M. Alexander Otto

SAN ANTONIO – Four days of antibiotics is sufficient and safe for percutaneous drainage of complicated intra-abdominal infections in non-ICU patients, according to investigators from the University of Miami.

“There was no difference in outcome between a shorter and longer duration of antimicrobial therapy in those with percutaneously drained source control of a CIAI [complicated intra-abdominal infection]. Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy,” they concluded.

The findings are from a posthoc subgroup analysis of the influential STOP-IT [Study to Optimize Peritoneal Infection Therapy] trial, which found that in CIAI patients with adequate source control, “the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 7 days) that extended until after the resolution of physiological abnormalities” (N Engl J Med. 2015 May 21;372[21]:1996-2005).

STOP-IT lumped together patients who had both surgical and percutaneous source control. Unlike surgical clean out, percutaneous drainage usually leaves behind some infection; the Miami investigators wanted to see if that made a difference in the safety and effectiveness of short-course antibiotics. Seventy-two patients received a 4-day course and 57 were on antibiotics until 2 days after their symptoms resolved, which usually worked out to about 7 days.

There were no statistically significant differences between the groups in the rates of recurrent intra-abdominal infection (9.7% in the 4-day group vs. 10.5% in the longer-duration group, P = 1.00), Clostridium difficile infection (0% vs. 1.8%; P = .442), and hospital days (a mean of 4 days in both). The only difference was that the time to recurrent infection was shorter in the 4-day group (12.7 vs. 21.3 days; P = .015). None of the patients died.

The big caveat with STOP-IT and the posthoc analysis is that the patients weren’t very sick. Their mean APACHE [Acute Physiology and Chronic Health Evaluation] score was 10, and fevers and leukocytosis were generally mild. Patients without adequate source control, patients with open abdomens, and those likely to die within 72 hours were excluded.

“They were very different from our patients in the ICU with major complex intra-abdominal infections and septic shock and multiorgan dysfunction. To take STOP-IT or our analysis and say we are going to extrapolate that to our sickest patients and stop their antibiotics at 4 days is dangerous without further study. That’s the population everyone’s asking about now. We need a larger [randomized, controlled trial] in a much sicker population” to know how to handle the issue, said posthoc investigator Dr. Rishi Rattan, a critical care and trauma surgery fellow at the University of Miami.

The other big question, as raised by an audience member, and one at the other end of the spectrum is if antibiotics are needed at all after adequate source control, at least in some patients.

“We should look at that. I think we need to push the envelope and drill down even further to 48 and 24 hours, and study that versus 4 days,” Dr. Rattan said at the Eastern Association for the Surgery of Trauma scientific assembly.

Patients in STOP-IT were aged 16 years and older with either a temperature of at least 38º C, white blood cell counts of 11,000 cells/mm³ or higher, or peritonitis-induced gastrointestinal dysfunction. Baseline demographics, comorbidities, and illness severity were similar between treatment arms. Appendicitis was limited to about 10% of infections, so there was a diversity of infections and heterogeneity in the study population. Antibiotic selection was empiric, based on investigators’ institutions.

Based on STOP-IT, the University of Miami now usually limits antibiotics to 4 days after source control of CIAI in less-sick patients. The University was a STOP-IT site, which is why the posthoc team had access to the data.

The investigators have no disclosures.

[email protected]

SAN ANTONIO – Four days of antibiotics is sufficient and safe for percutaneous drainage of complicated intra-abdominal infections in non-ICU patients, according to investigators from the University of Miami.

“There was no difference in outcome between a shorter and longer duration of antimicrobial therapy in those with percutaneously drained source control of a CIAI [complicated intra-abdominal infection]. Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy,” they concluded.

The findings are from a posthoc subgroup analysis of the influential STOP-IT [Study to Optimize Peritoneal Infection Therapy] trial, which found that in CIAI patients with adequate source control, “the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 7 days) that extended until after the resolution of physiological abnormalities” (N Engl J Med. 2015 May 21;372[21]:1996-2005).

STOP-IT lumped together patients who had both surgical and percutaneous source control. Unlike surgical clean out, percutaneous drainage usually leaves behind some infection; the Miami investigators wanted to see if that made a difference in the safety and effectiveness of short-course antibiotics. Seventy-two patients received a 4-day course and 57 were on antibiotics until 2 days after their symptoms resolved, which usually worked out to about 7 days.

There were no statistically significant differences between the groups in the rates of recurrent intra-abdominal infection (9.7% in the 4-day group vs. 10.5% in the longer-duration group, P = 1.00), Clostridium difficile infection (0% vs. 1.8%; P = .442), and hospital days (a mean of 4 days in both). The only difference was that the time to recurrent infection was shorter in the 4-day group (12.7 vs. 21.3 days; P = .015). None of the patients died.

The big caveat with STOP-IT and the posthoc analysis is that the patients weren’t very sick. Their mean APACHE [Acute Physiology and Chronic Health Evaluation] score was 10, and fevers and leukocytosis were generally mild. Patients without adequate source control, patients with open abdomens, and those likely to die within 72 hours were excluded.

“They were very different from our patients in the ICU with major complex intra-abdominal infections and septic shock and multiorgan dysfunction. To take STOP-IT or our analysis and say we are going to extrapolate that to our sickest patients and stop their antibiotics at 4 days is dangerous without further study. That’s the population everyone’s asking about now. We need a larger [randomized, controlled trial] in a much sicker population” to know how to handle the issue, said posthoc investigator Dr. Rishi Rattan, a critical care and trauma surgery fellow at the University of Miami.

The other big question, as raised by an audience member, and one at the other end of the spectrum is if antibiotics are needed at all after adequate source control, at least in some patients.

“We should look at that. I think we need to push the envelope and drill down even further to 48 and 24 hours, and study that versus 4 days,” Dr. Rattan said at the Eastern Association for the Surgery of Trauma scientific assembly.

Patients in STOP-IT were aged 16 years and older with either a temperature of at least 38º C, white blood cell counts of 11,000 cells/mm³ or higher, or peritonitis-induced gastrointestinal dysfunction. Baseline demographics, comorbidities, and illness severity were similar between treatment arms. Appendicitis was limited to about 10% of infections, so there was a diversity of infections and heterogeneity in the study population. Antibiotic selection was empiric, based on investigators’ institutions.

Based on STOP-IT, the University of Miami now usually limits antibiotics to 4 days after source control of CIAI in less-sick patients. The University was a STOP-IT site, which is why the posthoc team had access to the data.

The investigators have no disclosures.

[email protected]

SAN ANTONIO – Four days of antibiotics is sufficient and safe for percutaneous drainage of complicated intra-abdominal infections in non-ICU patients, according to investigators from the University of Miami.

“There was no difference in outcome between a shorter and longer duration of antimicrobial therapy in those with percutaneously drained source control of a CIAI [complicated intra-abdominal infection]. Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy,” they concluded.

The findings are from a posthoc subgroup analysis of the influential STOP-IT [Study to Optimize Peritoneal Infection Therapy] trial, which found that in CIAI patients with adequate source control, “the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 7 days) that extended until after the resolution of physiological abnormalities” (N Engl J Med. 2015 May 21;372[21]:1996-2005).

STOP-IT lumped together patients who had both surgical and percutaneous source control. Unlike surgical clean out, percutaneous drainage usually leaves behind some infection; the Miami investigators wanted to see if that made a difference in the safety and effectiveness of short-course antibiotics. Seventy-two patients received a 4-day course and 57 were on antibiotics until 2 days after their symptoms resolved, which usually worked out to about 7 days.

There were no statistically significant differences between the groups in the rates of recurrent intra-abdominal infection (9.7% in the 4-day group vs. 10.5% in the longer-duration group, P = 1.00), Clostridium difficile infection (0% vs. 1.8%; P = .442), and hospital days (a mean of 4 days in both). The only difference was that the time to recurrent infection was shorter in the 4-day group (12.7 vs. 21.3 days; P = .015). None of the patients died.

The big caveat with STOP-IT and the posthoc analysis is that the patients weren’t very sick. Their mean APACHE [Acute Physiology and Chronic Health Evaluation] score was 10, and fevers and leukocytosis were generally mild. Patients without adequate source control, patients with open abdomens, and those likely to die within 72 hours were excluded.

“They were very different from our patients in the ICU with major complex intra-abdominal infections and septic shock and multiorgan dysfunction. To take STOP-IT or our analysis and say we are going to extrapolate that to our sickest patients and stop their antibiotics at 4 days is dangerous without further study. That’s the population everyone’s asking about now. We need a larger [randomized, controlled trial] in a much sicker population” to know how to handle the issue, said posthoc investigator Dr. Rishi Rattan, a critical care and trauma surgery fellow at the University of Miami.

The other big question, as raised by an audience member, and one at the other end of the spectrum is if antibiotics are needed at all after adequate source control, at least in some patients.

“We should look at that. I think we need to push the envelope and drill down even further to 48 and 24 hours, and study that versus 4 days,” Dr. Rattan said at the Eastern Association for the Surgery of Trauma scientific assembly.

Patients in STOP-IT were aged 16 years and older with either a temperature of at least 38º C, white blood cell counts of 11,000 cells/mm³ or higher, or peritonitis-induced gastrointestinal dysfunction. Baseline demographics, comorbidities, and illness severity were similar between treatment arms. Appendicitis was limited to about 10% of infections, so there was a diversity of infections and heterogeneity in the study population. Antibiotic selection was empiric, based on investigators’ institutions.

Based on STOP-IT, the University of Miami now usually limits antibiotics to 4 days after source control of CIAI in less-sick patients. The University was a STOP-IT site, which is why the posthoc team had access to the data.

The investigators have no disclosures.

[email protected]

SAN FRANCISCO – Stopping a tumor necrosis factor inhibitor for nonmedical reasons is associated with significantly worse clinical outcomes and increased health care resource use, according to a review of 166 rheumatoid arthritis patients from the Physicians Consulting Network.

That’s probably not a surprise; the main value of the findings is that they provide ammunition to push back against insurance decisions that lead to stopping or switching tumor necrosis factor inhibitors (TNFi) that are helping patients.

After being stable on their TNFi for at least 6 months, 25 patients in the study were forced to stop their medication for a range of nonmedical economic reasons such as increased copays, change of insurance, or loss of job health insurance. Another 58 switched to a new TNFi for similar reasons. Those 83 patients were matched to 83 others who were also stable on their TNFi for at least 6 months but continued the therapy. Data came from chart reviews by rheumatologists, and all the patients were under the care of physicians participating in the Physicians Consulting Network, which provides feedback to GfK, a market research firm.

Over the next year, 48% of switchers/discontinuers were deemed to have well controlled RA by their rheumatologists, versus 84% of continuers. Switchers and discontinuers were almost 4 times as likely to flare, and more than 10 times as likely to have severe RA at the end of the year.

Switchers/discontinuers also had more inpatient days and emergency department and urgent care visits. Switchers and discontinuers had more than six times greater odds of visiting emergency departments and urgent care clinics at least once, compared with continuers. The differences were statistically significant. In short, payers may have saved on the front end, but probably lost on the back end.

“These real world data demonstrate that patients are significantly affected by switching or discontinuing their stable and effective [TNFi] therapy for rheumatoid arthritis. I don’t think there is any patient who asks to have their [TNFi] switched when they are doing well, and it would be uncommon for a rheumatologist to switch or discontinue [a TNFi] when patients are doing well. These are insurance-driven things that are impacting negatively on patient care, and this should stop. The [American College of Rheumatology] and other groups need to work together to get insurance companies to stop intervening in this way,” said investigator Dr. Douglas Wolf, medical director at Atlanta Gastroenterology Associates.

Similar problems have been reported when TNFi drugs are switched or stopped in Crohn’s disease, psoriasis, and other immunologic conditions, he said at the annual meeting of the American College of Rheumatology.

Switchers and discontinuers were more likely than were continuers to be Hispanic (27.7% vs. 15.7%; P = .041), but otherwise there were no significant differences between cohorts in baseline sociodemographic and disease characteristics, comorbidities, medication use, or resource utilization.

The investigators plan to continue the project to see if TNFi switchers fair better than discontinuers.

Dr. Wolf and other investigators disclosed relationships with AbbVie, including some who received payments from the company to participate in the research. Three authors are employees of AbbVie, maker of adalimumab (Humira).

[email protected]

SAN FRANCISCO – Stopping a tumor necrosis factor inhibitor for nonmedical reasons is associated with significantly worse clinical outcomes and increased health care resource use, according to a review of 166 rheumatoid arthritis patients from the Physicians Consulting Network.

That’s probably not a surprise; the main value of the findings is that they provide ammunition to push back against insurance decisions that lead to stopping or switching tumor necrosis factor inhibitors (TNFi) that are helping patients.

After being stable on their TNFi for at least 6 months, 25 patients in the study were forced to stop their medication for a range of nonmedical economic reasons such as increased copays, change of insurance, or loss of job health insurance. Another 58 switched to a new TNFi for similar reasons. Those 83 patients were matched to 83 others who were also stable on their TNFi for at least 6 months but continued the therapy. Data came from chart reviews by rheumatologists, and all the patients were under the care of physicians participating in the Physicians Consulting Network, which provides feedback to GfK, a market research firm.

Over the next year, 48% of switchers/discontinuers were deemed to have well controlled RA by their rheumatologists, versus 84% of continuers. Switchers and discontinuers were almost 4 times as likely to flare, and more than 10 times as likely to have severe RA at the end of the year.

Switchers/discontinuers also had more inpatient days and emergency department and urgent care visits. Switchers and discontinuers had more than six times greater odds of visiting emergency departments and urgent care clinics at least once, compared with continuers. The differences were statistically significant. In short, payers may have saved on the front end, but probably lost on the back end.

“These real world data demonstrate that patients are significantly affected by switching or discontinuing their stable and effective [TNFi] therapy for rheumatoid arthritis. I don’t think there is any patient who asks to have their [TNFi] switched when they are doing well, and it would be uncommon for a rheumatologist to switch or discontinue [a TNFi] when patients are doing well. These are insurance-driven things that are impacting negatively on patient care, and this should stop. The [American College of Rheumatology] and other groups need to work together to get insurance companies to stop intervening in this way,” said investigator Dr. Douglas Wolf, medical director at Atlanta Gastroenterology Associates.

Similar problems have been reported when TNFi drugs are switched or stopped in Crohn’s disease, psoriasis, and other immunologic conditions, he said at the annual meeting of the American College of Rheumatology.

Switchers and discontinuers were more likely than were continuers to be Hispanic (27.7% vs. 15.7%; P = .041), but otherwise there were no significant differences between cohorts in baseline sociodemographic and disease characteristics, comorbidities, medication use, or resource utilization.

The investigators plan to continue the project to see if TNFi switchers fair better than discontinuers.

Dr. Wolf and other investigators disclosed relationships with AbbVie, including some who received payments from the company to participate in the research. Three authors are employees of AbbVie, maker of adalimumab (Humira).

[email protected]

SAN FRANCISCO – Stopping a tumor necrosis factor inhibitor for nonmedical reasons is associated with significantly worse clinical outcomes and increased health care resource use, according to a review of 166 rheumatoid arthritis patients from the Physicians Consulting Network.

That’s probably not a surprise; the main value of the findings is that they provide ammunition to push back against insurance decisions that lead to stopping or switching tumor necrosis factor inhibitors (TNFi) that are helping patients.

After being stable on their TNFi for at least 6 months, 25 patients in the study were forced to stop their medication for a range of nonmedical economic reasons such as increased copays, change of insurance, or loss of job health insurance. Another 58 switched to a new TNFi for similar reasons. Those 83 patients were matched to 83 others who were also stable on their TNFi for at least 6 months but continued the therapy. Data came from chart reviews by rheumatologists, and all the patients were under the care of physicians participating in the Physicians Consulting Network, which provides feedback to GfK, a market research firm.

Over the next year, 48% of switchers/discontinuers were deemed to have well controlled RA by their rheumatologists, versus 84% of continuers. Switchers and discontinuers were almost 4 times as likely to flare, and more than 10 times as likely to have severe RA at the end of the year.

Switchers/discontinuers also had more inpatient days and emergency department and urgent care visits. Switchers and discontinuers had more than six times greater odds of visiting emergency departments and urgent care clinics at least once, compared with continuers. The differences were statistically significant. In short, payers may have saved on the front end, but probably lost on the back end.

“These real world data demonstrate that patients are significantly affected by switching or discontinuing their stable and effective [TNFi] therapy for rheumatoid arthritis. I don’t think there is any patient who asks to have their [TNFi] switched when they are doing well, and it would be uncommon for a rheumatologist to switch or discontinue [a TNFi] when patients are doing well. These are insurance-driven things that are impacting negatively on patient care, and this should stop. The [American College of Rheumatology] and other groups need to work together to get insurance companies to stop intervening in this way,” said investigator Dr. Douglas Wolf, medical director at Atlanta Gastroenterology Associates.

Similar problems have been reported when TNFi drugs are switched or stopped in Crohn’s disease, psoriasis, and other immunologic conditions, he said at the annual meeting of the American College of Rheumatology.

Switchers and discontinuers were more likely than were continuers to be Hispanic (27.7% vs. 15.7%; P = .041), but otherwise there were no significant differences between cohorts in baseline sociodemographic and disease characteristics, comorbidities, medication use, or resource utilization.

The investigators plan to continue the project to see if TNFi switchers fair better than discontinuers.

Dr. Wolf and other investigators disclosed relationships with AbbVie, including some who received payments from the company to participate in the research. Three authors are employees of AbbVie, maker of adalimumab (Humira).

[email protected]

Vancouver, B.C. – Resveratrol increased cerebral blood vessel dilation in a small study of adults with type 2 diabetes mellitus, suggesting a possible role for slowing disease-related cognitive decline, according to investigators from the University of Newcastle (Australia).

Type 2 diabetes impairs the ability of blood vessels to dilate effectively in response to demand, which may impact mental performance and perhaps contribute to the greater risk of dementia in people with the disease, according to investigator Rachel Wong, Ph.D., a biomedical researcher at the university.

Her team previously demonstrated that resveratrol – a polyphenol found in berries, nuts, grapes, and, famously, red wine – improves vasodilation in the systemic circulation, so they wanted to see if would do the same in the brain (Nutr Metab Cardiovasc Dis. 2011 Nov;21(11):851-6).

Thirty-six dementia-free adults with type 2 diabetes took one of three doses of synthetic resveratrol – 75 mg, 150 mg, and 300 mg – or placebo at weekly intervals. Before and about an hour after each dose, the patients briefly breathed carbogen gas (95% oxygen, 5% carbon dioxide) to induce hypercapnia and subsequent cerebral vasodilation. Transcranial Doppler ultrasound was used to assess the change in blood flow in the middle and posterior cerebral arteries before and after dosing.

The percentage change in mean blood flow velocity in the middle cerebral arteries increased after all three doses of resveratrol, but not after placebo. The 75 and 300 mg doses both increased flow velocity by about 10%, while the 150 mg dose increased it by about 6%. Meanwhile, the 75 mg dose was the only one to increase vasodilator responsiveness in the posterior cerebral arteries.

“This is the first clinical evidence that resveratrol can enhance vasodilator responsiveness in people with type 2 diabetes. We are now investigating if regular supplementation can restore cerebral perfusion, and if that can attenuate the accelerated cognitive decline seen in this population,” Dr. Wong said.

They plan to test that with the 75 mg dose, the amount of resveratrol in about 30 liters of red wine. “I think it’s better to get it in the synthetic form,” she said.

The patients in the study were 68 years old on average, with a mean body mass index of 30 kg/m². They had diabetes for about 10 years, and their mean hemoglobin A_1c was 6.7%. The majority of subjects were on oral diabetes therapies; none of them was on insulin.

The investigators have no disclosures. The work was funded in part by the Australian National University and by DSM Nutritional Products, which provided the resveratrol.

[email protected]

Vancouver, B.C. – Resveratrol increased cerebral blood vessel dilation in a small study of adults with type 2 diabetes mellitus, suggesting a possible role for slowing disease-related cognitive decline, according to investigators from the University of Newcastle (Australia).

Type 2 diabetes impairs the ability of blood vessels to dilate effectively in response to demand, which may impact mental performance and perhaps contribute to the greater risk of dementia in people with the disease, according to investigator Rachel Wong, Ph.D., a biomedical researcher at the university.

Her team previously demonstrated that resveratrol – a polyphenol found in berries, nuts, grapes, and, famously, red wine – improves vasodilation in the systemic circulation, so they wanted to see if would do the same in the brain (Nutr Metab Cardiovasc Dis. 2011 Nov;21(11):851-6).

Thirty-six dementia-free adults with type 2 diabetes took one of three doses of synthetic resveratrol – 75 mg, 150 mg, and 300 mg – or placebo at weekly intervals. Before and about an hour after each dose, the patients briefly breathed carbogen gas (95% oxygen, 5% carbon dioxide) to induce hypercapnia and subsequent cerebral vasodilation. Transcranial Doppler ultrasound was used to assess the change in blood flow in the middle and posterior cerebral arteries before and after dosing.

The percentage change in mean blood flow velocity in the middle cerebral arteries increased after all three doses of resveratrol, but not after placebo. The 75 and 300 mg doses both increased flow velocity by about 10%, while the 150 mg dose increased it by about 6%. Meanwhile, the 75 mg dose was the only one to increase vasodilator responsiveness in the posterior cerebral arteries.

“This is the first clinical evidence that resveratrol can enhance vasodilator responsiveness in people with type 2 diabetes. We are now investigating if regular supplementation can restore cerebral perfusion, and if that can attenuate the accelerated cognitive decline seen in this population,” Dr. Wong said.

They plan to test that with the 75 mg dose, the amount of resveratrol in about 30 liters of red wine. “I think it’s better to get it in the synthetic form,” she said.

The patients in the study were 68 years old on average, with a mean body mass index of 30 kg/m². They had diabetes for about 10 years, and their mean hemoglobin A_1c was 6.7%. The majority of subjects were on oral diabetes therapies; none of them was on insulin.

The investigators have no disclosures. The work was funded in part by the Australian National University and by DSM Nutritional Products, which provided the resveratrol.

[email protected]

Vancouver, B.C. – Resveratrol increased cerebral blood vessel dilation in a small study of adults with type 2 diabetes mellitus, suggesting a possible role for slowing disease-related cognitive decline, according to investigators from the University of Newcastle (Australia).

Type 2 diabetes impairs the ability of blood vessels to dilate effectively in response to demand, which may impact mental performance and perhaps contribute to the greater risk of dementia in people with the disease, according to investigator Rachel Wong, Ph.D., a biomedical researcher at the university.

Her team previously demonstrated that resveratrol – a polyphenol found in berries, nuts, grapes, and, famously, red wine – improves vasodilation in the systemic circulation, so they wanted to see if would do the same in the brain (Nutr Metab Cardiovasc Dis. 2011 Nov;21(11):851-6).

Thirty-six dementia-free adults with type 2 diabetes took one of three doses of synthetic resveratrol – 75 mg, 150 mg, and 300 mg – or placebo at weekly intervals. Before and about an hour after each dose, the patients briefly breathed carbogen gas (95% oxygen, 5% carbon dioxide) to induce hypercapnia and subsequent cerebral vasodilation. Transcranial Doppler ultrasound was used to assess the change in blood flow in the middle and posterior cerebral arteries before and after dosing.

The percentage change in mean blood flow velocity in the middle cerebral arteries increased after all three doses of resveratrol, but not after placebo. The 75 and 300 mg doses both increased flow velocity by about 10%, while the 150 mg dose increased it by about 6%. Meanwhile, the 75 mg dose was the only one to increase vasodilator responsiveness in the posterior cerebral arteries.

“This is the first clinical evidence that resveratrol can enhance vasodilator responsiveness in people with type 2 diabetes. We are now investigating if regular supplementation can restore cerebral perfusion, and if that can attenuate the accelerated cognitive decline seen in this population,” Dr. Wong said.

They plan to test that with the 75 mg dose, the amount of resveratrol in about 30 liters of red wine. “I think it’s better to get it in the synthetic form,” she said.

The patients in the study were 68 years old on average, with a mean body mass index of 30 kg/m². They had diabetes for about 10 years, and their mean hemoglobin A_1c was 6.7%. The majority of subjects were on oral diabetes therapies; none of them was on insulin.

The investigators have no disclosures. The work was funded in part by the Australian National University and by DSM Nutritional Products, which provided the resveratrol.

[email protected]

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

Vancouver, B.C. – The new, longer-acting injectable basal insulins Tresiba (insulin degludec) and Toujeo (insulin glargine U300 [300 units/mL]) will probably be most helpful for slender patients with low insulin requirements, according to Dr. Matthew C. Riddle, Jr., professor of medicine at the Oregon Health & Science University in Portland.

Longer durations of action – over 24 hours for both agents – mean lower doses of insulin and less peak and trough variation, both of which reduce the risk of hypoglycemia. Since lighter patients with low insulin requirements are most at risk for hypoglycemia, Dr. Riddle expects them to benefit most from degludec and glargine U300.

“My prediction is when daily insulin requirements are under about 25 units, there will be a clinically demonstrable difference in hypoglycemia. I think low-dose requiring slender patients” – most people with type 1 diabetes, and even some with type 2 – “should get the most benefit, but we don’t have direct proof of that yet. My guess is that maybe 25% of patients are going to see a difference with the new basal insulins,” he said.

Insulin degludec, available in 100 units/mL and 200 units/mL formulations, “is very long-acting,” 42 hours or longer, due to delayed absorption and clearance. Insulin glargine U300 uses the same molecule as insulin glargine U100 (Lantus), but it is more concentrated and absorbed more slowly. Lantus lasts about 24 hours in some patients and fewer in others. The U300 formulation lasts perhaps 30 hours (Diabetes Care. 2015 Apr;38[4]:637-43).

Meanwhile, concentrated insulins – Dr. Riddle included Humulin R U-500 on the list, but also glargine U300 and degludec U200 – might help patients with high daily insulin requirements; concentrated formulations mean fewer shots and, perhaps, greater adherence.

“Cost is the elephant in the room” with the newer insulins. “It cannot be left out of scientific meetings anymore because it drives behavior. In my community, there is a 10-fold difference between human insulins and the newer analogs. Some of our patients are going back to NPH and regular insulin,” because they cost less, he said.

Biosimilar insulins might help with the cost issue. The efficacy of the newly approved Basaglar (insulin glargine injection 100 unit/mL), for instance, was virtually indistinguishable from Lantus in testing and, at least in Europe, is slightly less expensive.

In general, “if you start insulin early, you get better results” in patients with type 2 diabetes mellitus. When patients start insulin with a hemoglobin A_1c below 8%, that measure of long-term blood glucose control will drop below 7 in 75% “quickly and easily. That’s not rocket science. But, in general, we do not start insulin early. We probably should,” Dr. Riddle said.

At the end of his talk, he fielded a question about glucagon-like peptide-1 receptor agonists, a newer class of injectables for type 2 diabetes.

“In our clinic, we are still using basal insulin as the first agent 80% of the time” for type 2. “We know the safety and capability of insulins,” but “don’t have long term data” on the GLP-1 agonists, so “I don’t think that’s going to change in the short term.” In trials, the agonists were no better at glucose control than basal insulin alone, so they seem best at this point “when weight control is very important. I’d use” GLP-1 agonists and insulin “separately before using them together,” he said.

Dr. Riddle disclosed travel expenses, institutional research grants, consulting fees, or lecture honoraria from AstraZeneca, Eli Lilly, Novo Nordisk, Sanofi, and other companies.

[email protected]

Vancouver, B.C. – The new, longer-acting injectable basal insulins Tresiba (insulin degludec) and Toujeo (insulin glargine U300 [300 units/mL]) will probably be most helpful for slender patients with low insulin requirements, according to Dr. Matthew C. Riddle, Jr., professor of medicine at the Oregon Health & Science University in Portland.

Longer durations of action – over 24 hours for both agents – mean lower doses of insulin and less peak and trough variation, both of which reduce the risk of hypoglycemia. Since lighter patients with low insulin requirements are most at risk for hypoglycemia, Dr. Riddle expects them to benefit most from degludec and glargine U300.

“My prediction is when daily insulin requirements are under about 25 units, there will be a clinically demonstrable difference in hypoglycemia. I think low-dose requiring slender patients” – most people with type 1 diabetes, and even some with type 2 – “should get the most benefit, but we don’t have direct proof of that yet. My guess is that maybe 25% of patients are going to see a difference with the new basal insulins,” he said.

Insulin degludec, available in 100 units/mL and 200 units/mL formulations, “is very long-acting,” 42 hours or longer, due to delayed absorption and clearance. Insulin glargine U300 uses the same molecule as insulin glargine U100 (Lantus), but it is more concentrated and absorbed more slowly. Lantus lasts about 24 hours in some patients and fewer in others. The U300 formulation lasts perhaps 30 hours (Diabetes Care. 2015 Apr;38[4]:637-43).

Meanwhile, concentrated insulins – Dr. Riddle included Humulin R U-500 on the list, but also glargine U300 and degludec U200 – might help patients with high daily insulin requirements; concentrated formulations mean fewer shots and, perhaps, greater adherence.

“Cost is the elephant in the room” with the newer insulins. “It cannot be left out of scientific meetings anymore because it drives behavior. In my community, there is a 10-fold difference between human insulins and the newer analogs. Some of our patients are going back to NPH and regular insulin,” because they cost less, he said.

Biosimilar insulins might help with the cost issue. The efficacy of the newly approved Basaglar (insulin glargine injection 100 unit/mL), for instance, was virtually indistinguishable from Lantus in testing and, at least in Europe, is slightly less expensive.

In general, “if you start insulin early, you get better results” in patients with type 2 diabetes mellitus. When patients start insulin with a hemoglobin A_1c below 8%, that measure of long-term blood glucose control will drop below 7 in 75% “quickly and easily. That’s not rocket science. But, in general, we do not start insulin early. We probably should,” Dr. Riddle said.

At the end of his talk, he fielded a question about glucagon-like peptide-1 receptor agonists, a newer class of injectables for type 2 diabetes.

“In our clinic, we are still using basal insulin as the first agent 80% of the time” for type 2. “We know the safety and capability of insulins,” but “don’t have long term data” on the GLP-1 agonists, so “I don’t think that’s going to change in the short term.” In trials, the agonists were no better at glucose control than basal insulin alone, so they seem best at this point “when weight control is very important. I’d use” GLP-1 agonists and insulin “separately before using them together,” he said.

Dr. Riddle disclosed travel expenses, institutional research grants, consulting fees, or lecture honoraria from AstraZeneca, Eli Lilly, Novo Nordisk, Sanofi, and other companies.

[email protected]

Vancouver, B.C. – The new, longer-acting injectable basal insulins Tresiba (insulin degludec) and Toujeo (insulin glargine U300 [300 units/mL]) will probably be most helpful for slender patients with low insulin requirements, according to Dr. Matthew C. Riddle, Jr., professor of medicine at the Oregon Health & Science University in Portland.

Longer durations of action – over 24 hours for both agents – mean lower doses of insulin and less peak and trough variation, both of which reduce the risk of hypoglycemia. Since lighter patients with low insulin requirements are most at risk for hypoglycemia, Dr. Riddle expects them to benefit most from degludec and glargine U300.

“My prediction is when daily insulin requirements are under about 25 units, there will be a clinically demonstrable difference in hypoglycemia. I think low-dose requiring slender patients” – most people with type 1 diabetes, and even some with type 2 – “should get the most benefit, but we don’t have direct proof of that yet. My guess is that maybe 25% of patients are going to see a difference with the new basal insulins,” he said.

Insulin degludec, available in 100 units/mL and 200 units/mL formulations, “is very long-acting,” 42 hours or longer, due to delayed absorption and clearance. Insulin glargine U300 uses the same molecule as insulin glargine U100 (Lantus), but it is more concentrated and absorbed more slowly. Lantus lasts about 24 hours in some patients and fewer in others. The U300 formulation lasts perhaps 30 hours (Diabetes Care. 2015 Apr;38[4]:637-43).

Meanwhile, concentrated insulins – Dr. Riddle included Humulin R U-500 on the list, but also glargine U300 and degludec U200 – might help patients with high daily insulin requirements; concentrated formulations mean fewer shots and, perhaps, greater adherence.

“Cost is the elephant in the room” with the newer insulins. “It cannot be left out of scientific meetings anymore because it drives behavior. In my community, there is a 10-fold difference between human insulins and the newer analogs. Some of our patients are going back to NPH and regular insulin,” because they cost less, he said.

Biosimilar insulins might help with the cost issue. The efficacy of the newly approved Basaglar (insulin glargine injection 100 unit/mL), for instance, was virtually indistinguishable from Lantus in testing and, at least in Europe, is slightly less expensive.

In general, “if you start insulin early, you get better results” in patients with type 2 diabetes mellitus. When patients start insulin with a hemoglobin A_1c below 8%, that measure of long-term blood glucose control will drop below 7 in 75% “quickly and easily. That’s not rocket science. But, in general, we do not start insulin early. We probably should,” Dr. Riddle said.

At the end of his talk, he fielded a question about glucagon-like peptide-1 receptor agonists, a newer class of injectables for type 2 diabetes.

“In our clinic, we are still using basal insulin as the first agent 80% of the time” for type 2. “We know the safety and capability of insulins,” but “don’t have long term data” on the GLP-1 agonists, so “I don’t think that’s going to change in the short term.” In trials, the agonists were no better at glucose control than basal insulin alone, so they seem best at this point “when weight control is very important. I’d use” GLP-1 agonists and insulin “separately before using them together,” he said.

Dr. Riddle disclosed travel expenses, institutional research grants, consulting fees, or lecture honoraria from AstraZeneca, Eli Lilly, Novo Nordisk, Sanofi, and other companies.

[email protected]