GLP-1-Shift

When it comes to treating type 2 diabetes, more options are available to your patients than ever before. Lifestyle modifications are a good start but even with this initial approach, many patients struggle to maintain glycaemic control and healthy weight, putting them at risk of long-term complications, such as myocardial infarction, diabetic kidney disease or stroke.^1–3

A shift in approach towards early intensification of treatment, as soon as it becomes necessary, could be all your patients need to reduce their HbA_1c, maintain a healthy weight and reduce the risk factors that could lead to serious complications.^3–5

50% of people living with type 2 diabetes

With uncontrolled HbA_1c, a 1% drop could make all the difference.

An early shift could change lives.

90% of people living with type 2 diabetes

Is it time to shift the scale on type 2 diabetes with weight loss?

*Among adults with HbA_1c ≥7%
† In patients with HbA_1c 7.0–7.9%. After at least 6 months on 2 oral glucose lowering medications.

The closer people living with type 2 diabetes are to their target HbA_1c, the lower the risk of complications in the future. Observational and clinical trial analyses suggest that a 1% reduction in HbA_1c has the potential to reduce the risk of complications and prevent deaths related to diabetes.^3,10

In people living with type 2 diabetes, glycaemic control can worsen over time. Despite the established benefits of intensive blood glucose control, there is an increasing proportion of patients not achieving desired glycaemic targets. This video covers the importance of good glycaemic control for reducing the risk of microvascular and macrovascular complications. Some of the key results of the UKPDS are summarized and explained, showing how delaying treatment intensification can have a dramatic effect on the risk of diabetes complications.^1,6,10,11,14

Weight loss reduces cardiometabolic risk factors

Improved diet and physical activity are powerful first-line tools to help your patients reduce their blood glucose levels and lose weight. But for some people living with type 2 diabetes, diet and exercise aren't enough. Those patients may also need medication to keep the many aspects of their disease under control, and the medication you choose can have an impact on your patients’ weight.²²

Metformin, GLP-1 RA, SGLT2i, α-glucosidase inhibitors

DDP-4i

Insulin secretagogues, TZD, SUs, insulin

Agents associated with varying degrees of weight loss include metformin, glucagon-like peptide 1 receptor agonists (GLP-1 RAs), and sodium–glucose co-transporter 2 inhibitors (SGLT2is), α-glucosidase inhibitors.²²

Dipeptidyl peptidase 4 inhibitors (DPP-4is) are weight neutral.²² Insulin secretagogues, thiazolidinediones, and insulin often cause weight gain.²²

Risk of any complication related to diabetes

Find out more about the various complications your type 2 diabetes patient could face as a consequence of delayed intensification of treatment

ADA/EASD consensus report for early treatment

Explore this simple guide to early treatment recommendations for type 2 diabetes as stated in the EASD/ADA consensus report.

Learn more about GLP-1 RA as a second-line treatment for people living with type 2 diabetes.

Stay informed about the latest approaches to type 2 diabetes and GLP-1 RA therapy.

Correa MF, Li Y, Kum H-C et al. Assessing the Effect of Clinical Inertia on Diabetes Outcomes: a Modeling Approach. J Gen Intern Med 2019;34:372–378.

Paul SK, Klein K, Thorsted BL et al. Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol. 2015;14:100.

Lind M, Imberg H, Coleman RL et al. Historical HbA1c, values may explain the type 2 diabetes legacy effect: UKPDS 88. Diabetes Care. 2021;44(10):2231-2237.

Burke GL, Bertoni AG, Shea S, et al. The impact of obesity on cardiovascular disease risk factors and subclinical vascular disease. Archives of Internal Medicine. 2008;168(9):928.

Mendis S, Puska P, Norrving B. Global Atlas on Cardiovascular Disease Prevention and Control. World Health Organization, Geneva 2011.

Carls G, Huynh J, Tuttle E et al. Achievement of glycated hemoglobin goals in the US remains unchanged through 2014. Diabetes Ther. 2017;8(4):863-873.

Mannucci E, Monami M, Dicembrini I et al. Achieving HbA1c targets in clinical trials and in the real world: a systematic review and meta-analysis. J Endocrinol Invest 2014;37:477–495.

Pantalone KM, Misra-Hebert AD, Hobbs TM et al. Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set. Diabetes Care. 2018;41:e113-e114.

Whitmore C. Type 2 diabetes and obesity in adults. Br J Nurs. 2010;19(14):880, 882-886.

10.

Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective Observational Study. BMI. 2000;321(7258):405-412.

11.

Khunti K, Wolden ML, Thorsted BL et al. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013;36:3411–3417

12.

Barnett AH. The importance of treating cardiometabolic risk factors in patients with type 2 diabetes. Diab Vasc Dis Res. 2008;5(1):9-14.

13.

Chatterjee A, Harris SB, Leiter LA et al. Managing cardiometabolic risk in primary care. Can Fam Physician. 2012;58(4): 389–393.

14.

UKPDS group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet.1998;352(9131):837–53.

15.

Del Prato S, Felton A-M, Munro N et al. Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. Int J Clin Pract 2005;59:1345–1355.

16.

Abdul-Ghani M, Puckett C, Triplitt C et al. Initial combination therapy with metformin, pioglitazone and exenatide is more effective than sequential add-on therapy in subjects with new-onset diabetes. Results from the efficacy and durability of initial combination therapy for type 2 diabetes (EDICT): a randomized trial. Diabetes Obes Metab 2015;17: 268–275.

17.

Desai U, NY Kirson NY, Kim J et al. Time to treatment intensification after monotherapy failure and its association with subsequent glycemic control among 93,515 patients with type 2 23 diabetes. Diabetes Care 2018; 41: 2096–2104.

18.

Holman RR, Paul SK, Bethel MA et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–1589.

19.

Laiteerapong N Ham SA, Gao Y et al. The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Diabetes Care. 2019;42:416–426.

20.

American Diabetes Association. 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021;44:S7–S14.American Diabetes Association. 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021;44:S7–S14.

21.

Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022 Nov 1;45(11):2753-2786.

22.

American Diabetes Association. 8. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(suppl 1):S89-S97.

23.

Jensen MD, Ryan DH, Apovian CM et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and The Obesity Society. Circulation. 2014;129(25 suppl 2):S102- S138.

24.

Stratton IM, Cull CA, Adler AI et al. Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study (UKPDS 75). Diabetologica 2006;8:1761-1769.

25.

Brunton, SA et al. Clinician Reviews: Type 2 diabetes 2021. J Fam Practice (Suppl). Available at: https://cdn.mdedge.com/files/s3fs-public/cr_envision2020_web_final_12.14.20_1.pdf

26.

American Diabetes Association. Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43(Suppl 1)S1–S2; 2.

27.

Gæde P, Oellgaard J, Carstensen B et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia 2016;59:2298–307.

American Diabetes Association. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). American Diabetes Association, 2022. Copyright and all right reserved. Material from this publication has been used with the permission of American Diabetes Association.

Models are not real patients and situations shown do not reflect models’ experience.

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HQ22DI00280 | April 2023

For healthcare professionals only