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.
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.
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.
Clinical Implications of Semaglutide for Obesity Care
Semaglutide caused 2 times greater weight loss than liraglutide. In a 20 week trial, a dose of 2.4 mg Semaglutide per week with no lifestyle interventions resulted in up to 7% weight loss in adults with obesity. The superior efficacy demonstrates GLP-1 signaling is a powerful tool & effective target for obesity, providing a new opportunity to control obesity and its medical complications.
Hypoglycemia, Glycemic Variability & Cardiac Arrhythmia Risk in Insulin-Treated Patients with T2D
Implantable cardiac monitor (ICM) of Insulin-treated patients with T2D detected 724 episodes of clinically relevant arrhythmias in 57% of patients with atrial fibrillation. The incidence of cardiac arrhythmias during the night was directly proportional to the increasing glycemic variability. So arrhythmias in T2D patients on insulin were associated with glycemic variability, not hypoglycemia.
High/Normal Carbohydrate Intake Optimises Performance and Glycemia
Consuming a high Carb diet after exercise increased the resting muscle glycogen concentration, a 13 g/Kg increase in a 36 hours period compared to a 3g/Kg in a low carb diet. A high CHO diet enhances endurance performance, cell signaling, gene expression, enzymatic changes, lipid oxidation and overall performance.
Association of Lipid Levels with COVID-19 Risk
The severity of COVID-19 infection and lipid levels outcomes shown by various studies suggests that an increased risk of death was inversely related to HDL C and apolipoproteins A1 Levels. Increased LDL C and apolipoproteins B levels were not associated with an increased risk of COVID-19 infections. While low HDL levels were linked to increased COVID-19 susceptibility.
Diabetic Kidney Disease - What is on the Horizon?
A large cohort study revealed that patients undergoing bariatric surgeries had 67% reduction in the incidence of renal endpoint over an 18 year follow-up period. RAASi, SGLT2i, GLP-1 RA and lifestyle modifications have all had a positive effect on the outcomes and can be used as effective strategies to improve renal outcomes in DKD patients.
Heart Failure in Diabetes - New Therapeutic Insights
Biyem Bozkurt, a heart failure specialist from Houston, presented newer insights on heart failure risk associated with Diabetes, which is a major risk factor. Firstly considering the poor glycemic control factor wherein a 1% increase in HbA1c increases chances of HF by 8%. Various guidelines such as ADA, AACE/ACE etc. support use of SGLT2i to reduce HF risk in patients with T2D.
