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Cardio Diabetes Medicine 2017 403

Real World Effect of Type 2 Diabetes

Therapies On HbA1c and Weight

Dr. Kevin Shotliff, UK

Consultant Physician, Diabetes and Endocrinology
beta Cell Diabetes Centre
Chelsea and Westminster Hospital, London.

Abstract: Conclusions: These results suggest that it may be ap-
Background: Type 2 Diabetes Mellitus is an ever-in- propriate to tailor treatment choices towards individu-
creasing healthcare problem worldwide. Several new- al patients. GLP-1 receptor agonists and Dapagliflozin
er agents have been developed in order to tackle this may have a role if weight loss is particularly desired.
burden and reduce the incidence of diabetes related Keywords: Type 2 diabetes, Therapies, Weight
complications. Revised National Institute for Health
and Care Excellence (NICE) guidelines for the man- Introduction
agement of Type 2 Diabetes have met with some Type 2 Diabetes Mellitus (T2DM) is an increasingly
controversy, including the order and combination in prevalent worldwide issue, affecting over 3.2 million
which some therapeutic options have been recom- people, and causing 22,000 premature deaths a year
mended.
in England and Wales. There are also a further 5 mil-
Objectives: To collect and analyse patient data re- lion people who have blood glucose levels giving a
lated to Type 2 Diabetes for those who have been high risk of developing type 2 diabetes (PHE August
commenced upon newer agents in order to compare 2015). This chronic metabolic condition, costing 10%
the performance of different therapies/ class against of the NHS budget or £8.8 billion per year, involves
each other. a combination of pancreatic insufficiency and insu-
lin resistance resulting in hyperglycemia and is typi-
Methods: Patient records for those with Type 2 Dia- cally associated with obesity. Management of blood
betes Mellitus who had attended the Beta cell clinic glucose levels and other cardiovascular risk factors
at Chelsea and
helps to reduce the number developing microvascu-
Westminster Hospital were examined for commence- lar and macrovascular complications, such as chronic
ment upon Sulphonylureas, GLP-1 receptor agonists, kidney disease (CKD), cardiovascular disease, periph-
DPP-4 eral neuropathy and diabetic retinopathy, the leading
cause of preventable sight loss in people of working
inhibitors and SGLT-2 inhibitors. Demographic and
biochemical data relevant to the assessment of Type age in the UK (1,2,3).
2 Diabetes was collected at baseline and after 3 and The association between T2DM and obesity is well
12 months. Data were analysed using Analysis of documented and in England at present.~90% of adults
Variance (ANOVA) and the Unpaired T Test. with T2DM have a BMI>25. The benefits of weight
loss in T2DM are not only to improve glycaemic con-
Results: There was no significant difference for
change in any of the outcome measures, exclud- trol, but also on other obesity related co-morbidities
ing change in weight, between any of the treatment such as; hypercholesterolaemia, cardiovascular dis-
options. GLP-1 receptor agonists and Dapagliflozin ease and arthritis. NICE / National Institute of Clinical
caused the largest fall in weight, and Sulphonylureas Excellence guidance on the management of T2DM
caused a slight rise in weight. Within the individual (NG28) now reinforces medical management deci-
therapeutic classes, there were no significant differ- sions based not only on HbA1c, but also body weight.
ences between individual agents for change in any This is helped by several newer therapies, such as
of the outcome measures. Glucagon-like peptide-1 (GLP-1) receptor agonists, Di-

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