July 2024 Condition Watch: Diabetes

Disparities Contribute to Increasing Rates of Diabetes

The prevalence of diabetes has been increasing worldwide due to the rise in obesity, highlighting the need for prevention and control of type 2 diabetes (T2D), according to results of a study published in The Lancet. The authors said understanding disparities in risk factors and diabetes burden in various populations can help inform public health strategies.

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Investigators identified 27,193 various data sources and applied the methodological framework from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. The analysis does not include the potential impact of COVID-19 on diabetes prevalence and burden. The authors primarily report on diabetes prevalence and burden; however, they also provide mortality estimates in the analysis.

According to the authors, there were approximately 529 million individuals worldwide living with diabetes in 2021, accounting for a global age-standardized prevalence of 6.1%. Investigators estimated that approximately 485 million adults aged 20 to 79 years had diabetes in 2021 compared with approximately 321 million individuals aged 18 years and older who had diabetes in 2010.

For type-specific diabetes, T2D accounted for approximately 96% of all diabetes cases. Furthermore, there were 37.8 million total diabetes-related years of life lost (YLL) and 41.4 million years lived with disability (YLD). T2D accounted for approximately 94% of YLLs and 96.6% of YLDs, according to the study authors.

Investigators analyzed 16 risk factors, finding that high body mass index was the primary risk factor for T2D worldwide, accounting for 52.2% of disability-adjusted life years. Further, dietary risks accounted for 25.7%, environmental or occupational risks for 19.6%, tobacco use for 12.1%, and low physical activity for 7.4%.—Ashley Gallagher, Associate Editor

Reference

GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203-234. doi:10.1016/S0140-6736(23)01301-6

FDA Clears First OTC Continuous Glucose Monitoring Systems

The FDA has cleared marketing for the first OTC continuous glucose monitoring (CGM) systems, including Dexcom’s Stelo Glucose Biosensor System, which is an integrated CGM for individuals aged 18 years and older who do not use insulin or individuals who treat diabetes with oral medication. Further, it can also be used by those without diabetes who may want to understand how diet and exercise can impact blood sugar levels, according to a news release from the FDA.¹

Additionally, in June the FDA cleared the Lingo and Libre Rio (Abbott) CGM systems for OTC use. Lingo is intended for general consumers 18 years and older who want more personalized insights for healthier habits and a better metabolism, whereas the Libre Rio system is designed specifically for individuals with type 2 diabetes who do not use insulin.²

CGM systems involve a wearable sensor that goes on the back of the arm and can be paired using an application to the user’s smartphone or other smart device.^1,2 It continuously measures, records, analyzes, and displays glucose values and presents blood glucose measurements and trends every 15 minutes via the application. —Ashley Gallagher, Associate Editor

References

1. FDA clears first over-the-counter continuous glucose monitor. News release. FDA. March 5, 2024. Accessed March 5, 2024. https://www.fda.gov/news-events/press-announcements/fda-clears-first-over-counter-continuous-glucose-monitor

2. Abbott receives US FDA clearance for 2 new over-the-counter continuous glucose monitoring systems. News release. Abbott. June 10, 2024. Accessed June 12, 2024. https://www.pharmacytimes.com/view/fda-gives-clearance-to-2-otc-continuous-glucose-monitoring-systems

Semaglutide Improves Chronic Kidney Disease in Patients With T2D

New research published in The New England Journal of Medicine found that semaglutide (Wegovy; Novo Nordisk) could reduce the risk of clinically important kidney outcomes and death caused by cardiovascular issues among individuals with type 2 diabetes (T2D) and chronic kidney disease. The results were found in the international, double-blind, randomized, place-controlled phase 3 FLOW trial (NCT03819153), which assessed the safety and efficacy of a 1-mg dose of semaglutide weekly.

The 3533 study participants were randomly assigned to receive semaglutide or placebo. The study authors noted that an 8-week dose-escalation regimen was used, increasing from 0.25 mg per week for 4 weeks to 0.5 mg per week for 4 weeks, then continuing with a 1-mg maintenance dose until the end of the study. The median follow-up was 3.4 years.

The results showed that the primary outcome of major kidney disease events, a composite of onset of kidney failure, was 24% lower among individuals treated with semaglutide compared with the placebo group (331 vs 410 first events; HR, 0.76; 95% CI, 0.66-0.88; P =.0003). Additionally, semaglutide displayed favorable results over the placebo group among kidney-specific components and death from cardiovascular causes, according to study authors.

Serious adverse events were reported to be fewer among individuals in the semaglutide group compared with individuals in the placebo group (877 [49.6%] vs. 950 [53.8%]).1 However, the study authors noted that this could be due to fewer infections or serious cardiovascular disorders in the semaglutide group.—Kennedy Ferruggia, Assistant Editor

Reference

Perkovic V, Tuttle KR, Rossing P, et al; FLOW Trial Committees and Investigators. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. Published online May 24, 2024. doi:10.1056/NEJMoa2403347