London, UK – What changed in Diabetes clinical practice in 2011? Everything from novel agent approvals, blockbuster trials results and negative reports, leading to questioning of potentially important therapies. HbA1C Blog reporters spoke to Healthcare professionals across 8 different subspecialties to ask them what they thought the biggest news was in their field this past year.

Diabetes and Dyslipidemia

HbA1C Blog: What was the biggest advance in Diabetes and Dyslipidemia management in 2011?

Zachary T. Bloomgarden, MD, FACE (Editor, the Journal of Diabetes and Clinical Professor, Department of Medicine, Mount Sinai School of Medicine, NY, USA).

“Sadly, the big news of 2011 in diabetes and dyslipidemia is not in therapeutic advances, but rather in the increasing attention being paid to negative reports, leading to questioning of potentially important therapies.  Two examples.  First, in lipids, niacin, with the AIM-HIGH trial ending early, ostensibly because the investigators felt there would be a neutral outcome, but likely because of the widely reported initial assessment of outcome suggesting an increase in stroke — with less hasty subsequent analysis showing that this was not in fact the case.

Second, in diabetes, pioglitazone, with tremendous attention being paid to possible evidence of bladder cancer risk, in the absence of any attempt to fully determine the risk-benefit equation with this drug which has definite cardiovascular and renal protective properties, as well as, leading to sustained glycemic control over a several year period.  In neither of these cases should we say that the drugs are perfectly safe, with no side effects – but there are no such agents, and by rushing to pay attention to early findings we risk limiting the use of potentially important therapeutic modalities”.

Diabetic nephropathy

HbA1C Blog: What changed in diabetic nephropathy management in 2011?

David J. Leehey, MD, FACP (Section Chief, Renal & Hypertension, Professor of Medicine, Loyola University Medical Center).

the “Biggest advance in 2011 was the NEJM report of phase 2 trial showing benefit of bardoxolone on renal function in diabetic nephropathy.  At this point, (the) drug is in phase 3 trials so it will not affect clinical practice yet.  This certainly could be a “game changer” but we will not know for a while.”

Prof Merlin C Thomas (NHMRC Senior Research Fellow, Baker IDI Heart and Diabetes Institute, Australia).

HbA1C Blog: What was the biggest advance in Diabetic nephropathy in 2011?
Bardoxolonemethyl (NEJM 2011)

HbA1C Blog: How will this affect your practice?
Not today, but if this works as well as it appears in trials it may be 2-3 delay in requiring dialysis for patients with severe CKD

HbA1C Blog: What was the biggest setback for Diabetic nephropathy clinical practice in 2011?
ALTITUDE is stopped by Novartis, after it fails to show improvement and may have risked patients
The idea that more RAS blockade is better than what we are doing know is now sitting on shaky ground