Severe Hypoglycaemia in Patients Receiving Insulin and Sulphonylureas
A study found that incidence of severe hypoglycaemia was lower in T2D patients treated sulphonylureas than insulin. Risk of SH increased with age, diabetes duration, creatinine, a BMI more than 30 kg/m2 and low HbA1c. The validated prediction tool can identify those at high risk and optimise their treatment to minimise risk by switching of insulin/SU, reducing dose, or changing to Gliclazide MR.
SURMOUNT-1: Safety and Efficacy of Tirzepatide in Adults With Obesity or Overweight
Tirzepatide 15mg reduced body weight in adults with obesity or overweight compared to placebo. Upto 57% of participants achieved the ≥ 20% weight–reduction target withTirzepatide. Of participants who had prediabetes >95% reverted to normoglycemia in Tirazepatide group. There was 0.5% decrease in HbA1c and an improvement in insulin sensitivity with all doses of Tirazepatide at 72 weeks.
Improved Beta Cell Function Following 8 weeks High-intensity Interval Training
HIIT combining rowing and cycling induced beta-cell function in men with T2D, and to a smaller extent in obese and lean controls. No differences were seen in the HIIT induced responses on insulin secretion and insulin sensitivity. However, after the HIIT-protocol, the beta-cell function was still severely impaired in men with T2D, suggesting that this component of T2D is less reversible.
Effects of Different Volumes of Exercise on Beta Cell Function
A study found that 16 weeks of high volume of exercise along with dietary weight loss improves beta-cell function more than standard care or diet alone in adults with T2D. The improvement was mediated by improved insulin sensitivity, whereas adding exercise to the dietary intervention did not seem to increase glucose- or meal-stimulated insulin secretion beyond dietary weight loss alone.
Precision Medicine in Diabetes: How Far Can We Get?
Precision Medicine in diabetes is an approach to reduce hyperinsulinemia, visceral adiposity, improve insulin sensitivity, reduce liver fat content and beta cell protection. Replication of prediabetes clusters, prospective treatment trials, identification of early/predictive biomarkers of the clusters, redefining endotypes help deliver more precise treatment in prediabetics.
Chances and Opportunities With Precision Medicine
Precision medicine involves intelligent analysis of data about a person's biology, behaviors, clinical characteristics or contextual features to reduce error in medical decision making. It should refine the characterization of disease and optimize its prevention, diagnosis, treatment or prognosis. It should be safer, efficacious, accessible and economically viable than contemporary medicine.
Semaglutide Reduces the 10-year T2D Risk in Overweight or Obese People
A study presented by T.W. Garvey at EASD showed that treatment with Semaglutide 2.4 mg reduces the 10-year risk of T2D by nearly 60% regardless of initial glycaemic status. In adults with overweight or obesity, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight.
Effect of SGLT2i Dapagliflozin on Substrate Metabolism in Humans With Prediabetes
Dapagliflozin treatment for 2 weeks in prediabetics improved fat oxidation. It had significant effects on 24h glucose and free fatty acid levels, and on nocturnal β-hydroxybutyrate levels. Dapagliflozin also improved skeletal muscle mitochondrial oxidative capacity. The study concluded that dapagliflozin elicits metabolic health effects that may mimic the effects of calorie restriction.
Different Effects of SGLT-2i on Subcutaneous and Epicardial Adipose Tissue Metabolome
SGLT-2i elicits different metabolic responses in subcutaneous (SAT) and epicardial (EAT) adipose tissue of heart failure subjects, with SAT showing mainly accented ketogenesis, while the preservation of EAT suggests other functions including potential cardioprotection. The exact role of increased sphingolipids and ether linked lipids in both adipose tissue depots remains to be elucidated.
Association Between Microangiopathic Complications and Cardiac Structure and Function
Valensi P. evaluated the relationship between microangiopathic complications and left ventricle structural and functional alterations in patients with T2D. Multivariate analyses showed that hypertrophy, septal thickness and NT-proBNP were significantly associated with the number of microangiopathic complications, independently from gender, diabetes duration, hypertension and SMI.
Accuracy of a Real-time Continuous Glucose Monitoring System During Cardiac Surgery
A study determined Dexcom G6 CGMS accuracy during cardiac surgery using hypothermic ECC. The mean absolute relative difference between sensor and reference method was 29.1% during surgery and 41.6% during deep hypothermic cardiac arrest. Conditions such as DHCA challenge Dexcom G6 performance. However, the accuracy recovered in most cases with adequate performance in the post-surgery period.
Fully Automated Closed-loop Insulin Delivery vs Standard Insulin Therapy
Dr C.K. Boughton evaluated the safety and efficacy of fully closed-loop insulin delivery compared with standard insulin therapy in adults with T2D. It was found that fully closed-loop insulin delivery reduced HbA1c and improved glucose control without increasing the risk of hypoglycaemia in adults with T2D. The treatment may represent a safe and effective method of achieving glycaemic target.
Cardio-renal-metabolic Interplay: Emerging Notions and Clinical Treatment Strategies
Dr Eberhard described the role of Cardio-Renal-Metabolic specialists in changing cardio–renal metabolic landscape which included assuring early diagnosis of DM, CKD and CVD (HF) by signs, symptoms and biomarkers (eGFR/albuminurea/Natriuretic peptides), assuring compliance with cardio-nephrologic therapy, addressing cardio-renal protection and tailoring personalized glucose lowering therapy.
Mechanistic Insights into the Effects of Empagliflozin in Patients With T2D and Heart Failure
The EFFORT trials, included 63 patients with T2D and HF, showed that the Empagliflozin significantly reduced the biomarker KIM-1 compared to placebo. It had a renal tubular protective effect in HF patients. It also contributed to the reduction of adverse cardiac remodelling. These CV benefits of empagliflozin can most likely not be explained by anti-inflammatory actions.
SGLT2i: Key Treatment Option Beyond T2D Regardless of Cardiac Ejection Fraction
HF Patients are likely to benefit from SGLT2i treatment, regardless of ejection fraction. And its benefits in diabetes prevention seems to be consistent with Dapagliflozin. Treating HF patients with prediabetes by a SGLT2i is an attractive opportunity. Its mechanism involves improvement of insulin sensitivity and secretion, reduction of glucose variability and depression of sympathetic activity.
FIGARO-DK- Finerenone Reduces Cardiovascular Mortality in Patients With T2D and CKD
FIGARO-DKD trial showed that finerenone has salutary effects on CV outcomes among patients with T2DM and CKD, who were on a background of maximal RAS blockade therapy, primarily due to a reduction in hospitalization for HF. There was also a reduction in ESKD. New-onset HF was reduced among patients without HF at baseline. There was a higher risk of hyperkalemia with finerenone.
REVIVED-BCIS2 Trial - Efficacy and Safety of Percutaneous Coronary Intervention to Improve Survival
Percutaneous coronary intervention does not improve event-free survival in patients with ischaemic left ventricular systolic dysfunction. 700 patients with LVEF ≤35% and coronary artery disease were randomly assigned to PCI plus optimal medical therapy or optimal medical therapy alone. PCI did not result in a lower incidence of death from any cause or hospitalisation for HF over 3.4 years.
ACT Inpatient Trial: Colchicine and Rivaroxaban Plus Aspirin in Patients Hospitalized With COVID-19
One out of every five patients in the ward with COVID-19 died in the ACT inpatient trial (high mortality rate). Colchicine did not give a mortality advantage in the ACT study, regardless of whether the patient is on MV or has previously been vaccinated, or if the patient has long or short duration of symptoms. A meta-analysis of anticoagulation in inpatients showed 40% decrease in VTE.
Implementing Best Practices Across The Spectrum of Heart Failure
To avoid morbidity, patients with HFpEF and HTN should be administered titrated drugs to achieve their BP targets. SGLT2i is an ideal cardio-renal-metabolic therapy for HF, as one pill/day improves survival, prevents hospitalization, and improves QoL and functional status. In a 55-year-old patient with HFrEF, comprehensive therapy (with ARNI+BB+MRA+SGLT2i) provided an overall 6.3 additional years.
SGLT2 Inhibitors in HFpEF - Light at The End of The Tunnel
SGLT2i was first intended to treat diabetes, but studies have shown that it is also useful in treatment of HF. In individuals with HFpEF or HFmrEF, dapagliflozin treatment decreases the risk of the primary composite outcome of CV death or worsening HF. EMPEROR-Preserved trial showed that empagliflozin improved HF outcomes in patients with symptomatic stable HFpEF on good baseline GDMT.
