Marit de Jong et al used UK biobank to study MI events in people with and without diabetes and study the differences by gender and A1c level. They saw that MI was more frequent in men both in diabetes and people without it, but that diabetes raised risk more in women. A1c was also clearly associated with MI, increasing 18% risk for every 1% A1c.
A review from Giulia Ferrannini about cardiovascular risk in diabetes. 4785 words just to smach our brains with 3 basic ideas : 1.- people with CV events frequently have hyperglycemia; 2.- those people usually have worse prognosis and many and undiagnosed or insufficiently treated; 3.- we've got newer (and expensive) drugs that have showed CV reduction in this population. In my opinion it's just part of the campaign advocating for cardiologist to detect and treat diabetes with SGLT2-i and GLP-RAs. The abuse of terms like "disglycemia" and "holistic" and the use of graphs like this:
Acarbose Cardiovascular evaluation (ACE) trial was conducted in China and included 6000 individuals with prediabetes (IGT) and CHD. Randomized to acarbose or placebo, the researchers saw that Acarbose reduced diabetes incidence, but just 18%. It also contributed to regression to normoglycemia, but just 16%. More important would have been to know if it lowered Cv events, but that's not mentioned.
Which GLP-1 RAs are better when associated to insulin, short-acting or long-acting? That's what Jessica Huthmacher and colleagues wanted to know. They meta-analyzed 14 RCT and found that long-acting (lira-, dula-, weekly exe-, semaglutide) drugs were better than short ones (lixi and exenatide twice daily) in terms of A1c, weight and hypoglycemia. By the way, severe hypo was similar in both groups.
In USA, people at risk for diabetes enrolled in CDC's Diabetes Prevention Recognition Program (diet and exercise basically). Cannon et al wanted to know factors associated to adherence to it and saw that, at week 17, older and white people (what they understand for white, i.e. not me for instance) dropped less than black, hispanics and youngs.
In "Perspectives of Care", Davidson advocates for not using metformin in prediabetes, because 2/3 will never develop diabetes, 1/3 spontaneously return to normal glycemia, and none of them have microvascular risk.
In commentaries, Marx from Germany comments on the implications of shifting every eligible patient with T2DM to newer drugs with CV benefits. Even if in the long run (assuming you believe results from trials will translate to clinical practice) it were cost-effective, initial costs woult be gigantic, difficult to assume for any health system. Discussion is served.
Ahead of print:
- Duration-8 randomly assigned dapaglyflozin, weeekly exenatide or both to T2DM patients on metformin with A1c >8%. It took 2 years and was completed only by 60%. Dual treatment reduced A1c in 1,7%, exenatide 1,29% and dapa 1,09%.
- Unsworth reported increased incidence of type 1 diabetes during covid pandemics, but only a minority had PCR or Ab evidence of SARS-COV-2 infection and absolute number was low, so it can be a random event.
- Real-time CGM underestimates hypoglycemia in hyperinsulinemic hypoglycemic clamp, compared to standard blood glucose meters.
There are many more articles that I've no space to comment but you will find all them by clicking here.
