Expanding Early Intensive Treatment Beyond Glycemia in Type 2 Diabetes

At the American Diabetes Association annual meeting, findings from the SURPASS-EARLY trial added to growing evidence that treating type 2 diabetes aggressively from the time of diagnosis may improve long-term outcomes beyond glycemic control alone.

In this MedPage Today video, investigator Stefano Del Prato, MD, of the University of Pisa in Italy, discusses the broader clinical implications of the findings and what they might mean for the future of type 2 diabetes management.

Following is a transcript of his remarks:

We have the data with the UKPDS [U.K. Prospective Diabetes Study], but it’s not just the UKPDS. We also have the data from the Steno-2 trial. The Steno-2 trial was addressing the potential for reducing cardiovascular risk in people with type 2 diabetes, not just through improvement in glycemic control, but also taking into consideration other cardiovascular risk factors — blood pressure, lipid profile, and so on and so forth — and demonstrating that early intervention of close metabolic control can also result in a metabolic legacy that can provide really a benefit over time to people with type 2 diabetes.

And also this kind of treatment, tirzepatide [Mounjaro] in this specific case, provides us a better opportunity to really try to meet the recommendation from guidelines or consensus like the most recent or the last version of the ADA/EASD [American Diabetes Association/European Association for the Study of Diabetes] consensus where it was recommended that at the time of the diagnosis in people with type 2 diabetes, we should really try and strive to achieve good glycemic control, still the main factor driving the risk of microvascular complication; to focus more on body weight, because early [loss] in initial body weight can provide more metabolic effect and actually increase the potential for diabetes remission; focus from the very beginning on cardiovascular risk factors — lipids, blood pressure, hypertension, and inflammation and so on and so forth; and of course to consider whatever is needed to do a specific intervention because people may already have an organ damage like a prior cardiovascular event or an initial chronic kidney disease.

So what I think SURPASS-EARLY suggests is a potential to have a more holistic comprehensive treatment from the very beginning of the disease with the expectation, of course, that would require specific evidence to be gathered to bend what has been seen so far as the natural history of type 2 diabetes. The natural history of diabetes has been so far depicted as an unavoidable progression toward either worsening or intensification of the treatment. These results shed initial light on potential for really being more comprehensive from the very beginning and really hit multiple targets with a more simplified system approach.

And this is also supported by the fact that, of course, we also looked into these early stage people with type 2 diabetes at the safety and the tolerability. And safety was the typical one that has been reported for GLP-1 receptor agonists. Yes, the patients that we recruited in SURPASS-EARLY had some gastrointestinal side effects, but those are very similar to the ones that have been reported also in the control group. Remember, 85% also in the control group were on a GLP-1 receptor agonist. There was not very much a difference in terms of the dropout of these subjects.

So the tolerability was what could be expected with a typical treatment with a GLP-1 receptor agonist. Which also supports the potential implementation and persistent use of this approach in people with early disease and with type 2 diabetes.