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Hypothetical male T2D Patient

Early control of HbA1c
and excess weight:

A shift in the type 2 diabetes (T2D) treatment paradigm

Early control of type 2 diabetes (T2D) is achievable and can lead to long-term benefits: New treatment approaches can be a solution

T2D can progress for years before patients are diagnosed. According to the latest ADA-EASD Consensus Report, a proactive approach to achieving HbA1c targets early is important for long-term outcomes, and weight management is central from the beginning for comprehensive T2D care in people with T2D and excess weight1,2

Meet Ahmed

Ahmed’s hypothetical treatment journey will be used to help us see the potential benefits of an early treatment approach that addresses more than HbA1c alone.

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At Diagnosis

Ahmed is a 42-year-old man diagnosed with T2D during his initial visit to your clinic.

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Clinical examination results at diagnosis for a hypothetical patient with type 2 diabetes, including HbA1c, BMI, waist-to-hip ratio, blood pressure, and lipid profile values
Clinical examinationResult
HbA1c7.8 %
BMI29 kg/m2
Waist-to-hip Ratio0.97
Blood Pressure131/79 mmHg
Lipidprofil - HDL1.4 mmol/(54.1 mg/dL)
Lipidprofil - LDL2.8 mmol/L(108.3 mg/dL)
Lipidprofil - Gesamtcholesterin5.6 mmol/L(216.6 mg/dL)
Lipidprofil - Triglycerides4.9 mmol/L(434 mg/dL)
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What does Ahmed’s clinical workup tell us about his T2D?

There could be multiple defects driving his T2D progression, and if hyperglycemia is not treated to goal, his risk of developing irreversible complications such as diabetic neuropathy, chronic kidney disease, or cardiovascular morbidity and mortality is increased.1,3,4

  1. Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753-2786. doi:10.2337/dci22-0034

  2. Kendall DM, Cuddihy RM, Bergenstal RM. Clinical application of incretin-based therapy: therapeutic potential, patient selection and clinical use. Am J Med. 2009;122(6 suppl): 41 S37-S50. doi:10.1016/j.amjmed.2009.03.015

  3. Schwartz SS, Epstein S, Corkey BE, et al. The time is right for a new classification system for diabetes: rationale and implications of the β-cell-centric classification schema. Diabetes Care. 2016;39(2):179-186. doi:10.2337/dc15-1585

  4. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-853. doi:10.1016/S0140-6736(98)07019-6

  5. DeFronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795. doi:10.2337/db09-9028

  6. Chait A, den Hartigh LJ. Adipose tissue distribution, inflammation and its metabolic consequences, including diabetes and cardiovascular disease. Front Cardiovasc Med. 2020;7:22. doi:10.3389/fcvm.2020.00022

  7. de Luca C, Olefsky JM. Inflammation and insulin resistance. FEBS Lett. 2008;582(1):97-105. doi:10.1016/j.febslet.2007.11.057

  8. Xu H, Barnes GT, Yang Q, et al. Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest. 2003;112(12):1821-1830. doi:10.1172/JCI19451

  9. Trouwborst I, Bowser SM, Goossens GH, Blaak EE. Ectopic fat accumulation in distinct insulin resistant phenotypes; targets for personalized nutritional interventions. Front Nutr. 2018;5:77. doi:10.3389/fnut.2018.00077

  10. Raji A, Seely EW, Arky RA, Simonson DC. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. J Clin Endocrinol Metab. 2001;86(11):5366-5371. doi:10.1210/jcem.86.11.7992

  11. Kozawa J, Shimomura I. Ectopic fat accumulation in pancreas and heart. J Clin Med. 2021;10(6):1326. doi:10.3390/jcm10061326

  12. Ye R, Onodera T, Scherer PE. Lipotoxicity and β cell maintenance in obesity and type 2 diabetes. J Endocr Soc. 2019;3(3):617-631. doi:10.1210/js.2018-00372

  13. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140-149. doi:10.2337/dc14-2441

  14. Mounjaro (tirzepatide once weekly) [Summary of Product Characteristics]. Houten, The Netherlands: Eli Lilly and Company.

  15. Campbell IW. Need for intensive, early glycemic control in patients with type 2 diabetes. J Brit Cardiol. 2000;7:625-631.

  16. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577-1589. doi:10.1056/NEJMoa0806470

  17. Matthews D, Del Prato S, Mohan V, et al. Insights from VERIFY: early combination therapy provides better glycaemic durability than a stepwise approach in newly diagnosed type 2 diabetes. Diabetes Ther. 2020;11(11):2465-2476. doi:10.1007/s13300-020-00926-7 42

  18. Del Prato S, Foley JE, Kothny W, et al. Study to determine the durability of glycaemic control with early treatment with a vildagliptin-metformin combination regimen vs. standard-of-care metformin monotherapy—the VERIFY trial: a randomized double-blind trial. Diabet Med. 2014;31(10):1178-1184. doi:10.1111/dme.12508

  19. American Diabetes Association Professional Practice Committee. 6. Glycemic targets: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022;45(suppl 1):S83-S96.

  20. Gomes MB, Rathmann W, Charbonnel B, et al. Treatment of type 2 diabetes mellitus worldwide: baseline patient characteristics in the global DISCOVER study. Diabetes Res Clin Pract. 2019;151:20-32. doi:10.1016/j.diabres.2019.03.024

  21. Lind M, Imberg H, Coleman RL, et al. Historical HbA1c values may explain the type 2 diabetes legacy effect: UKPDS 88. Diabetes Care. 2021;44(10):2231-2237. doi:10.2337/dc20-2439

  22. Laiteerapong N, Ham SA, Gao Y, et al. The legacy effect in type 2 diabetes: impact of early glycemic control on future complications (The Diabetes & Aging Study). Diabetes Care. 2019;42(3):416-426. doi:10.2337/dc17-1144