Benefits of SGLT2 Inhibition for Kidney Protection
More intensive glucose control suggested better kidney outcomes. Several new classes of glucose lowering treatments are now widely used like DPP4i, GLP-1 RAs, and SGLT2i. SGLT2i reduces intraglomerular pressure, renal damage as well as hyperfiltration via tubuloglomerular feedback. SGLT2i and ACEi/ARBs reduce intraglomerular pressure that leads to renal protection, preventing kidney failure.
AMPLITUDE-O Trial: Effect of Efpeglenatide on Cardiovascular Outcomes
Findings of the AMPLITUDE O trial indicate that efpeglenatide, an exendin-4 based GLP-1 RA, is an effective cardioprotective drug for type 2 diabetes patients with cardiovascular and/or kidney disease. The trial showed a significant reduction in first occurrence of a heart attack, or death, and a reduction in kidney disease in patients with type 2 diabetes with weekly use of efpeglenatide.
Results of the Glycemia Reduction Approaches in Diabetes
Effectiveness of 4 most used classes of medication in conjunction with metformin i.e. sulfonylurea glimepiride, DPP-4 inhibitor sitagliptin, insulin glargine and the GLP-1 receptor agonist liraglutide were studied. Results: Liraglutide had a relative benefit compared with the other three medicines in reducing a composite outcome of heart attacks, stroke, and other heart and vascular complications.
Global Use of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Type 2 Diabetes
A study found that the global use of glucose lowering medication with cardiovascular benefits has increased over time but remains suboptimal. It emphasised the importance of raising awareness about the potential benefits of SGLT2i and GLP1 RA medications beyond glucose control, as well as better targeting of medications to patients with established ASCVD.
Adolescents & Young Adults - Managing the Co-occurring Life Challenges & Diabetes
Kellee M Miller diabetes paper highlighted that mean A1C's aren't even close to ADA's recommendations in Adolescents & Young Adults (AYA) with diabetes. AYA from regional, ethnic minorities and SCS backgrounds has higher mean A1C levels. Diabetes may also increase the risk for psychological problems in AYA. It is recommended to address the psychosocial needs of AYA with diabetes.
Remote Management of Diabetes Emergencies Using Telehealth
Remote telehealth can be effective for managing diabetes emergencies like hypoglycemia, hyperglycemia, and early diabetic ketoacidosis (DKA). Mobile apps and continuous ketone monitoring would add to the readiness of the healthcare system. This would allow clinicians to evaluate patients at risk of ketoacidosis.
Role of Adrenal Hormones in Type 2 Diabetes
Researchers investigated gene-driven physiology and population heterogeneity in the management of glucose metabolism. It was found that aldosterone is associated with higher insulin resistance, higher odds of prevalent diabetes and increased risk of diabetes over 10 years. Aldosterone could provide more structured and precise approaches to diabetes prevention and treatment.
Combinations for Type 2 Diabetes - Insulin and SGLT2 Inhibitors
The combination of Insulin & SGLT2i is a perfect match pathophysiologically owing to the suppression of glucagon and EGP levels. This combination could also provide better efficacy such as reducing HbA1c levels, insulin dose, weight gain, and hypoglycemia.
Association between health care coverage and glycemic control
Mean HbA1c values were similar for both types of diabetes in patients with public insurance. But a spike in blood glucose levels was observed in type 1 diabetes patients with no insurance. Concluding that healthcare coverage and access appeared to have a strong correlation with better glycemic control in adults with type 1 diabetes but the same cannot be said for adults with type 2 diabetes.
Safety Outcomes in Patients with and without Type 2 Diabetes
The clinical trials showed safety outcomes were consistent and the lab parameters were stable during hospitalization in patients treated with dapagliflozin and placebo regardless of their diabetes status. The values such as serum bicarbonate, eGFR, Hematocrit, Glucose levels all had a similar trajectory in patients with or without diabetes.
Triglycerides and Residual Atherosclerosis Risk
The study shows triglycerides are at the least a risk marker and likely risk enhancer for atherosclerotic cardiovascular disease even in low-risk persons who are not diabetic. In persons with low to moderate CV risk, hypertriglyceridemia was associated with subclinical atherosclerosis and vascular inflammation, even in those with normal LDL-C levels.
Venous and Arterial Thromboembolism in Patients With Cancer
Researchers examine the literature on venous and arterial thromboembolism in patients with cancer. Venous thromboembolism rates in cancer patients are 4-7 fold higher compared to healthy individuals, with approximately 15% of patients experiencing VTE. Conversely, 20% of unprovoked VTEs are the first sign of an underlying malignancy. The incidence of ATE was 4.7% in all patients with cancer.
Efficacy Outcomes in Patients with and without Type 2 Diabetes
The primary outcome of recovery showed similar results in patients on Dapagliflozin vs placebo with/without diabetes. The composite key endpoint: AKI, Initiation of renal replacement or all cause death. Patients on Dapagliflozin had fewer events than the placebo group and the outcome was 7.7% and 10.4% in patients on Dapagliflozin vs placebo. Results for all-cause mortality were also similar.
Significance of Aortic Branch Aneurysms in Patients with Marfan syndrome (MFS)
Aortic branch aneurysms were observed in one-quarter of patients with MFS, and the presence of these was independently associated with subsequent aortic surgery. The connective tissue abnormalities of MFS can result in abnormalities in the aortic branch vessels. However, the prevalence of aortic branch aneurysms is not established, and their clinical significance has not been clear.
Study Finds Cancer Increases Risk of AFib, But Varies Depending on Type of Cancer
Patients with cancer may be at higher risk for atrial fibrillation (AFib), although the impact on AFib development varies by cancer type. During a median follow-up of 4.5 years, AFib was diagnosed in 25,356 patients with cancer. Patients with multiple myeloma or esophageal cancer showed the highest risk of AFib, and those with stomach cancer had the lowest risk of AFib.
N-3 Polyunsaturated Fatty Acids for CVD: New Studies, Continued Debate
The beneficial effects of n-3 polyunsaturated fatty acids (PUFA) remain controversial due to disagreements over study design and choice of placebo. PUFA increases the rates of atrial fibrillation, emphasizing the importance of elucidating the true benefits of this class of medications. Despite the link, there remains debate about whether supplementation with PUFA improves cardiovascular outcomes.
Racial Disparities in Outcomes of Arrhythmias Among Patients Undergoing TAVR
Racial disparities in treatment and their impacts on outcomes in patients undergoing transcatheter aortic valve replacement were studied. Patients with arrhythmia undergoing TAVR have statistically substantial racial differences in length of stay and cost of hospitalization. The mean length of stay was high in African Americans (7.7) and Hispanics (7) than Caucasians (5.6) in the arrhythmia group.
Structural Grey Matter Alterations and Cognitive Function in Diabetes
A study compared the grey matter volume of participants with diabetes to those without diabetes. Peripheral cortical grey matter, superior frontal gyrus, right anterior and posterior division of the supramarginal gyrus, paracingulate gyrus, and precentral gyrus were lower in the diabetic group. Concluding decrease in global grey matter volume in specific brain regions of people with diabetes.
Liraglutide Is a Safe and Effective Treatment of Bile Acid Malabsorption
Excessive spill-over of bile acids to the colon causes Bile acid malabsorption (BAM). The only recommended treatment of BAM is Bile acid sequestrant (BAS). However, it has a poor effect and low compliance. A study shows that Liraglutide, a Glucagon-Like Peptide-1 Analog, enhances the reabsorption of bile acids and is safe and effective for the treatment of BAM.
Efficacy & Safety of Once-Weekly Efpeglenatide VS Placebo as Monotherapy in Patients with T2D
A Phase 3 study included patients who were unable to control type 2 diabetes with diet and exercise alone to evaluate the efficacy and safety of Efpeglenatide as a weekly subcutaneous treatment. Efpeglenatide showed significant reductions in HbA1c and body weight compared to placebo. However, it caused mild to moderate gastrointestinal adverse effects.
