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Diabetes breakthrough A drug targeting the immune system can delay diabetes onset by two years – WIN takes a look at some recent diabetes research
has been found to reduce the risk of heart failure, major cardiovascular events and earlier death, according to a major Scandinavian registry study. Only an association was observed in the study, which means causality cannot be established, but the findings expand on similar insights made in 2017. Sodium-glucose co-transporter-2 (SGLT2) inhibitors work by reducing the amount of glucose being reabsorbed into the blood within the kidneys so that it is passed out in the urine, therefore lowering blood glucose levels. Researchers from Sweden, Norway and Denmark wanted to explore whether the drugs had a positive effect elsewhere on people’s health. The findings were based on drug data from more than 21,000 people with type 2 diabetes who began using SGLT2 inhibitors between April 2013 and December 2016. This information was then compared with an equally sized matched population who began treatment with a different dia- betes drug, a DPP4 inhibitor. The primary outcomes in the study were major cardi- ovascular events (defined as myocardial infarction, stroke or cardiovascular death) and hospital admission for heart failure. In the primary analysis, the patients were monitored throughout the follow-up period, regardless of whether they had completed their treatment. The researchers found that the use of SGLT2 inhibitors was associated with a reduced risk of heart failure but not with major cardiovascular events. The risk of heart failure was 34% lower in the SGLT2-inhibitor group than in the DPP4-inhibitor group. The use of SGLT2 inhibitors was also linked to a 20% lower risk of death. The results are applicable primarily to dapaglifozin, which was the predominant SGLT2 inhibitor used in Scan- dinavia during the study period. The results were published in the BMJ .
“This is the first study to show that a drug can delay type 1 diabetes diagnosis a median of two years in people at high risk. As anyone with type 1 diabetes will tell you, and particularly for children who are most commonly affected, every day you can delay this disease is important,” said Dr Kevan Herold, professor of immu- nobiology and internal medicine at Yale University in the US. “The key point for the millions of people at risk to develop this disease is we now have the first immunotherapy that signifi- cantly delays the onset of type 1 diabetes,” said Bill Russell, TrialNet principal investiga- tor and director of the Division of Paediatric Endocrinology and Diabetes at Vanderbilt University in the US. “Eighty-five percent of the almost 3,000 patients in the children’s diabetes pro- gramme at Vanderbilt have type 1 diabetes. The subject population all had positive diabetes antibodies in their circulation, indicating that their immune systems were targeting their beta cells in the pancreas,” Dr Russell said. “They also had impaired glucose toler- ance, meaning their glucose response to an oral glucose tolerance test was not normal but it wasn’t yet in the diabetic range. We now call this stage 2 of type 1 diabetes.” Dr Russell said people who are in stage 2, (antibodies plus impaired glucose tolerance) have an 85% likelihood of developing diabe- tes (stage 3) within five years. “We are now exploring a full-blown pre- vention trial in people even earlier in the disease process,” Dr Russell said. “And we are also looking at delaying or preventing progression to stage 3.” The study was published in the New Eng- land Journal of Medicine . Lower heart failure risk with SGLT2 inhibitor for type 2 diabetes The new category of drugs for type 2 diabetes, the so-called SGLT2 inhibitors,
Recent findings presented at the Amer- ican Diabetes Association Scientific Meeting revealed that a drug targeting the immune system can delay type 1 diabetes for an average of two years in children and adults at high risk. “This is an incredible advancement that gets us one step closer to our ultimate goal – a future without type 1 diabetes,” said Anna Clarke, health promotion manager at Diabetes Ireland. TrialNet is a clinical trial network that tests innovative clinical studies to find ways to maintain insulin production before and after diagnosis. It is funded by the US National Institutes of Health and the Juve- nile Diabetes Research Foundation. TrialNet’s ‘Teplizumab (anti-CD3) Path- way to Prevention Study’ identified 21 adults and 55 children who were relatives of people with type 1 diabetes. All had two or more autoantibodies and abnormal blood glucose levels and were therefore considered to have an almost 100% life- time risk of developing type 1 diabetes. These high-risk individuals were randomly assigned to either the treatment group, which received a 14-day course of tepli- zumab, or the control group, which received a placebo. All participants received regu- lar glucose tolerance tests until the study ended, or until they developed clinical type 1 diabetes. Some 72%of people in the control group developed clinical diabetes, compared to only 43% of the teplizumab group. The average time for people in the control group to develop clinical diabetes was just over 24 months, while the average time for the treatment group was 48 months. Samples collected during the trial are being studied to help researchers under- stand why certain people responded to teplizumab better than others. After this, the researchers hope to conduct additional studies to look for ways to extend the ben- efits of the drug.
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