SGLT-2 Inhibitors and GLP-1 RA Are Associated With Lower Mortality
A study analyzed individuals with T2D, aged 40-69 years, and the diagnosed with MI between 2016 and 2020. 26.8% patients was prescribed an SGLT-2i, 9.4% a GLP-1 RA and 13.6% drugs from both these classes. While 50.3% neither received an SGLT-2i nor a GLP1-RA. It was found that prescription of an SGLT-2 inhibitor or a GLP1-RA was associated with lower five-year mortality.
Effect of Empagliflozin on Left Ventricular Contractility and Peak Oxygen Uptake
EMPA-HEART trial revealed that empagliflozin has neutral impact on both LV-GLS and exercise tolerance in subjects with T2D and normal left ventricular function. Nonetheless, in patients with subclinical systolic dysfunction (baseline LV-GLS
Prognostic Value of Diabetes Microvascular Complication for 21-years All-cause Mortality
A study showed that chronic microvascular complications increased the 21-year all-cause mortality risk in patients with diabetes, regardless of age, sex, BMI, glycaemic control, diabetes type, and duration.The presence of 2 or 3 concomitant microvascular complications (DKD, DR, and cardiac autonomic neuropathy) increased the adjusted risk for all-cause mortality by 203% and 692% respectively.
Exercise Time Affect Multi-tissue Metabolome and Skeletal Muscle Proteome Profiles
Metabolic effects of exercise depends on the time of day it is performed. A study found that morning and afternoon HIT increased plasma diacylglycerols, skeletal muscle acyl-carnitines, subcutaneous adipose tissue sphingomyelins, and lysophospholipids in men with T2D. However, afternoon HIT increased skeletal muscle lipids and mitochondrial content to a greater degree than morning training.
Pharmacotherapy for the Treatment of Type 2 Diabetes and CKD
In people with CKD, SGLT2i and GLP-1 RA reduce MACE risk independent of eGFR. SGLT2i also reduce the risks of HF and kidney outcomes. In people with CKD, eGFR ≥20 ml/min per 21.73m and UACR >3.0 mg/mmol, an SGLT2i with proven benefit should be initiated to reduce MACE and HF and improve kidney outcomes. If such treatment is not tolerated, GLP-1 RA with proven CV benefit could be considered.
Improve Glycemic Management in People With Type 2 Diabates
To improve glycaemic management focus should be on behavioural approaches, medications, and metabolic surgery. Weight reduction has been seen as a strategy to improve HbA1c. However, it was recently suggested that weight loss of 5–15% should be a primary target of management for many people with T2D. It also reduces risk for cardiometabolic disease and improve quality of life.
Paradigm Shift in Clinical Practice, eGFR and/or Albuminuria as Indicator for DKD
A study identified a robust kidney risk inflammatory signature (KRIS), consisting of 17 proteins enriched in tumor necrosis factor-receptor superfamily members, that was associated with a 10-year risk of end-stage renal disease in both Type I and type II diabetes. These proteins point to new tests to identify subjects at high risk, as well as biomarkers to measure responses to treatment of DKD.
Heart failure With Preserved Ejection Fraction in Type 2 Diabetes
T2DM increases risk of HF, especially HFpEF. In HFpEF only SGLT2/1 - inhibitors are effective. In patients with diabetes and recent worsening heart failure, sotagliflozin therapy, initiated before or shortly after discharge resulted in a significantly lower total number of deaths from cardiovascular causes and hospitalizations and urgent visits for heart failure than placebo.
COMPASS 31 Questionnaire Can Predict Cardiovascular Autonomic Neuropathy
The use of Composite Autonomic Symptom Score 31 (COMPASS 31) and a clinic-based CAN Risk Score improves their diagnostic performance for cardiovascular autonomic neuropathy (CAN) in both type 1 and type 2 diabetes. They can allow a stepwise screening strategy for CAN, by suggesting CAN absence with combined normality, and increasing the odds of CAN with combined abnormality.
DELIVER in Perspective: SGLT2 Inhibition in the Treatment of HF
Dapagliflozin improved symptoms in HF patients compared to placebo, with a mean change of 2.4 (1.5, 3.4 ), p < 0.001. SGLT2i is the first foundational therapy in all HF as it showed decreased CV death events and hospitalizations for HF, also improved symptoms, physical limitations, and quality of life (QoL) with a favorable safety profile across a range of EF, age, glycaemia, kidney function.
Higher Level of Glycaemia is Associated With Corneal Neurodegeneration
Maastricht study assessed the association of glucose metabolism status and glycemia with corneal nerve fiber measures. It was found that a more adverse glucose metabolism status and higher levels of glycemia are linearly and independently associated with corneal neurodegeneration. Glycemia-associated corneal neurodegeneration is a continuous process that already starts before the onset of T2D.
Cardiovascular and Metabolic Morbidity in Women With Previous Gestational Diabetes
A study investigated the incidence of cardiovascular and metabolic morbidity (CVMM) in women with previous GDM. It was found that GDM was associated with increased risk of CVMM, major CVD hypertension, dyslipidemia, and venous thrombosis. Insulin treatment during pregnancy and development of manifest diabetes exacerbated risk. The risk was exacerbated by proxies of β-cell impairment.
Risk of Diabetes After Hysterectomy: E3N cohort study
81144 women who were free of diabetes were followed-up for 16.4 years. A total of 4367 women developed T2D during the follow-up. Women with a history of hysterectomy had an increased risk of incident diabetes.The association was not altered after adjustment for reproductive factors or hormonal treatments. Diet and physical activity did not modify the association with incident diabetes.
Dapagliflozin or Dulaglutide Improves Cardiovascular Function in Patients With T2D
A study found that 4 month treatment with Dulaglutide or Dapagliflozin improves arterial stiffness and cardiac performance, but only Dulaglutide improves endothelial glycocalyx in patients with T2DM and ischemic stroke. Patients treated with Dapagliflozin had greater reduction of pulse wave velocity (PWV) and central SBP than patients who took insulin or Dulaglutide.
What Can We Still Do for Prevention of Diabetic Retinopathy?
Diabetic Retinopathy can be prevented by maintaining a tight control of hyperglycemia, hypertension and lipid levels. Statins reduce microaneurisms and decrease vision loss. Fenofibrate plus Simvastatin prevents the progression of DR. Fish consumption, mediterranean diet, olive oil, Vitamins D, A, B1 and C reduces risk of developing DR. Reduced exposure to sunlight can prevent DR.
16-week Diet Intervention on Hepatic Fat Content in People With Type 2 Diabetes
A study evaluated whether an energy-reduced diet, with/without concomitant exercise training in people with T2D will reduce liver fat in a dose-dependent manner. It was found that a 16-week intervention with a 25% caloric deficit is able to reduce liver fat in people with T2D. There is an additional reduction in liver fat when a high volume of exercise training is added to the diet intervention.
One Night of Prolonged Fasting Improves Nocturnal Substrate Oxidation
A randomized trial included 11 participants with NAFL and 10 control participants who did either an overnight 9.5-hrs of fasting (short period) or 16-hrs of fasting (extended). Hepatic glycogen levels were not affected by extending overnight fasting time in the NAFL or control group. Extending fasting time led to a lower nocturnal carbohydrate oxidation and higher fat oxidation in both groups.
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.
