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10-06-2019 | Diabetes | News | Article

ADA 2019

RISE adult medication results highlight disparity with youth with diabetes

medwireNews: Intensive antidiabetic treatment in adults with newly diagnosed type 2 diabetes slows the decline in beta-cell function, but this is not sustained after the treatment is stopped, show the results of the RISE adult medication study.

The 267 study participants, who were aged an average of 54 years, had been diagnosed with type 2 diabetes within 12 months before enrollment. They were randomly assigned to receive 12 months of treatment with metformin alone, metformin plus liraglutide, placebo, or 3 months of insulin glargine followed by 9 months of metformin.

Addressing the press at the 79th ADA Scientific Sessions in San Francisco, California, USA, researcher Kieren Mather (Indiana University School of Medicine, Indianapolis, USA) described how the team jointly evaluated patients’ beta-cell function and insulin sensitivity at baseline and after 12 months of treatment. They found that all active treatments produced an improvement in the acute beta-cell response to glucose, including a “marked” improvement in patients given liraglutide and metformin. Placebo had no such effect.

There was also a striking improvement in the steady-state beta-cell response for people given the liraglutide plus metformin combination, and modest improvements for those taking metformin or placebo, but no change for those who took glargine plus metformin.

The maximal response, to arginine plus glucose, was not improved in any group and was in fact worse in the liraglutide plus metformin group. In their publication in Diabetes Care, the researchers suggest that the effects of glucagon-like peptide-1 receptor agonists on beta-cell function may be specific to glucose-stimulated responses, or “alternatively, there could be a ceiling for the maximal response in this population.”

The improvements in beta-cell responses that were seen, however, were lost when the team retested the participants 3 months after they stopped their randomized treatment.

This suggests that “the interventions that we have done have not produced a sustained improvement in beta-cell function, which optimally would have been the outcome,” observed co-researcher Steven Kahn (University of Washington, Seattle, USA).

Kahn presented a comparison of the adult medication study and the youth medication study, which was published last year and showed persistent deterioration of beta-cell function despite intensive treatment (metformin or glargine followed by metformin). The comparison, which is published in Diabetes, suggests “that the disease is much more aggressive in youth than it is in adults,” he said.

He noted that the analysis is “the first ever true comparison” of youth versus adults with prediabetes or early diabetes, because although the studies were separate, they were designed so that the two age groups given metformin with/without glargine were treated and evaluated in exactly the same way, allowing outcomes to be compared directly.

The comparison “supports in our minds a more adverse trajectory of beta-cell in youth,” said Kahn.

He stressed, however, that the youth study did not include a placebo group, for ethical reasons, so it is possible that the participants’ beta-cell function might have declined even faster without the treatment they received.

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Diabetes Care 2019; doi:10.2337/dc19-0556
Diabetes 2019; doi:10.2337/db19-0299
79th ADA Scientific Sessions; San Francisco, California, USA: 7–11 June 2019