Asian Diabetes Xchange Summit Philippines: Bridging Excellence in Diabetes Care

Diabetes mellitus continues to threaten millions of lives worldwide. As we move forward from the aftermath of the pandemic, there is a renewed commitment to address this threat globally. In fact, this year’s theme for world diabetes day revolves around improving diabetes awareness and education among healthcare workers.

ZP Therapeutics joins this global call to action against diabetes thru the Asian Diabetes Xchange Summit, a series of scientific events conducted throughout Asia, with the aim of delivering the latest updates on diabetes management and technology.

The final leg of this series - the Asian Diabetes Xchange (ADX) Summit Philippines - was held last November 11-12, 2022 at the Bellevue Manila, Muntinlupa, Philippines. Working in collaboration with the relevant medical societies, ZP Therapeutics engaged physicians at the frontline of diabetes diagnosis and management.

In the traditional ZP Therapeutics fashion, the scientific event brought together leading experts and key opinion leaders to deliver these latest updates and initiate important discussions on issues of diabetes management in the local context.



Among the speakers was Professor Esteban Jodar, Head of the Endocrinology Department at University Hospitals at Quiron Salud Madrid. He was joined by a panel of key opinion leaders for a multidisciplinary discussion on diabetes care beyond glucose. The said panel was composed of Dr Sjoberg Kho (endocrinology), Dr Rima Tan (diabetology), Dr Christopher Nazal (cardiology), and Dr Lynn Gomez (nephrology). The plenaries for the first day were moderated by Dr Cynthia Manabat, the chief of the section of Endocrinology at the University of Perpetual Help Medical Center - Las Piñas.

Clinical Inertia, Early Initiation of GLP1-RAs and Holistic Diabetic Care 
During the first day of the summit, Professor Jodar delivered a lecture tackling the impact of early initiation of GLP1-RAs in patients with diabetes and reiterated important points regarding the course of type 2 diabetes mellitus (T2DM). First, T2DM is known to have a progressive course, marked by the eventual development of micro and macrovascular complications that at times begin even prior to the diagnosis being made.¹ Second, glycemic control has been shown to deteriorate over time, which necessitates progressive intensification of individualized therapy.² At present, many pharmacologic agents can be added to current therapy to help achieve and maintain glycemic targets in patients with T2DM. This then begs the question: which among the available repertoire of anti-DM medications should be added to therapy? 



In reviewing the pathophysiology of T2DM, Professor Jodar enumerated the 12 pathophysiological defects that contribute to beta cell failure in T2DM to demonstrate the pervasive impact of the disease.³ He further points out how injectable GLP1- receptor agonists (GLP1-RAs) address each of these pathological defects.³

Unfortunately, despite the multitude of available pharmacologic treatments, the achievement of glycemic control in some adults remains suboptimal.⁴ According to Professor Jodar, an important factor for such predicaments is clinical inertia which is a multifaceted problem in clinical practice worldwide. He further expounds on clinical inertia as a lack of adherence to guideline recommendations, or simply, the failure to advance therapy when required.^4,5

Although clinical inertia may be encountered in any phase of T2DM management, this is most apparent when patients are only initiated with injectable therapy after years of poor glycemic control, ⁶ despite the availability of clinical trials demonstrating the effectiveness and simplicity of adding injectable therapy to treatment regimens. In fact, a study by Lin et al. showed a significant prevalence (73%) of clinical inertia in the management of T2DM.⁷ As such, clinical inertia contributes heavily to poor glycemic control, and results in the delay of effective intensification of therapy. This would then translate to an increased risk of microvascular⁸ and macrovascular⁹ events as well as suboptimal glycemic control in the long term.¹⁰

In his lecture, Professor Jodar recapitulates that overcoming clinical inertia by initiating early intensification with appropriate therapeutic agents is central to preventing long-term T2DM complications. He further elucidates the role of GLP1-RAs in T2DM management and that equally important is the suitable timing of its initiation. In revisiting the latest European Association for the Study of Diabetes (EASD)/American Diabetes Association (ADA) guidelines, he points out that GLP1- RAs should be considered and even initiated prior to Insulin in patient with T2DM.¹¹ Among the available GLP1- RAs, real world data on change in HbA1c and weight loss has been shown to favor Dulaglutide.¹² Likewise, the PREFER study also demonstrated a patient preference for Dulaglutide injection devices over those of Semaglutide.¹³ This is further supported by data showing greater persistent use of Dulaglutide compared to Semaglutide and Exenatide.¹⁴

Following Professor Jodar's lecture, he was joined by the previously mentioned panelists and key opinion leaders for a multidisciplinary discussion on diabetes care beyond glucose. They discussed other facets of diabetes care by reiterating guideline recommendations for glycemic targets, intensification, and de-escalation strategies. They also mentioned special considerations for elderly patients with diabetes and those with concomitant kidney diseases.

Cardiovascular Event Prevention in Diabetes and Injectable Solutions for T2DM
Professor Jodar returned for the 2nd day of the summit to deliver another lecture on the impact of glycemic control on cardiovascular event prevention for patients with diabetes. In this plenary, Professor Jodar reviewed the existing evidence that demonstrates the strong correlation between T2DM and cardiovascular diseases such as myocardial infarction, ischemic and hemorrhagic stroke.¹⁵ These findings have introduced large-scale cardiovascular outcome trials (CVOTs) that have since transformed the landscape of T2DM management.  



Professor Jodar referred to the meta-analysis by Fei et al., which exemplified the cardiovascular benefit afforded by SGLT-2 inhibitors as well as GLP-1 RAs.¹⁶ These are reflected in the recent guidelines on T2DM management published by the EASD and ADA which recommend the preferential use of SGLT-2 inhibitors and GLP-1 RAs for patients with diabetes who possess multiple risk factors for cardiovascular disease.¹¹

In the context of injectable therapy, GLP1-RAs were likewise demonstrated to result in better glycemic control when compared to Insulin,¹⁷ with added benefits regarding body weight, hypoglycemia, blood pressure, and lipoproteins. Comparing the different GLP1-RAs, Dulaglutide has been demonstrated to have a greater reduction in HbA1c and body weight versus Liraglutide,¹² and is preferred by patients over Semaglutide,¹³ resulting to lower discontinuation rates. Moreover, HbA1c reduction has been observed as early as 3 months upon initiation of therapy and persisted through 24 months, as demonstrated in the real-world study by Mody et al.¹⁴

This lecture was followed by another multidisciplinary discussion on the utility of injectable therapy in the Philippines. In this final plenary of the ADX summit, Dr Caprice Yang - a practicing endocrinologist from Pagadian Doctor’s Hospital - joined Dr Rima Tan and Dr Christopher Nazal in sharing their own experiences with real-world patients to illustrate important considerations on individualized therapy with injectable solutions for T2DM. 

ADX Summit: Elevating Diabetes Care
The Asian Diabetes Xchange Summit, which is being projected to become a yearly event, is a testament to the commitment of ZP Therapeutics to remain as forerunners in the global effort to address the impact of diabetes worldwide and achieve excellence by elevating the quality of diabetes care while improving patient access in the Philippines.