction in Young Adults With Diabetes
Evidence indicates that patients with diabetes are at high risk for heart failure with preserved ejection fraction due to diabetic cardiomyopathy (DCM), which leads to myocardial fibrosis and remodeling and has left ventricular (LV) diastolic dysfunction as one of the first signs. To compare the prevalence of diastolic dysfunction among young adults with youth-onset type 1 diabetes (T1D) with that of those with youth-onset type 2 diabetes (T2D), researchers measured cardiovascular risk factors and diastolic function via echocardiography after an average disease duration of 10.9 years among more than 450 young adults. Diastolic dysfunction was defined as abnormal LV filling volume, LV pressure, or transmitral velocity, based on published norms for age. Compared with participants with T1D, those with T2D had a worse cardiovascular risk profile, including lower HDL cholesterol and higher BMI, systolic and diastolic blood pressure, triglycerides, A1C, and LDL cholesterol. Those with T2D also had lower levels on all measures of diastolic function. However, unadjusted prevalence of diastolic dysfunction was high in both groups (57.7% in T2D, 47.2% in T1D). “These findings support monitoring of young adults with diabetes for development of heart-related complications,” write the study authors.
Disparities in Newer Diabetes Medication Use
Previous studies indicate a higher burden of coronary artery disease, chronic kidney disease, and hypoglycemia among patients with type 2 diabetes (T2D) who are racial/ethnic minorities or of lower socioeconomic status, when compared with others with T2D. Although these patient populations may especially benefit from new diabetes medication classes (GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors), high costs may limit their access. To assess the associations of race/ethnicity and SES with newer diabetes medication use, study investigators estimated the association between self-reported race/ethnicity and socioeconomic factors and time to initiation of any newer diabetes medication through October 2019 among nearly 5,000 participants of the Look AHEAD trial. After adjustments for time-varying A1C, BMI, number/type of diabetes medications, baseline study arm, demographics, and comorbidities, black race was associated with significantly lower initiation of newer diabetes medications when compared with white race (hazard ratio [HR], 0.81). No differences were observed by other race/ethnic group. Yearly family income was inversely associated with new diabetes medication initiation (HR, 0.69) when comparing the lowest and highest income groups, while no significant associations were seen with education, employment, and health insurance.
Once-Weekly Insulin has Comparable Efficacy & Safety to Once-Daily
A novel basal insulin analog with a terminal half-life of about 196 hours is in development as the first once-weekly insulin (OWI). Researchers conducted a 26-week, randomized, double-blind, double-dummy, treat-to-target, phase II trial to assess its efficacy and safety versus that of once-daily insulin glargine U100 (IGlar U100) in insulin-naïve patients with type 2 diabetes inadequately controlled with metformin. Mean A1C levels decreased from 8.1% and 8.0% at baseline for OWI and IGlar U100, respectively, to 6.69% and 6.87% at 26 weeks, representing a non-statistically significant treatment difference for change in A1C. Estimated fasting plasma glucose levels at week 26 were 123 mg/dL for OWI and 127 mg/dL for IGlar U100. Observed rates of level 2 and 3 hypoglycemia were low in both treatment groups, and no unexpected safety findings were recorded.