JAMA,
Journal Year:
2023,
Volume and Issue:
329(15), P. 1261 - 1261
Published: March 6, 2023
Importance
Evidence-based
therapies
to
reduce
atherosclerotic
cardiovascular
disease
risk
in
adults
with
type
2
diabetes
are
underused
clinical
practice.
Objective
To
assess
the
effect
of
a
coordinated,
multifaceted
intervention
assessment,
education,
and
feedback
vs
usual
care
on
proportion
prescribed
all
3
groups
recommended,
evidence-based
(high-intensity
statins,
angiotensin-converting
enzyme
inhibitors
[ACEIs]
or
angiotensin
receptor
blockers
[ARBs],
sodium-glucose
cotransporter
[SGLT2]
and/or
glucagon-like
peptide
1
agonists
[GLP-1RAs]).
Design,
Setting,
Participants
Cluster
randomized
trial
43
US
cardiology
clinics
recruiting
participants
from
July
2019
through
May
2022
follow-up
December
2022.
The
were
not
already
taking
therapies.
Interventions
Assessing
local
barriers,
developing
pathways,
coordinating
care,
educating
clinicians,
reporting
data
back
clinics,
providing
tools
for
(n
=
459)
per
practice
guidelines
590).
Main
Outcomes
Measures
primary
outcome
was
recommended
at
6
12
months
after
enrollment.
secondary
outcomes
included
changes
factors
composite
all-cause
death
hospitalization
myocardial
infarction,
stroke,
decompensated
heart
failure,
urgent
revascularization
(the
powered
show
these
differences).
Results
Of
1049
enrolled
(459
20
590
23
clinics),
median
age
70
years
there
338
women
(32.2%),
173
Black
(16.5%),
90
Hispanic
(8.6%).
At
last
visit
(12
97.3%
participants),
those
group
more
likely
be
(173/457
[37.9%])
(85/588
[14.5%]),
which
is
difference
23.4%
(adjusted
odds
ratio
[OR],
4.38
[95%
CI,
2.49
7.71];
P
<
.001)
each
(change
baseline
high-intensity
statins
66.5%
70.7%
58.2%
56.8%
[adjusted
OR,
1.73;
95%
1.06-2.83];
ACEIs
ARBs:
75.1%
81.4%
69.6%
68.4%
1.82;
1.14-2.91];
SGLT2
GLP-1RAs:
12.3%
60.4%
14.5%
35.5%
3.11;
2.08-4.64]).
associated
factors.
occurred
457
(5%)
40
588
(6.8%)
hazard
ratio,
0.79
0.46
1.33]).
Conclusions
Relevance
A
increased
prescription
disease.
Trial
Registration
ClinicalTrials.gov
Identifier:
NCT03936660
Diabetes/Metabolism Research and Reviews,
Journal Year:
2023,
Volume and Issue:
40(3)
Published: Sept. 19, 2023
Diabetes
related
foot
complications
have
become
a
major
cause
of
morbidity
and
are
implicated
in
most
minor
amputations
globally.
Approximately
50%
people
with
diabetes
ulcer
peripheral
artery
disease
(PAD)
the
presence
PAD
significantly
increases
risk
adverse
limb
cardiovascular
events.
The
International
Working
Group
on
Diabetic
Foot
(IWGDF)
has
published
evidence
based
guidelines
management
prevention
since
1999.
This
guideline
is
an
update
2019
IWGDF
diagnosis,
prognosis
mellitus
ulcer.
For
this
IWGDF,
European
Society
for
Vascular
Surgery
decided
to
collaborate
develop
consistent
suite
recommendations
relevant
clinicians
all
countries.
three
new
systematic
reviews.
Using
Grading
Recommendations,
Assessment,
Development,
Evaluation
framework
clinically
questions
were
formulated,
literature
was
systematically
reviewed.
After
assessing
certainty
evidence,
formulated
which
weighed
against
balance
benefits
harms,
patient
values,
feasibility,
acceptability,
equity,
resources
required,
when
available,
costs.
Through
process
five
developed
diagnosing
person
diabetes,
without
or
gangrene.
Five
relating
estimating
likelihood
healing
amputation
outcomes
Fifteen
treatment
encompassing
prioritisation
revascularisation,
choice
procedure
post-surgical
care.
In
addition,
Writing
Committee
highlighted
key
research
where
current
lacking.
believes
that
following
these
will
help
healthcare
professionals
provide
better
care
reduce
burden
complications.
Diabetes Care,
Journal Year:
2024,
Volume and Issue:
47(4), P. 531 - 543
Published: Feb. 27, 2024
In
high-income
countries,
rates
of
atherosclerotic
complications
in
type
2
diabetes
have
declined
markedly
over
time
due
to
better
management
traditional
risk
factors
including
lipids,
blood
pressure,
and
glycemia
levels.
Population-wide
reductions
smoking
also
helped
lower
so
reduce
premature
mortality
diabetes.
However,
as
excess
adiposity
is
a
stronger
driver
for
heart
failure
(HF),
obesity
levels
remained
largely
unchanged,
HF
risks
not
much
may
even
be
rising
the
increasing
number
people
developing
at
younger
ages.
Excess
weight
an
underrecognized
factor
chronic
kidney
disease
(CKD).
Based
on
evidence
from
range
sources,
we
explain
how
must
influencing
most
well
before
develops,
particularly
younger-onset
diabetes,
which
linked
greater
adiposity.
We
review
potential
mechanisms
linking
CKD
speculate
some
responsible
pathways-e.g.,
hemodynamic,
cellular
overnutrition,
inflammatory-could
favorably
influenced
by
intentional
loss
(via
lifestyle
or
drugs).
On
basis
available
evidence,
suggest
that
cardiorenal
outcome
benefits
seen
with
sodium-glucose
cotransporter
inhibitors
partially
derive
their
interference
these
same
pathways.
note
many
other
common
(e.g.,
hepatic,
joint
disease,
perhaps
mental
health)
are
variably
adiposity,
aggregated
exposure
has
now
increased
All
such
observations
need
tackle
earlier
AJP Heart and Circulatory Physiology,
Journal Year:
2024,
Volume and Issue:
326(5), P. H1159 - H1176
Published: March 1, 2024
Atherosclerotic
cardiovascular
disease
is
a
chronic
condition
that
often
copresents
with
type
2
diabetes
and
obesity.
Glucagon-like
peptide-1
receptor
agonists
(GLP-1RAs)
are
incretin
mimetics
endorsed
by
major
professional
societies
for
improving
glycemic
status
reducing
atherosclerotic
risk
in
people
living
diabetes.
Although
the
cardioprotective
efficacy
of
GLP-1RAs
their
relationship
traditional
factors
well
established,
there
paucity
publications
have
summarized
potentially
direct
mechanisms
through
which
mitigate
atherosclerosis.
This
review
aims
to
narrow
this
gap
providing
comprehensive
in-depth
mechanistic
insight
into
antiatherosclerotic
properties
demonstrated
across
large
outcome
trials.
Herein,
we
describe
landmark
trials
triggered
widespread
excitement
around
as
modern
class
agents,
followed
summary
origins
action.
The
effects
at
each
pathophysiological
milestone
atherosclerosis,
observed
clinical
trials,
animal
models,
cell
culture
studies,
described
detail.
Specifically,
provides
recent
preclinical
evidence
suggest
preserve
vessel
health
part
preventing
endothelial
dysfunction,
achieved
primarily
promotion
angiogenesis
inhibition
oxidative
stress.
These
protective
addition
broad
range
processes
target
downstream
include
systemic
inflammation,
monocyte
recruitment,
proinflammatory
macrophage
foam
formation,
vascular
smooth
muscle
proliferation,
plaque
development.
Diabetes & Metabolism,
Journal Year:
2023,
Volume and Issue:
50(1), P. 101506 - 101506
Published: Dec. 21, 2023
With
the
rising
tide
of
fatty
liver
disease
related
to
metabolic
dysfunction
worldwide,
association
this
common
with
chronic
kidney
(CKD)
has
become
increasingly
evident.
In
2020,
more
inclusive
term
dysfunction-associated
(MAFLD)
was
proposed
replace
old
nonalcoholic
(NAFLD).
2023,
a
modified
Delphi
process
led
by
three
large
pan-national
associations.
There
consensus
change
nomenclature
and
definition
include
presence
at
least
one
five
cardiometabolic
risk
factors
as
diagnostic
criteria.
The
name
chosen
NAFLD
steatotic
(MASLD).
from
MAFLD
then
MASLD
resulted
in
reappraisal
epidemiological
trends
associations
developing
CKD.
observed
between
MAFLD/MASLD
CKD
our
understanding
that
can
be
an
epiphenomenon
linked
underlying
support
notion
individuals
are
substantially
higher
incident
than
those
without
MASLD.
This
narrative
review
provides
overview
literature
on
(a)
evolution
criteria
for
diagnosing
highly
prevalent
disease,
(b)
evidence
linking
CKD,
(c)
mechanisms
which
(and
strongly
MASLD)
may
increase
(d)
potential
drug
treatments
benefit
both
Journal of Clinical Hypertension,
Journal Year:
2023,
Volume and Issue:
25(9), P. 801 - 807
Published: Aug. 7, 2023
Hypertension
is
the
leading
cause
of
death
worldwide,
affecting
1.4
billion
people.
Treatment
options
include
widely
used
calcium
channel
blockers,
among
which
amlodipine,
a
dihydropyridine,
has
unique
characteristics
that
distinguish
it
from
other
drugs
within
this
class.
This
review
aims
to
provide
an
updated
overview
evidence
supporting
use
amlodipine
over
past
30
years
and
highlights
its
cardiovascular
benefits
in
current
hypertension
management.
Amlodipine
low
renal
clearance
(7
mL/min/mg)
long
half-life
(35-50
h)
duration
action,
allows
sustain
anti-hypertensive
effect
for
more
than
24
h
following
single
dose.
Additionally,
blood
pressure
(BP)
control
maintained
even
when
dose
been
missed,
providing
continuous
protection
case
incidental
noncompliance.
It
proven
reduce
BP
variability
successfully
lower
BP.
also
controls
patients
with
systolic/diastolic
130/80
mm
Hg
or
higher,
diabetes,
chronic
kidney
disease
without
worsening
glycemic
function.
wise
choice
older
adults
due
ability
protect
against
stroke
myocardial
infarction.
Side
effects
edema,
palpitations,
dizziness,
flushing,
are
common
higher
10
mg.
cost
effective
predicted
be
saving
compared
usual
care.
Obesity Pillars,
Journal Year:
2023,
Volume and Issue:
5, P. 100056 - 100056
Published: Jan. 28, 2023
This
Obesity
Medicine
Association
(OMA)
Clinical
Practice
Statement
(CPS)
is
intended
to
provide
clinicians
an
overview
of
type
2
diabetes
mellitus
(T2DM),
obesity-related
cardiometabolic
risk
factor.
Annals of Medicine,
Journal Year:
2023,
Volume and Issue:
55(1), P. 502 - 513
Published: Jan. 31, 2023
Persons
with
diabetes
and
chronic
kidney
disease
(CKD)
have
a
high
residual
risk
of
developing
cardiovascular
(CV)
complications
despite
treatment
renin-angiotensin
system
blockers
sodium-glucose
cotransporter
type
2
inhibitors.
Overactivation
mineralocorticoid
receptors
plays
key
role
in
the
progression
renal
CV
disease,
mainly
by
promoting
inflammation
fibrosis.
Finerenone
is
nonsteroidal
selective
antagonist.
Recent
clinical
trials,
such
as
FIDELIO-DKD
FIGARO-DKD
combined
analysis
FIDELITY
demonstrated
that
finerenone
decreases
albuminuria,
CKD
progression,
subjects
(T2D)
CKD.
As
result,
should
thus
be
considered
part
holistic
approach
to
persons
T2D
In
this
narrative
review,
impact
on
analyzed
from
practical
point
view.Key
messages:Despite
inhibition
2,
remain
risk.Overactivation
fibrosis
not
targeted
traditional
treatments.Finerenone
antagonist
only
but
also
