New Data Reveal Third of Million Type 2 Diabetes Patients Miss Glycaemic Target

Study presented at DUK conference highlights advantages of combination over monotherapy

Wednesday 20 April, Diabetes UK Annual Professional Conference 2005, Glasgow - New data, analysing recent UK prescribing trends, suggest that a third of a million patients with Type 2 diabetes are uncontrolled on monotherapy.¹ This amounts to around 330,000 monotherapy patients currently missing a glycaemic control target of HbA1c <7%.¹ This target is recommended best practice by NICE. The data released today suggest that these targets are not being adequately met.

With the rapid growth in the number of people being diagnosed with Type diabetes, it is important to ensure that patients are treated as effectively as possible in order to achieve sustained glycaemic control and, thereby, minimise the impact of the condition and its complications on NHS budgets and healthcare practices. 

Dr Colin J Kenny acting chair of the Primary Care Diabetes Society (PCDS) echoed these sentiments: “In order to reduce the burden of Type 2 diabetes we need to find the most effective way to achieve sustained glycaemic control.  The data released today, combined with the ambitious goals set by the GMS contract quality indicators in diabetes, suggests that we may need to look at moving patients more quickly onto combination therapy to meet our glycaemic targets. If this does not happen, it is inevitable that the outlook for our patients, in terms of future complications, will be poor.”

Also presented at the conference was a 24-week double-blind study comparing increasing the dose of metformin monotherapy with the fixed-dose combination therapy Avandamet (metformin and rosiglitazone) as a second line treatment for Type 2 diabetes.  The results show Avandamet to be more effective at maintaining glycaemic control than simply increasing the dosage of metformin, with 54% achieving target control of 7% HbA1c on Avandamet compared to 35.7% on a higher dose (uptitration) of metformin.² Furthermore, Avandamet was shown to be better tolerated than metformin, with only half as many withdrawals due to adverse events (such as diarrhoea, abdominal pain and GI events).²  

Study author and Head of Diabetes Research at Aston University , Dr Cliff Bailey, commented: “These data strengthen the case for introducing combination therapy at an earlier stage in the treatment process, rather than continuing to increase to high dose metformin.  Moving to Avandamet when patients are uncontrolled on maximal tolerated metformin monotherapy in Type 2 diabetes is effective in helping to ensure that glycaemic control targets are met and the improvement is continued.”

For further information, please contact:

Helen Laurence or Tina Edwards at Virgo HEALTH PR Telephone: 0208 822 6707   helen.laurence@virgohealthpr.com

About DINLINK monotherapy data

DIN-LINK data, (Compufile Ltd October 2004) was analysed and the results extrapolated to provide estimated data for the Type 2 diabetes population. Glycaemic control was estimated for monotherapy patients who had their HbA1c tested, assessed by attainment of target HbA1c <7%.

About Avandamet vs. metformin study

In this 24 week double blind study, Type 2 diabetes mellitus patients receiving mono or combination metformin were randomized after 4 weeks 2g metformin run-in period to receive Avandamet (4 mg rosiglitazone/2 g metformin) or metformin (2.5g) for 8 weeks, increased to Avandamet (8 mg rosiglitazone/2 g metformin) or metformin (3g) for 16 weeks based on GI tolerability. Primary endpoint was change in HbA1c at week 24.

About Type 2 diabetes

1..      Over 100,000 people are diagnosed with Type 2 diabetes each year in the UK³ – approximately one person every five minutes.  Type 2 diabetes is the fourth leading cause of death in most developed countries.⁴

2.        Type 2 diabetes is a complex and currently incurable condition in which the body is unable to properly process glucose (sugar) levels in the blood due to a combination of genetic and environmental factors, particularly lack of physical activity and obesity.⁵

  3.        Such factors lead to insulin resistance, a failure by the body to use its own insulin properly.  This then leads to Type 2 diabetes where the body cannot control blood glucose levels.⁵

  4.         Type 2 diabetes is a progressive condition that can lead to serious long-term complications, such as heart disease, stroke, blindness and kidney failure.⁵

References

1. Ambery P, Leaney K, Bowers R.  Are we still missing the goal with respect to glycaemic targets in 2004?  Abstract presented at Diabetes UK Annual Professional Conference 2005, 20 – 22 April 2005, Glasgow .

2. Bailey C et al .  Rosiglitazone/metformin fixed dose combination (AVM) is associated with attainment of glycaemic targets for a greater proportion of patients with Type 2 diabetes (T2DM) than uptitrated metformin (MET).  Abstract presented at Diabetes UK Annual Professional Conference 2005, 20 – 22 April 2005, Glasgow .

3. Diabetes in the UK . October 2004.
   http://www.diabetes.org.uk/infocentres/reports/in_the_UK_2004.doc

4. Pagano E, Brunetti M, Tediosi F, Garattini L. Costs of diabetes. A methodological analysis of the literature. Pharmacoeconomics 1999; 15 (6): 583-595

5. Barnett A et al.  DEFINe Dossier – D iabetes: E valuating F uture I mpact N ow.  November 2004. (Sponsored by GlaxoSmithKline)

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Obesity sends Type 2 diabetes rates in children soaring

Research results revealed at the Diabetes UK Annual Professional Conference show 22 children under 16 have Type 2 diabetes in East London
alone. Type 2 diabetes traditionally affected adults over 40, but
increasing rates of childhood obesity have led to a rise in the number of
children with the condition. Recent figures suggested there were only
around 100 diagnosed cases in the UK , this now appears to be a vast
underestimate.

The research confirms that 95 per cent of these children with Type 2
diabetes are overweight or obese, and were as young as nine years old when
diagnosed. The study also reveals that all but one of the children come
from black and minority ethnic (BME) groups. Type 2 diabetes tends to
develop sooner in people of BME origin and the prevalence is at least five
times higher. Type 1 diabetes, which accounts for the vast majority of
cases of diabetes in children, is not linked to obesity.

Douglas Smallwood, Chief Executive at Diabetes UK said, "These cases in
East London confirm a shocking trend that Type 2 diabetes in children is
increasing. Diabetes can lead to long term complications such as heart
disease, blindness, kidney failure and reduced life expectancy. Unless
children are educated to eat a healthy diet and take up physical activity
the number of children with the condition will continue to increase.
Specialist diabetes services for children are already under a lot of
pressure. If this problem is getting worse, the NHS has to ensure resources
are in place to deal with it."

Dr Jeremy Allgrove, Consultant in Paediatric Diabetes at the East London
Centre for Paediatric and Adolescent Diabetes said, "Ten years ago we did
not see Type 2 diabetes in children under 16 but it is now increasingly
becoming a part of paediatric practice. In addition to these children with
diabetes, there is another group that have insulin resistance and are obese
who are at risk of developing diabetes in the foreseeable future. This is a
time bomb waiting to explode."

The research into the prevalence of Type 2 diabetes in children was
conducted at Barts and the London and Newham University Hospital Trusts.

Ensuring access to high quality, local, specialist services for all
children with diabetes is one of Diabetes UK 's priorities in its new Action
today, health tomorrow campaign.  The other issues being highlighted are
getting the eyes of all people with diabetes specially checked at least
once a year and ensuring that all people with the condition have access to
the education they need to effectively manage their condition on a day to
day basis.

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Weight management pack updated

Diabetes UK has revised the Weight Management Pack giving healthcare professionals up-to-date and practical information on helping patients control their weight.

With continued support from Cambridge Health & Weight Plan, the pack includes a comprehensive guide for healthcare professionals on patient weight management with increased information on drug treatment and specialist obesity centres in the UK , and a revised method to measure waist circumference. The pack also contains a leaflet for the patients themselves with an updated height-weight chart and a poster.

Simon O'Neill, Director of Care and Policy at Diabetes UK said, "Almost every GP practice in the country received our pack last year. The feedback we received from many healthcare professionals acknowledged it is an effective tool in weight management. As GPs are coming under increasing pressure to tackle the obesity problem, they will find our revised pack invaluable in helping their patients lose weight."

Dr Martin Hadley-Brown, a GP from Norfolk said, "Weight management is crucial for everyone, particularly people with diabetes and those at risk of developing it. Increasing levels of obesity in the UK mean GPs and their teams need all available resources to tackle the issue head on.  The updated toolkit offers more guidance on empowering people with diabetes and helping them to control their weight."

Kate Leivesley, a Practice Nurse from St Helens said, "The pack continues to offer practical tips for people with diabetes to keep tight control of their weight. For healthcare professionals, it's essential to stay abreast of weight management issues and the revised toolkit has more in depth information to help us do this."

Over 80 per cent of people with Type 2 diabetes are overweight at diagnosis. Weight management in people with Type 2 diabetes is important to help control blood glucose levels and reduce the risk of long-term complications.

To download a copy, visit www.diabetes.org.uk/catalogue/education. To receive a pack, contact the Diabetes UK distribution department on 0800 585 088.


For further information, please contact Maria Lam on 020 7424 1166.

Notes 

1 Cambridge Health & Weight Plan offers a range of flexible calorie controlled weight management programmes.  The foundation for all these programmes is the Cambridge Diet, a nutritionally complete formula food that can be used as a sole source of nutrition or as part of a balanced weight management programme. The use of a Very Low Calorie Diet programme can see a marked improvement in glycaemic control. For more information, go to www.cambridge-health-plan.co.uk


(21/4/05)