New ADA-EASD Guidelines for Managing Type 2 Diabetes

I'm calling Simon Heller. I am a Professor of Clinical Diabetes at the University of Sheffield, in the North of England, and I am delighted to talk about some of the highlights of the EASD meeting in Berlin.

On Friday, we heard about the new ADA-EASD guidelines for the management of type 2 diabetes. And I think that these are really important, especially since they were really revised at a very important time for them. practitioners, physicians treating diabetes, especially primary care physicians.

And the reason I think it's so important, is that in recent years, we've witnessed a proliferation of new treatments, particularly SGLT2 inhibitors, which not only improve blood sugar control, but also help people lose weight. shown to reduce mortality quite substantially, and quite rapidly. And that is almost certainly because they have effects on heart failure. So it's a new class of drugs that we use.

We now also have evidence that incretin-based treatments have beneficial effects and that several GLP-1 analogues can also reduce mortality.

This means that the treatment of diabetes is becoming more complicated. And the previous guidelines basically defined the drug and invited the practitioner to make a choice. I do not see that as guidelines. And what we have seen is that the new guidelines, which have been published, are really much better, because they help practitioners, depending on the characteristics of the patient (for example, if they are overweight, have a disease), to select the appropriate treatment.

Do I think it's an individualization of therapy? Not quite, but I think we're getting closer.

Another highlight was an oral session that I had the honor of chairing.^[1], and that looked at the new analogs of ultra-long-acting insulin Toujeo insulin glargine U-300 and insulin degludec Tresiba.

And we have seen trials of these products compared to other drugs, suggesting that both have benefits, especially in terms of reducing hypoglycemia. And in the DEVOTE study^[2] Degludec insulin, they actually showed a dramatic drop in severe hypoglycemia.

But in this particular session, we heard about the BRIGHT study^[3], which was a face-to-face comparison between the two, sponsored by Sanofi-Aventis. And the result is that this one – year study showed no difference between the two. Both reduced hypoglycemia and improved HbA1c to the same extent.

I think it's interesting and useful. We need more one-on-one studies.

We also presented real-world studies suggesting that degludec insulin was more effective. But I guess, rightly, that in the discussion, real-world studies are subject to confusion, and I think we can not be sure of the success of this product. We really need more data.

The last strong point I would like to mention is a major European project entitled "Innovation Medicines Initiative", worth 26 million euros. And the reason why it's so exciting, is that it brings together academics, insulin manufacturers, the three and some continuous glucose production companies who have all accepted to put all their clinical trial data into one database.

And you could say, what is the benefit of that? But the advantage is that we can perform very powerful statistical analyzes and learn more about hypoglycemia. And what we hope for, especially using the new classifications^[4], which have been agreed by the ADA and the EASD, must begin to improve the evidence base and, most importantly, allows us to compare new treatments, whether they are therapeutic, that they are not. they are technological, even really educational. And if we can do these tests, we hope we can really identify ways in which we can reduce hypoglycemia as a burden for patients with type 2 or type 1 diabetes.