Quite a lot of stuff in this journal. First of all, three very interesting reviews whose reading could take up all the day if you want:
Diabetes care features in the elderly. Sinclair discussed the special characteristics of diabetes in patients >65, in particular in frail and older individuals: polypharmacy, risks of hypoglycemia, severity of adverse effects, reduced renal / hepatic metabolism, lower importance of long-term effects, as well as difficulties to enroll frail elderly patients in clinical trials. He comments on IMPERIUM trial, carried out in this population and its special features.
Heart failure in type 2 diabetes. Type 2 diabetes affects about 25% of cases of heart failure (HF), with a poorer prognosis ( 1 year mortality 31% vs 23%). BNP and pro-BNP are prognistic biomarkers.
The author goes over available drugs: ACE-i, ARBs, beta-blockers, digoxin, mineralocorticoid receptor antagonists, isosorbide+hydralazine, ivabradine, sacubitril/valsartan. Their effects on glycemic control are reviewed. Diabetic therapies are commented, focusing on those with negative effect on HF (TZD) and also extensively on iSGLT2 drugs, with several trials showing positive effect. There is a final review of iSGLT2 and sacubitril/valsartan.
Oral semaglutide: comments on PIONEER trials. Addition of SNAC (sodium N hydroxibenzoil amino caprylate) makes it possible for semaglutide to absorbe in stomach, provided no food in 30 minutes is eaten. Thus it is became the first orally available GLP-1. Daily doses of 3, 7 and 14 mg were inicially tested. 14 mg dose was equally effective in A1c reductions as 1,8 mg SC liraglutide, and superior to 25 mg of empaglyflozin, 100 mg of sitagliptin. As far as weight, 14 mg-dose was similar to empaglyflozin and better than liraglutide. Any dose was better than sitagliptin. With respect to safety, it was similar to placebo in MACE and superior in CV and global mortality (HR 0,49 and 0,51). Adverse effects were similar or higher than placebo, mostly mild and transient, nausea being the most common. Malignancies were few in number. Retinopathy was not evaluated because maculopaty and severe retinopathy were exclusion criteria for the trials.
In original articles section, a lot of interesting papers, for example: restricting calories but not proteins improves metabolic control preserving non-fat mass, CSII + CGM superior to MDI + SMBG in type 1 diabetes, combined incretin analogs improve NAFLD in mice, inhaled corticoids moderately increase type 2 diabetes risk in COPD, or metaanalysis of trials in metabolic surgery in type 2 diabetes, concluding there is not enought evidence to change current recommendations of BMI >35.
