Dr. Jaiwant Rangi presents the 2015 EDICT trial, which found that newly diagnosed diabetics given metformin, pioglitazone, and a GLP-1 agonist together showed better blood sugar control, less weight gain, and reduced fatty liver risk than those on metformin alone. Early aggressive treatment preserved beta-cell function and prevented progression to liver fibrosis.
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According to NHANCE, the prevalence of diabetes is 11% in the United States, pre diabetes 38% and obesity 41%. With the tsunami of cases that are happening because of metabolic complications from obesity, diabetes and other conditions, their risk of of preventable premature deaths has gone up. And with newer and newer medications coming out in the market, it is very confusing for patients and the doctors about the treatment strategy. Even though we have guidelines that are recommending using certain medications in certain patients earlier on, this is something which is not extended to majority of the patients. Because of that, I have decided to do certain series of teachings where the patients and my colleagues can both benefit from this. There is a study that was published in 2015 by Dr. Ralph DeFronzo, who's a pioneer in diabetes world. And in that study what they did was they had randomized new onset diabetic patients into standard of care or traditional therapy where the metformin was started initially and the other group had more aggressive treatment and a combination treatment with metformin, metformin, pioglitazone which is a TZD and axanitide which is a GLP1 agonist. And what was noticed at the end of six years was people who had more aggressive treatment earlier on did much better. Not only did they have better control of the diabetes, but they also showed better preservation of the beta cells and also insulin sensitivity. Now on the other hand, people who had more traditional approach of metformin were not in control, added sulfonylurea and insulin, eventually had more weight gain, more hypoglycemia and more poor control of diabetes. Having said that, with that background, there's a subset of the study that recently was published and that was about fatty liver. It's a very common condition in patients with obesity to have fatty liver. Some of these fatty liver cases end up going into liver cirrhosis and liver failure. Not everybody goes to that, but there's certain people who are at a higher risk. Therefore, it's very important for our patients to work with their doctors and understand their risk of progression and the stages of fatty liver. What was noticed as the extension of this EDICT trial was that patients who had combination therapy earlier on, not only did they have less risk of fatty liver, but they also had less progression to stiffness or liver fibrosis. So that is a very remarkable finding that helps us understand how an earlier approach of managing diabetes with more aggressive therapy can help us prevent long term complications. Now there's many medications out there in the market and there's a lot more GLP1 agonists that have shown beneficial effects on fatty liver. For example the study was done with exenatide which is traditionally known as Byeta or by Durion. Now we have other GLP1 agonists available in the market as well. There's plenty of data that is available with Semaglutide traditionally known as Ozempic or Rybelsus. So I would encourage you patients to talk to your doctors and understand where your diabetes is earlier in the stages it is better to be more aggressive to preserve your beta cells and to have better insulin sensitivity so that you can have less long term complications and if you have any complications from obesity like fatty liver even then you should know what is the stage and what are your options and how to risk stratify and how to be on the right medications among the various different options of medication that we have. I hope this has been helpful. We have lot new data that is coming out with diabetes and we will meet you soon again thank you so much.
