Effect of dapagliflozin on blood and breath ketones during supervised insulin withdrawal in adults with type 1 diabetes: A randomized crossover trial

Diabetes Obesity and Metabolism, Journal Year: 2025, Volume and Issue: unknown

Published: March 13, 2025

Abstract Aims Sodium‐glucose cotransporter 2 (SGLT2) inhibitors increase ketoacidosis risk, limiting their use in type 1 diabetes. To better understand the pathophysiology of SGLT2 inhibitor‐mediated ketoacidosis, we measured blood glucose, capillary and plasma β‐hydroxybutyrate (BOHB) breath acetone (BrACE) during supervised insulin withdrawal adults with diabetes without dapagliflozin treatment. Materials Methods Twenty underwent twice a randomized crossover design: usual care after treatment (10 mg daily for weeks plus test day). After withdrawal, BOHB BrACE measurements were obtained at least hourly until stopping rules met (>8 h elapsed, symptoms ketosis, glucose >400 mg/dL, >4 mmol/L or participant request). Results The peak values achieved both greater than care. Throughout study, was associated significantly concentrations. proportions participants reaching >1.5 >2.5 arm. Blood reached lower Conclusions In undergoing compared to ketone concentrations absence significant hyperglycaemia.

Language: Английский

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Cardiovascular risk in newly diagnosed patients with type 2 diabetes mellitus: a nationwide, facility-based, cross-sectional study in Bangladesh

International Journal of Cardiology Cardiovascular Risk and Prevention, Journal Year: 2025, Volume and Issue: 25, P. 200399 - 200399

Published: April 6, 2025

Evidence on cardiovascular (CV) risk stratification in Bangladeshi patients with type 2 diabetes mellitus (T2DM) who are asymptomatic for disease (CVD) is limited. This study aimed to assess the 10-year CV newly diagnosed T2DM. In 2023, a cross-sectional was carried out at endocrinology clinics tertiary hospitals throughout Bangladesh, involving T2DM aged 25 84 had no prior history of CVD and were condition. assessed classified using QRISK3. 1617 (age 44.92 ± 11.84 years, male 49.5 %) analyzed. Their median QRISK3 score 11.0 %, 46.5 % low, 25.7 moderate, 27.8 high risk, respectively. The increased age both men women, consistently scoring higher than women every group. Among groups 25-39, 40-64, 65-84, percentages 3.3 34.0 94.5 relative (RR) 4.3. RR decreased sexes, lower across all groups. A sleep duration 6-9 h associated risk. Many have substantial can assist clinicians predicting choosing appropriate treatments prevent CVD.

Language: Английский

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Possibilities of Optimizing Drug Therapy for Myocardial Infarction: a Consensus on the Use of Type 2 Sodium-Glucose Co-Transporter Inhibitors. Conciliation Document of the Expert Group

Kardiologiia, Journal Year: 2025, Volume and Issue: 65(3), P. 35 - 47

Published: March 31, 2025

Ischemic heart disease, including previous myocardial infarction (MI), is one of the main causes for development and progression failure (HF). The presence HF before MI or in setting acute coronary catastrophe an extremely unfavorable prognostic factor leading to a multiple increase risk death rehospitalization due post-infarction period. In 2024, results two randomized clinical trials (RCTs) (DAPA-MI EMPACT-MI) were published, which assessed effect sodium-glucose co-transporter type 2 inhibitors (SGLT2i) on outcomes patients with MI. both studies, predetermined primary composite endpoint was not achieved. At same time, it shown that SGLT2i significantly reduced hospitalization (empagliflozin) contributed improvement metabolic (dapagliflozin). Also, safety early initiation period demonstrated. Based available observational working group has substantiated need implementing these RCT into practice proposed algorithm administering SGLT2 Thus, compelling anamnestic criteria diagnosis previously diagnosed diabetes mellitus, and/or chronic kidney HF, continuation timely during index recommended improve cardiovascular renal outcomes. RCTs taking account individual factors discharge may be considered order reduce HF.

Language: Английский

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6. CARDIO-RENAL PROTECTION IN TYPE 2 DIABETES

Diabetes Research and Clinical Practice, Journal Year: 2025, Volume and Issue: unknown, P. 112150 - 112150

Published: April 1, 2025

Language: Английский

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Use of NT‐proBNP for the screening, diagnosis and risk‐stratification of left ventricular dysfunction

Diabetes Obesity and Metabolism, Journal Year: 2025, Volume and Issue: unknown

Published: April 9, 2025

Abstract Heart failure (HF) is a major health problem, and preventing the onset of heart could have large cost implications for healthcare systems globally. Screening its precursor, left ventricular dysfunction, allow patients to receive therapies shown reduce risk incident failure, such as ACE inhibitors beta blockers. Using echocardiography screen costly. Natriuretic peptides be used populations asymptomatic function. However, natriuretic peptide levels vary by age, sex presence comorbidities atrial fibrillation kidney disease. one threshold value in population may impair sensitivity specificity an approach, but prior studies community‐based adults suggest that this feasible strategy. A higher yield strategy would high‐risk patients, those with diabetes mellitus, current guidelines management using unrecognised failure. can also help ascertain future cardiovascular events deaths diabetes. established themselves central part definition more work needs done determine optimal body weight‐based thresholds, well thresholds like chronic These are needed optimise diagnosis Clinicians should use guideline‐recommended diagnose HF consider factors influence levels, function, etc. It yet unclear if guide

Language: Английский

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Clinical Practice Guideline for detection and management of diabetic kidney disease: A consensus report by the Spanish Society of Nephrology

Nefrología (English Edition), Journal Year: 2025, Volume and Issue: 45, P. 1 - 26

Published: April 1, 2025

To address all the changes in management of people with diabetes (DM) and chronic kidney disease (CKD), under auspices Spanish Society Nephrology (SEN), Diabetic Nephropathy Study Group (GEENDIAB) decided to publish an updated Clinical Practice Guideline for detection diabetic (DKD). It is aimed at a wide audience clinicians treating CKD. The terminology patients has evolved toward more inclusive nomenclature that avoids underdiagnosis this entity. Thus, terms "diabetes disease" "diabetic are those proposed latest KDIGO 2022 guidelines designate whole spectrum who can benefit from comprehensive therapeutic approach only differentiated according eGFR range albuminuria. Recommendations have been divided into five main areas interest: Chapter 1: Screening diagnosis disease, 2: Metabolic control CKD, 3: Blood pressure 4: Treatment targeting progression CKD 5: Antiplatelet or anticoagulant therapy World Health Organization (WHO) recommendations guideline development were followed report guideline. Systematic reviews carried out, outcome ratings summaries findings, we reported strength following "Grading Assessment, Development Evaluation" GRADE evidence profiles.

Language: Английский

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The Use of an Artificial Intelligence Platform OpenEvidence to Augment Clinical Decision-Making for Primary Care Physicians

Journal of Primary Care & Community Health, Journal Year: 2025, Volume and Issue: 16

Published: April 1, 2025

Background: Artificial intelligence (AI) platforms can potentially enhance clinical decision-making (CDM) in primary care settings. OpenEvidence (OE), an AI tool, draws from trusted sources to generate evidence-based medicine (EBM) recommendations address questions. However, its effectiveness real-world cases remains unknown. Objective: To evaluate the performance of OE providing EBM for five common chronic conditions care: hypertension, hyperlipidemia, diabetes mellitus type 2, depression, and obesity. Methods: Five patient were retrospectively analyzed. Physicians posed specific questions, responses evaluated on clarity, relevance, evidence support, impact CDM, overall satisfaction. Four independent physicians provided ratings using a 0 4 scale. Results: accurate, all cases, aligning with physician plans. was scored scale zero four, where very unclear, four clear. Mean scores across clarity (3.55 ± 0.60), relevance (3.75 0.44), support (3.35 0.49), satisfaction (3.60 0.60). CDM limited (1.95 1.05), as primarily reinforced rather than modified Conclusion: rated high reinforcing decisions conditions. While minimal due study’s retrospective nature, shows promise augmenting physician. Prospective trials are needed utility complex multidisciplinary

Language: Английский

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Liraglutide improves peripheral perfusion and markers of angiogenesis and inflammation in people with type 2 diabetes and peripheral artery disease: An 18‐month follow‐up of a randomized clinical trial

Diabetes Obesity and Metabolism, Journal Year: 2025, Volume and Issue: unknown

Published: April 25, 2025

Abstract Aims In a six‐month randomized clinical trial, improved peripheral perfusion has been shown with liraglutide, associated favourable vascular effects in people type 2 diabetes and artery disease (PAD). We aimed to evaluate the durability of these benefits elucidate some mechanisms underlying liraglutide's effect over an 18‐month follow‐up. Methods STARDUST was trial which compared liraglutide up 1.8 mg/day tailored therapeutic prescriptions manage cardiovascular risk factors 55 participants PAD. report data who have reached follow‐up for primary outcome (transcutaneous oxygen pressure, TcPO ) also additional secondary outcomes (markers inflammation, angiogenesis kidney function), as well glycemic metabolic parameters. assessed transcutaneous oximetry. Circulating levels angiogenic progenitor cells serum inflammation markers were evaluated by flow cytometry enzyme‐linked immunosorbent assay, respectively. Results Compared control group, significant differences favouring group observed at 18 months [estimated treated difference (95% CI), 10.9 mmHg (7.6 14.1 mmHg), p < 0.001]. At follow‐up, those had reduction urine albumin creatinine ratio (estimated difference, −103.9 mg/g Cr, 95%CI, −170.8 −37.1, = 0.003), C‐reactive protein (−0.5 mg/dL, −0.8 −0.2, 0.002), interleukin‐6 (−32.6 pg/mL, −54.6 −10.5, 0.004). showed significantly higher concentrations circulating endothelial both 6 months, CD34 + , CD133 KDR /KDR /CD133 . Liraglutide increase growth factor A (70.1 44.7 95.4, 0.001). Conclusions PAD, increased perfusion, amelioration

Language: Английский

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Feasibility and Efficacy of a Plant-Based Nutrition Intervention for Type 2 Diabetes in a Primary Care Setting

American Journal of Lifestyle Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: May 1, 2025

Objective: To determine the feasibility and efficacy of a plant-based nutrition intervention for type 2 diabetes in primary care setting. Methods: Adults (n = 76) with were enrolled self-paid, online program between August 2023 September 2024. All participants advised to attend weekly group classes follow diet 12 weeks. Body weight, medication usage, HbA 1c, cholesterol levels assessed at baseline Results: Among 58 who completed (mean age 63.4 years; 69% female), mean body weight (−3.7 kg; 95% CI, −4.4 −2.9; P < .0001) 1c (−0.6%; −0.8 −0.3; decreased Participants not following experienced greater reductions . Total low-density lipoprotein amongst taking lipid-lowering medications, 22% reduced dosages medications. Conclusion: In setting, novel 12-week was accessible, economically viable, led , total LDL levels.

Language: Английский

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Incretin hormone agonists: Current and emerging pharmacotherapy for obesity management

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy, Journal Year: 2024, Volume and Issue: 44(9), P. 738 - 752

Published: Sept. 1, 2024

Abstract Obesity continues to be a significant global health challenge, affecting over 800 million individuals worldwide. Traditional management strategies, including dietary, exercise, and behavioral interventions, often result in insufficient unsustainable weight loss. Lifestyle modification remains the cornerstone of obesity management, providing foundation for other strategies. While options such as bariatric surgery remain an effective intervention severe obesity, it is associated with its own set risks typically reserved patients who have not achieved desired results pharmacotherapy lifestyle interventions. Incretin hormone agonists represent advancement offering substantial reduction cardiometabolic benefits. Agents like liraglutide, semaglutide, tirzepatide supported by key clinical trials Satiety Clinical Adipose Liraglutide Evidence (SCALE), Semaglutide Treatment Effect People (STEP) program trials, Tirzepatide Once Weekly (SURMOUNT‐1) demonstrated remarkable efficacy promoting loss improving metabolic outcomes. Additionally, novel therapies, dual triple incretin agonists, are under investigation hold potential further advancements treatment. These therapies can categorized their mechanisms action route administration into oral glucagon‐like peptide‐1 (GLP‐1) receptor (targeting GLP‐1, glucose‐dependent insulinotropic polypeptide [GIP], glucagon receptors), receptor‐GLP‐1 co‐agonists. Other innovative approaches include GIP‐GLP‐1 co‐agonists, combination long‐acting amylin GLP‐1 agonists. The ongoing development incretin‐based expanding availability currently available agents expected enhance outcomes reduce burden obesity‐related complications. This review aims discuss current emerging management.

Language: Английский

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