Back Back
ADA 2024 Highlights
Insights From the Field: Expert Commentary on ADA 2024 Highlights

Released: October 10, 2024

Expiration: October 09, 2025

Martin J. Abrahamson
Martin J. Abrahamson, MD, FACP
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • In the FLOW study, semaglutide significantly reduced the risk of clinically important renal outcomes by 24% compared with placebo, with additional benefits in cardiovascular health, including an 18% reduction in major adverse cardiovascular events.
  • The TIGHT trial found no significant difference in glycemic control between continuous glucose monitoring (CGM) and standard blood glucose monitoring in non-ICU hospitalized patients, indicating limited benefits of CGM in this setting.
  • The CATALYST trial revealed a high prevalence (24%) of hypercortisolism among patients with difficult-to-control type 2 diabetes, underscoring the need for further evaluation of cortisol levels in this population.

Commentary on Recent Advances in Diabetes Management
As we navigate the evolving landscape of diabetes care, recent studies presented at ADA 2024 shed light on pivotal findings that can significantly impact our clinical practice. The FLOW, TIGHT, and CATALYST studies offer important insights, particularly for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). Let’s dive into the primary outcomes, authors’ conclusions, and potential clinical implications for our patient population.

The FLOW Trial: A Step Forward in Renal Risk Reduction
In the FLOW trial, people with T2D and varying degrees of CKD were randomized to receive semaglutide or placebo in addition to their usual diabetes care. The primary endpoint was a composite of clinically relevant renal outcomes, including a persistent decline in estimated glomerular filtration rate (eGFR), end-stage renal disease, and renal death, or cardiovascular death. Notably, the results demonstrated a significant 24% reduction in the composite outcome (HR: 0.76; 95% CI: 0.66-0.88; P = .0003) for those treated with semaglutide compared with placebo recipients. When excluding cardiovascular death, the reduction remained robust at 21% (HR: 0.79; 95% CI: 0.66-0.94).

Moreover, secondary outcomes highlighted a less steep decline in eGFR slope for the semaglutide group, with a rate of -2.19 mL/min/1.73 m2/yr vs -3.36 mL/min/1.73 m2/yr for placebo (P <.001). There was also an 18% reduction in major adverse cardiovascular events (MACE) and a 20% reduction in all-cause mortality, affirming the multifaceted benefits of semaglutide in a high-risk population.

The implications for clinical practice are clear: semaglutide should be considered a key therapeutic option for patients with T2D and CKD, aiming not just to manage glycemia but also to mitigate renal decline and improve overall cardiovascular health.

Additional Insights: SUMMIT and STEP HFpEF DM Data
Other notable results presented regarding GLP-1 receptor agonists and GIP/GLP-1 coagonists confirm the many benefits of this class of medications. Top line results of the SUMMIT trial were announced in early August.  In this study, tirzepatide was evaluated in patients with heart failure with preserved ejection fraction (HFpEF) and obesity, with or without T2D. This study reported a remarkable 38% reduction in adverse cardiovascular outcomes (HR: 0.62; 95% CI: 0.41-0.95; P = .026) and demonstrated significant weight loss, reinforcing the therapeutic potential of GLP-1 receptor agonists in managing obesity, T2D, and related comorbidities.

Similarly, data from the STEP HFpEF DM trial highlighted the role of semaglutide in improving heart failure symptoms among patients with obesity and T2D. These studies collectively emphasize the importance of addressing cardiovascular and renal outcomes in our treatment strategies for diabetes.

TIGHT Trial: Reevaluating Continuous Glucose Monitoring in Non-ICU Settings
The TIGHT trial evaluated the efficacy of continuous glucose monitoring (CGM) vs standard blood glucose monitoring in non ICU hospitalized patients with T2D. The primary outcomes—mean glucose levels and the percentage of time spent below 54 mg/dL—showed no significant differences between the CGM and standard groups. Mean glucose level was 170 mg/dL in the CGM group compared with 175 mg/dL in the standard monitoring group (P = .25), and the incidence of severe hypoglycemic events was low across both groups.

These findings suggest that CGM may not provide substantial benefits in non-ICU settings and raise questions about the integration of CGM into routine hospital care protocols. However, this contrasts with data from the outpatient setting, where CGM has been shown to improve A1C levels by approximately 0.31% and reduce the time spent above and below target glucose levels.

CATALYST Trial: Uncovering Hypercortisolism in T2D Patients
The CATALYST study brought attention to the often-overlooked prevalence of hypercortisolism in patients with difficult-to-control T2D. Findings revealed that 24% of patients exhibited evidence of hypercortisolism based on a low dose (1 mg) overnight dexamethasone suppression test, a staggering statistic that underscores the complexity of managing T2D in patients on multiple antihyperglycemic medications.

The authors noted a significant correlation between the number of antihypertensive medications and the likelihood of hypercortisolism, with a 35% prevalence among those on 3 or more antihypertensives. This suggests that clinicians should remain vigilant in screening for hypercortisolism in this patient population, especially given the potential implications for glycemic control and overall health.

Conclusion
In summary, the insights gleaned from these studies provide a wealth of knowledge that can enhance our approach to managing T2D. As we integrate these findings into our clinical practice, we must remain cognizant of the multifactorial nature of diabetes and the interrelatedness of glycemic control, renal protection, and cardiovascular health. With emerging data supporting the benefits of GLP-1 receptor agonists and GIP/GLP-1 coagonists, we are better equipped to optimize treatment strategies for our patients, ultimately improving their quality of life and health outcomes.

Your Thoughts? 
What are your thoughts about these new data presented at ADA 2024? Join the discussion by posting a comment. 

Continue

Poll

1.

I plan to apply key data from the ADA conference to optimize care of patients with diabetes.

Submit