Dulaglutide Reduces Cardiovascular Disease in People with Type 2 Diabetes
The Researching Cardiovascular Events With a Weekly Incretin in Diabetes (REWIND) trial has found dulaglutide, an injectable, glucagon-like peptide-1 (GLP-1) receptor agonist, demonstrates superiority in the reduction of cardiovascular events for a broad range of people living with type 2 diabetes (T2D), according to research presented today at a symposium at the American Diabetes Association’s® (ADA’s) 79th Scientific Sessions®. The REWIND trial is the first study to include a majority of participants (69%) with no history of cardiovascular disease (CVD) at enrollment. Additionally, the REWIND trial had a median follow-up period of more than five years, the longest for a cardiovascular (CV) outcome trial of a GLP-1 receptor agonist.
This international, double-blind randomized controlled trial enrolled 9,901 people, age 50 and older with T2D from 24 countries at 371 care centers. The study evaluated whether weekly subcutaneous injections of 1.5 mg dulaglutide could reduce major adverse cardiovascular events (MACE) compared to placebo. A wide spectrum of participants similar to those seen in a community practice were studied, including many without previous cardiovascular disease and many with guideline-recommended glucose levels. Participants had a mean A1C level of 7.3% (with half having a level below 7.2%) at the beginning of the study, 46% were women, and 69% of participants did not have prior cardiovascular disease. Researchers randomly assigned participants to receive either the placebo or dulaglutide for up to eight years, and the average follow-up duration was 5.4 years.
GLP-1 therapies work by affecting glucose control in the body via several mechanisms, including enhancement of glucose-dependent insulin secretion, slowed emptying of the stomach, and reduction of postprandial glucagon and food intake. They may also have other cardiovascular effects. The REWIND trial aimed to assess whether dulaglutide could reduce major cardiovascular events (MACE) and other serious outcomes in people with T2D, when added to their anti-hyperglycemic regimen.
REWIND’s primary CV outcome was the first occurrence of MACE, the composite of CV death or non-fatal myocardial infarction or non-fatal stroke. The secondary outcomes included each component of the primary composite CV outcome, a composite clinical microvascular outcome comprising retinal or renal disease, hospitalization for unstable angina, heart failure requiring hospitalization or an urgent heart failure visit, and all-cause mortality. Established CVD at baseline within REWIND was defined as prior myocardial infarction, prior ischemic stroke, prior unstable angina with electrocardiogram changes, prior myocardial ischaemia on imaging or stress test, or prior coronary, carotid, or peripheral revascularisation.
“The REWIND trial was an ambitious study that conclusively assessed the effects of dulaglutide on people with type 2 diabetes both with and without prior cardiovascular disease,” says Hertzel Gerstein, MD, MSc, FRCPC, professor of medicine, director of the division of endocrinology and metabolism, and deputy director of the Population Health Institute at McMaster University and Hamilton Health Sciences, in Ontario, Canada, and principal investigator of the REWIND trial. “The reduction in cardiovascular events observed in a wide range of people with diabetes regardless of sex, baseline cardiovascular disease, age or A1c level is compelling.”
The study confirmed a cardiovascular benefit, without unexpected side effects or an increase in hypoglycemia. Moreover, it modestly reduced A1C by about 0.6%, weight by about 1.5 kg, and systolic blood pressure by 1.7 mm Hg.
“Both healthcare providers and patients who are looking for ways to reduce cardiovascular risks while also lowering glucose levels, blood pressure and weight will welcome the findings of this trial,” says Matthew C. Riddle, MD, one of the lead investigators in REWIND and professor of medicine in the division of endocrinology, diabetes and clinical nutrition at Oregon Health and Science University in Portland, Oregon, and editor-in-chief of Diabetes Care, which is the highest-ranked diabetes research journal in the world and published by the American Diabetes Association.
To speak with Dr. Gerstein or Dr. Riddle, please contact the ADA Press Office on-site at San Francisco’s Moscone Convention Center on June 7-11, by phone at 415-978-3606 or by email at Sci SessionsPress@diabetes.org.
The American Diabetes Association’s 79th Scientific Sessions, the world’s largest scientific meeting focused on diabetes research, prevention and care, will be held June 7-11, 2019, at the Moscone Center in San Francisco, California. Nearly 15,000 leading physicians, scientists, health care professionals and industry representatives from around the world are expected to convene at the Scientific Sessions to unveil cutting-edge research, treatment recommendations and advances toward a cure for diabetes. During the five-day meeting, attendees will receive exclusive access to more than 850 presentations and 2,000 original research presentations, participate in provocative and engaging exchanges with leading diabetes experts, and can earn Continuing Medical Education (CME) or Continuing Education (CE) credits for educational sessions. The program is grouped into eight thematic areas: Acute and Chronic Complications; Behavioral Medicine, Clinical Nutrition, Education and Exercise; Clinical Diabetes/Therapeutics; Epidemiology/Genetics; Immunology/Transplantation; Insulin Action/Molecular Metabolism; Integrated Physiology/Obesity; and Islet Biology/Insulin Secretion. Gretchen Youssef, MS, RDN, CDE, President of Health Care and Education, will deliver her address, “It’s All About Access!,” on Saturday, June 8, and Louis H. Philipson, MD, PhD, FACP, President of Medicine and Science, will deliver his lecture, “Precision Medicine—Addressing the Many Faces of Diabetes,” on Sunday, June 9. Join the Scientific Sessions conversation on social media using #ADA2019.
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Every day more than 4,000 people are newly diagnosed with diabetes in America. Nearly 115 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the nation’s leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For nearly 80 years the ADA has been driving discovery and research to treat, manage and prevent diabetes, while working relentlessly for a cure. We help people with diabetes thrive by fighting for their rights and developing programs, advocacy and education designed to improve their quality of life. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).