Is There an Added Value of Imaging to Composite Index Measurement of Disease Activity in RA Patient?
The study determined whether there is an added value of imaging to the composite index measurement of disease activity in patients with RA. Clinical evaluation of remission alone may be inadequate to capture a persistent lack of inflammation at different joint sites. Imaging can complement the assessment of patients in clinical remission, offering additional data.
How to Assess Heart Function in Rheumatic Diseases?
A study analyses the heart function in rheumatic diseases, particularly how to assess it either in systemic sclerosis & rheumatic arthritis as a prototype disease. Myocardial damage modifies electric conduction and functionality. The ischemic microcirculatory component is always present in SSc patients. The disturbance of electric potentials is fundamental to suspect primary heart involvement.
Lupus Low Disease Activity State (LLDAS)
LLDAS has better performance than other definitions of low disease activity and is associated with low mortality. It was found to be almost same as that of remissions when SLE was treated with belimumab while comparing real world evidence. Post hoc clinical trial data for drugs like Anifrolumab, Azathioprin etc, concluded that LLDAS is discriminatory in clinical trials.
Dapagliflozin Improves Renal Function in Obese Indian Diabetics with Microalbuminuria
Mahapatra H briefed about the Renoprotective effect of Dapagliflozin (DAPA) compared with the RAAS blockers in obese Indian type 2 diabetics (T2D) with microalbuminuria. Dapagliflozin showed substantial and analytically superior decrease in UACR than RAAS blocking agents in obese patients with microalbuminuric diabetes. Dapagliflozin utilization also showed substantial HbA1c reduction.
Insulin Driving Obesity-Related Cancers
Obesity and diabetes are associated with risk of cancers. IR/IGF-IR ratio in breast cancer is associated with BMI, NPI & race. Studies are going on to find therapeutics to treat cancer and improve metabolism. Hyperinsulinemia and insulin receptor signaling are important mechanisms contributing to cancer growth and progression, may explain part of the radical disparity in cancer outcome.
Heart Failure with Preserved Ejection Fraction: Can we Navigate the Black Hole of Heart failure?
SGLT2i reduced the composite of total cardiovascular deaths and hospitalizations for heart failure. These are first randomized data from prespecified analysis of clinical trials to show effect of a therapy on heart failure with preserved ejection fraction. The main goal is to manage co-morbidities. Potential drugs for HPpEF are MRA, ARNi, SGLT2i & Finerenone.
Heart Failure with Reduced Ejection Fraction: How to Prioritise among an Array of Therapy?
The four pillars of survival-enhancing medical therapy for HErEF are angiotensin receptor-neprilysin inhibitors, β-blocker, mineralocorticoid receptor antagonists & SGLT2i. Some ways to combat the situation with combination therapy include ensuring the patient can tolerate the medication and frequent use of telehealth services.
Finerenone in Patients with CKD and T2D by SGLT2i Treatment: FIDELIO-DKD Study Analysis
Finerenone was investigated in patients with CKD & T2D. Finerenone reduced the primary (kidney failure, reduction in eGFR ≥40%, or renal death) and secondary CV outcomes (CV death, nonfatal MI, nonfatal stroke, or hospitalization for HF). Benefits were consistent in the absence or presence of SGLT2i, with UACR improvement observed in patients receiving SGLT-2i at baseline.
Update on SCORED Trial - Main Results
Sotagliflozin is a dual inhibitor of SGLT2 and SGLT1 that is yet to be approved by the FDA. Clinical trials show that early use of this drug provides benefits across full range of albuminuria, a sign of kidney disease that involves excess of protein in the urine. It decreases the chance of heart attack by 32% & stroke by 34%.
Update on SOLOIST Trial - Main Results
Clinical trials were conducted to study the safety & efficacy of Sotagliflozin. Sotagliflozin was proved to be beneficial in patients hospitalized with acute heart failure. Early in-hospital initiation of Sotagliflozin reduced the risk of death from CVD and hospitalization or urgent visits for heart failure by 33%. The drugs were well tolerated among participants.
GIPR Signalling in Alpha Cells Completes the Incretin Axis
Incretin stimulates insulin secretion in a glucose-dependent manner as glucose is required to activate beta cells. GIP infusion elevates glucagon, this effect is glucose-dependent & only observed at hypoglycemia and euglycemia. GIP produced incretin requires activation by amino acid stimulation. Alpha cell GPCR is necessary for glucose homeostasis in response to mixed nutrient feeding.
Inflammatory Cytokines Rewire the Proinsulin Interaction Network in Islets
Cytokines induce proinsulin binding to KIF family microtubule-associated factors. Inflammatory cytokines rewire the proinsulin interaction network in human islets. The peroxidation of PRDX4 promotes proinsulin folding and is selectively disabled in islets from patients with T2D. Cytokines sensitize human beta cells. Proinsulin folding is maintained despite moderate ER stress induced by cytokines.
High Glucose Level Increases Expression of SARS-CoV-2 Receptor
A low incidence of SARS-CoV-2 receptors was observed on CD14 macrophage cells, pinpointing a poor recognition of the virus particle by CD14 cells. But a higher expression of the SARS-CoV-2 receptors was noted when HUVEC cells were cultured in HG for 7 days. Thus, a longer exposure of human endothelial cells to a high glucose condition increases the SARS-CoV-2 receptor expression.
Efficacy and Safety of Dapagliflozin by Glycemic Status in the DAPA-CKD Trial
The safety profile of dapagliflozin was similar over glycemic groups, with no incidents of major hypoglycemia or ketoacidosis in participants with normoglycemia or prediabetes, and no ketoacidosis in any participant managed with dapagliflozin. Dapagliflozin showed significant reduction in the risk of kidney and cardiovascular incidents independent of baseline glycemic status.
Soliqua: Sustained Cost Efficacy and Safety When Used in Combination with Metformin and Glimepiride
Soliqua trials evaluated Soilqua with Glimepiride and Metformin in patients with type 2 diabetes. Daily dose of Soliqua with metformin 1000-2000 mg were started pre-breakfast based on previous basal insulin dose. Soliqua is cost efficacious and safe in all patients irrespective of BMI, when administered in combination with glimepiride and metformin in the long term.
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.
