The FDA's Endocrinologic and Metabolic Drugs Advisory Committee has recommended against the approval of sotagliflozin (Zynquista, Lexicon) for glucose control as an adjunct to insulin in adults with type 1 diabetes and chronic kidney disease. The decision was based on concerns that the risks associated with the drug, especially the potential for diabetic ketoacidosis (DKA), did not outweigh its benefits.
The committee voted 11-3 against recommending the drug. "I really feel like we need a prospective trial," said Cecilia C. Low Wang, MD, professor of medicine at University of Colorado Anschutz Medical Campus and chairperson of the committee, who voted against the approval. "I have a really hard time voting to approve a drug when there are so little relevant data. I feel like it does my patients a disservice."
The rejection highlights ongoing challenges in managing type 1 diabetes in patients with chronic kidney disease, a population with limited treatment options. The FDA's decision reflects a cautious approach to approving new therapies when safety concerns are prominent.
Alternative Approaches Emphasized
In related news, the American College of Lifestyle Medicine has released a clinical practice guideline that emphasizes lifestyle interventions as the first-line treatment for prediabetes and type 2 diabetes. This guideline underscores the importance of diet, exercise, and behavioral changes in managing these conditions, potentially reducing the need for pharmacological interventions in some patients.
Continuous Glucose Monitoring Advances
Abbott has announced that the FDA has removed the contraindication for its continuous glucose monitoring (CGM) sensors to be used during imaging procedures. This update allows patients to continue using their CGM devices during MRI, CT scans, and other imaging tests, improving convenience and glucose monitoring adherence.
Holistic Obesity Treatment
Recent findings presented at the Cardiometabolic Health Congress suggest that behavioral modification through diet and exercise can achieve similar weight-loss benefits compared to pharmaceutical and surgical approaches for obesity management. However, the success of these interventions depends on patient adherence to the recommended lifestyle changes.
GLP-1 Receptor Agonist Use
Researchers have reported a significant increase in the use of GLP-1 receptor agonists among patients undergoing bariatric surgery between 2018 and 2023. The study found that this increased use was not associated with harmful outcomes, suggesting that GLP-1 receptor agonists can be safely used before weight-loss surgery.
