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Highlights: 25th March 2019

Medical Team,
USV Pvt Ltd
ADA and ACP Docs Debate Diabetes Goals: Outcome
Is Surprise

American College of Physicians (ACP) last year, stated that the HbA1c
goal "should be between 7% and 8% in most people."

This caused a furor at the time because it contrasted with long-standing
advice from the American Diabetes Association (ADA), which
recommends the "HbA1c goal should be < 7% for most people."

At the beginning of the debate, moderator Marie E. McDonnell, asked the
ENDO audience to vote on whether they agreed with the statement up
for debate: "A reasonable HbA1c goal for many non-pregnant adults
with diabetes is < 7% (53 mmol/mol)."

Delegates voted 82% to support that assertion (the ADA stance), with the
remaining 18% disagreeing and siding with ACP.

A vote was taken again at the end of the debate, and the results were
somewhat surprising.
ADA and ACP Docs Debate Diabetes Goals:
Outcome Is Surprise

Closing the debate, McDonnell, the moderator, said: "It occurs to me that
when we set a target, we don't actually get to it.

Buse agreed wholeheartedly: "The HbA1c target of < 7% is a tactic to get
to 7-8%," he emphasized. "My concern is that when you say the target is
7-8%," then the average HbA1cwill creep up to 7.9%, he stressed.

Wilt said: "Give clinicians some latitude. Until science suggests 8% is bad
versus < 8% — there is no evidence that it leads to bad health outcomes."

It seems that the endocrinologist audience at ENDO agreed with him.

On repeating the vote at the end of the debate, the audience had
changed its mind somewhat. Just 58% now agreed with Buse that "a
reasonable HbA1c goal for many nonpregnant adults with diabetes is <
7%" and 42% disagreed. A win for the ACP this time, it would seem.
Metformin Vs. Glyburide in GDM

Insulin more likely to control Glucose, TG/FFAs; Pricely, more

Metformin/Glyburide; Better than hyperglycemia; failed early

Consider Metformin: High risk maternal Hypoglycemia, Mild
GDM; Limited ability to use insulin. Avoid in placenta
insufficiency; can be used in 1st trimester

Consider Glyburide: Postprandial hyperglycemia, dose 30
mins-1 hr before meal, should not be used in night for
reducing FPG
PIONEER 3: Oral Semaglutide bests Sitagliptin for
HbA1c reduction

About 1,864 type 2 diabetes uncontrolled with metformin, with
or without a sulfonylurea, were randomly assigned to once-daily
oral semaglutide 3 mg, 7 mg or 14 mg, or sitagliptin 100 mg.

Semaglutide was started at 3 mg per day and then escalated every 4
weeks in ascending doses until the randomized dosage was achieved.

The mean change in HbA1c from baseline to 26 weeks — the primary
endpoint — was –0.6% with semaglutide 3 mg per day, –1% with
semaglutide 7 mg per day and –1.3% with semaglutide 15 mg per day
compared with –0.8% with sitagliptin (Januvia, Merck) 100 mg per day.

The 7-mg and 14-mg daily doses of semaglutide were superior to
sitagliptin for reducing HbA1c from baseline to week 26, resulting in an
estimated treatment difference of –0.3% and –0.5%, respectively (P < .001
for both).

The most frequent adverse events were gastrointestinal (GI) disorders in
the 14-mg semaglutide group and infections and infestations in the 3-mg
and 7-mg semaglutide and sitagliptin groups.

PIONEER 3 -Conclusion
The PIONEER 3 results are “consistent with other head-to-head
trials that have demonstrated superior glycemic control and
weight reduction with GLP-1 receptor agonists over DPP-IV
Pharmacological Management of Osteoporosis in
Postmenopausal Women: An Endocrine Society*
Clinical Practice Guideline

Provides recommendations for the treatment and
management of osteoporosis in postmenopausal

Emphasizes assessment after being on treatments to see
if further treatment is necessary
Algorithm for the Management of Postmenopausal
Summary: Four Management Principles

(i) The risk of future fractures in postmenopausal women should be

determined using country-specific assessment tools to guide

(ii) Patient preferences should be incorporated into treatment planning.

(iii) Nutritional and lifestyle interventions and fall prevention should

accompany all pharmacologic regimens to reduce fracture risk.

(iv) Multiple pharmacologic therapies are capable of reducing fracture

rates in postmenopausal women at risk with acceptable risk-benefit and
safety profiles.
Osilodrostat Continues to Show Promise for
Cushing's Disease

The investigational drug osilodrostat continues to show promise for
treating Cushing's disease, now with new phase 3 trial data.

Osilodrostat is an oral 11β-hydroxylase inhibitor, the enzyme that catalyzes
the last step of cortisol biosynthesis in the adrenal cortex.

Its mechanism of action is similar to that of the older Cushing's drug
metyrapone, but osilodrostat has a longer plasma half-life and is more potent
against 11β-hydroxylase.

Significantly more patients randomized to osilodrostat maintained a mean
urinary free cortisol (mUFC) response versus placebo at 34 weeks following a
24-week open-label period plus 8-week randomized phase, with rapid and
sustained mUFC reduction in most patients.

Patients also experienced improvements in clinical signs of hypercortisolism
and quality of life.

The drug was generally well-tolerated and had no unexpected side effects.
Thank You