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Medicine Matters diabetes

Hi. I'm Jay Shubrook, a professor in the primary care department and a primary care diabetologist at Touro University California in Vallejo, California in the United States. So we know that most people with type 2 diabetes die from cardiovascular disease. And despite having a plethora of treatments-- statins, aspirin, agents that reduce cardiovascular risk-- we still know that many of these patients, up to half of them, still have an unsuspected cardiovascular event beyond the risk reduction that we have found. And so there is still a need to find a way to reduce people's risk of the number one cause of death from type 2 diabetes.



So in the REDUCE-IT trial that was presented this year at the 2020 American Diabetes Association Scientific Sessions, the REDUCE-IT trial was looking at a subset of people with diabetes. And they were looking at the value of adding icosapent to ongoing evidence-based treatment, including statins, and looking at expanded MACE outcomes. What they found was that actually the addition of icosapent reduced both primary and secondary outcomes in these patients with type 2 diabetes and cardiovascular risk.



Now, why this is important is that now we know that we have another agent to add to our armamentarium to reduce the number one cause of death. And it is worthwhile to take the time to reduce triglycerides after you maximally provide benefit from a high or moderate moderately high intensity statin. So this is an important addition as we look at the science of preventing cardiovascular risk.



I know that many patients feel overwhelmed with the number of medicines they have to take. But in our patients who continue to have high triglycerides despite evidence-based treatment, it is a good option for us to consider. But I do think it's important that when we think about this study as it relates to our patients, that this year's presentation was related to a subgroup analysis of the larger REDUCE-IT trial.



The larger REDUCE-IT trial was published in the New England Journal of Medicine last year. And this subgroup analysis was not really powered for this outcome. Now, saying so, it still had a clinically significant outcome. So it is important to know that the study was not designed specifically for diabetes.



And it is important with all medications that there are risk and benefits to the treatment. So most importantly, make sure your patients are not at risk for pancreatitis. And there was a higher risk in bleeding in those people who took icosapent ethyl. And so if your patients have bleeding risk, you really would have to balance the risk and benefit profile for that patient.



So I think as we look at the evolution of the treatment of diabetes, this is another treatment to add to our armamentarium. I think the next thing is to actually look at real-world studies and look and see, how well do these get implemented? This is a twice-a-day medication. People with diabetes already have many medications they have to take. And the real-world studies really tell us, under common use, not under study use, does it provide the same benefit as it does in a randomized controlled trial. I really would look to see if they can repeat that in a real-world study.