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Regards,
Medical Team,
USV Pvt Ltd
ADA and ACP Docs Debate Diabetes Goals: Outcome
Is Surprise
●
American College of Physicians (ACP) last year, stated that the HbA1c
goal "should be between 7% and 8% in most people."
●
This caused a furor at the time because it contrasted with long-standing
advice from the American Diabetes Association (ADA), which
recommends the "HbA1c goal should be < 7% for most people."
●
At the beginning of the debate, moderator Marie E. McDonnell, asked the
ENDO audience to vote on whether they agreed with the statement up
for debate: "A reasonable HbA1c goal for many non-pregnant adults
with diabetes is < 7% (53 mmol/mol)."
●
Delegates voted 82% to support that assertion (the ADA stance), with the
remaining 18% disagreeing and siding with ACP.
●
A vote was taken again at the end of the debate, and the results were
somewhat surprising.
ADA and ACP Docs Debate Diabetes Goals:
Outcome Is Surprise
●
Closing the debate, McDonnell, the moderator, said: "It occurs to me that
when we set a target, we don't actually get to it.
●
Buse agreed wholeheartedly: "The HbA1c target of < 7% is a tactic to get
to 7-8%," he emphasized. "My concern is that when you say the target is
7-8%," then the average HbA1cwill creep up to 7.9%, he stressed.
●
Wilt said: "Give clinicians some latitude. Until science suggests 8% is bad
versus < 8% — there is no evidence that it leads to bad health outcomes."
●
It seems that the endocrinologist audience at ENDO agreed with him.
●
On repeating the vote at the end of the debate, the audience had
changed its mind somewhat. Just 58% now agreed with Buse that "a
reasonable HbA1c goal for many nonpregnant adults with diabetes is <
7%" and 42% disagreed. A win for the ACP this time, it would seem.
Metformin Vs. Glyburide in GDM
●
Insulin more likely to control Glucose, TG/FFAs; Pricely, more
difficult
●
Metformin/Glyburide; Better than hyperglycemia; failed early
GDM
●
Consider Metformin: High risk maternal Hypoglycemia, Mild
GDM; Limited ability to use insulin. Avoid in placenta
insufficiency; can be used in 1st trimester
●
Consider Glyburide: Postprandial hyperglycemia, dose 30
mins-1 hr before meal, should not be used in night for
reducing FPG
PIONEER 3: Oral Semaglutide bests Sitagliptin for
HbA1c reduction
●
About 1,864 type 2 diabetes uncontrolled with metformin, with
or without a sulfonylurea, were randomly assigned to once-daily
oral semaglutide 3 mg, 7 mg or 14 mg, or sitagliptin 100 mg.
●
Semaglutide was started at 3 mg per day and then escalated every 4
weeks in ascending doses until the randomized dosage was achieved.
●
The mean change in HbA1c from baseline to 26 weeks — the primary
endpoint — was –0.6% with semaglutide 3 mg per day, –1% with
semaglutide 7 mg per day and –1.3% with semaglutide 15 mg per day
compared with –0.8% with sitagliptin (Januvia, Merck) 100 mg per day.
●
The 7-mg and 14-mg daily doses of semaglutide were superior to
sitagliptin for reducing HbA1c from baseline to week 26, resulting in an
estimated treatment difference of –0.3% and –0.5%, respectively (P < .001
for both).
●
The most frequent adverse events were gastrointestinal (GI) disorders in
the 14-mg semaglutide group and infections and infestations in the 3-mg
and 7-mg semaglutide and sitagliptin groups.
PIONEER 3 -Conclusion
The PIONEER 3 results are “consistent with other head-to-head
trials that have demonstrated superior glycemic control and
weight reduction with GLP-1 receptor agonists over DPP-IV
inhibitors”
Pharmacological Management of Osteoporosis in
Postmenopausal Women: An Endocrine Society*
Clinical Practice Guideline
➢
Provides recommendations for the treatment and
management of osteoporosis in postmenopausal
women
➢
Emphasizes assessment after being on treatments to see
if further treatment is necessary
Algorithm for the Management of Postmenopausal
Osteoporosis
Summary: Four Management Principles