1,721,023 research outputs found
SMART diabetes: the way to go (Safe and Multifactorial Approach to reduce the Risk for Therapy in diabetes)
No full textPrevalence of type 2 diabetes is increasing worldwide. and management of diabetes is becoming increasingly complex because of the complexity of pathophysiology and the wide therapeutic options. The management of this complexity is difficult because of the different cardiometabolic features of patients. Thus, personalized approaches have been claimed by the most important international societies. Safety, Multifactorial-Approach and reduction of Risk are the three ingredients to get the best Therapy for Diabetes, abbreviated in SMART, as every physician involved in the management of type 2 diabetes should be
Bone Microarchitecture in Type 1 Diabetes: It Is Complicated
No full textPatients with type 1 diabetes (T1DM) experience a disproportionate number of fractures for their bone mineral density (BMD). Differences in bone microarchitecture from those without the disease are thought to be responsible. However, the literature is inconclusive. New studies of the microarchitecture using three-dimensional imaging have the advantage of providing in vivo estimates of "bone quality," rather than examining areal BMD alone. There are drawbacks in that most studies have been done on those with less than a 30-year duration of T1DM, and the techniques used to measure vary as do the sites assessed. In addition to the rise in these imaging techniques, very recent literature presents evidence of an intimate relationship between skeletal health and vascular complications in T1DM. The following review provides an overview of the available studies of the bone microarchitecture in T1DM with a discussion of the burgeoning field of complications and skeletal health
Buccal spray insulin (Oralgen) for type 2 diabetes: what evidence?
No full textINTRODUCTION:
The achievement of a good glycemic control and, in particular, the management of postprandial hyperglycemia represent the most significant treatment target for the management of diabetes. Multiple daily insulin injections are often still required to gain the treatment goals. Since the noncompliance with injected insulin therapy causes a slowdown in the process of glycemic compensation, novel non-injectable insulin formulations have been developed. Oral spray insulin (Oralgen) is a tasteless liquid formulation that provides insulin absorption via buccal mucosa.
AREAS COVERED:
To elucidate the current status of Oralgen in type 2 diabetes patients, studies of pharmacodynamic and pharmacokinetic and clinical trials are reviewed.
EXPERT OPINION:
The 'psychological insulin resistance,' represented by the reluctance of both patients and health-care professionals to initiate insulin therapy, could be won by alternative routes of insulin administration, improving patients' compliance. In particular, Oralgen seems to be suitable to manage the postprandial hyperglycemia without hypoglycemic risk, although no comparative studies with rapid-acting insulin analogs and no randomized controlled trials in large cohort subjects with type 2 diabetes are available to dat
Why only macro and not micro in type 2 diabetes? Time to change the goals of clinical trials in diabetes
No full textType 2 diabetes is a devastating disease causing several end-organ damages throughout the
body. Vascular complications are the major disease burden responsible for the increased
morbidity and mortality of diabetes. Therefore, the primary goal of diabetes treatment should
be to safely prevent, delay, or slow down the progression of complications.
While pharmaceutical companies race for commercializing new hypoglycaemic drugs, there are
only few and sparse data showing that using one drug instead of the other one effectively
impact vascular complications. At the end, several drugs for type 2 diabetes therapy are
available but whether these drugs really match the primary goal of treatment, especially in
primary prevention, is uncertain. That is despite the results of cardiovascular outcome trials
published since 2013. In terms of macrovascular complications, only about 35% of the
currently commercialized drugs approved for diabetes treatment have cardiovascular data
from ad hoc randomized controlled trials and most of these trials were not powered to
explore cardiovascular efficacy, but only safety.
2 What about the remaining 65%? In terms of
evidence-based medicine, we are prescribing the majority of anti-diabetes drugs (and
spending money) just to lower HbA1c, with a possible indirect effect on complications which
has not really been proven beneficial. When we move to microvascular complications, the
situation is even worse. Our knowledge about the impact of diabetes prescriptions on
microvasculature is stuck at the evidences from trials evaluating intensive glycaemic control.
All we have is information from subgroup or post-hoc analysis from some (even not all)
cardiovascular outcome trials. In the best cases, microvascular outcomes, especially renal
outcomes, have been considered as pre-specified secondary outcomes of the trials.
We have no data from large randomized controlled trials specifically designed to show whether
we may avoid blindness or neuropathy by using a specific anti-diabetes drug.
In 2008 the Food and Drug Administration (FDA) issued a “Guidance for industry” calling
for long-term safety trials evaluating cardiovascular risk of new antidiabetic therapies
Why China guidelines for type 2 diabetes represent an opportunity for treating this disease
No full textMore than one quarter of people affected by type 2 diabetes worldwide live in China, where an alarming increase in diabetes incidence is taking place. However, most of the evidence about diabetes management derives from studies conducted on non-Asian people, raising concerns about their validity in other ethnic groups, including the Chinese. The guidelines proposed by the Chinese Diabetes Society suggest tools for medical doctors in China and worldwide to appropriately face diabetes in Chinese people, whose number in non-Chinese countries is continuously increasing. However, additional efforts are still needed to achieve an evidence-based tailored therapy for type 2 diabetes in Chinese people. Copyright © 2016 John Wiley & Sons, Ltd
Cardiovascular effects of SGLT-2 inhibitors: what we have learned from cardiovascular outcome trials and what we still need to understand
No full textThe recent results of the DECLARE-TIMI 58 trial forces a profound reflection about the cardiovascular protection conferred by SGLT-2 inhibitors. DECLARE-TIMI 58, the largest cardiovascular outcome trial in diabetes, failed to show a significant reduction in the risk of major adverse cardiovascular events (MACEs) conferred by dapagliflozin compared with placebo. However, a lower rate of hospitalization for heart failure was reported. Whilst the lack of benefits on MACE may seem in contrast with the results of previous SGLT-2 inhibitors cardiovascular outcome trials, DECLARE clearly delineates the real cardiovascular effects of SGLT-2 inhibitors, which mainly tackle heart failure. Differences in study design and population enrolled are crucial to correctly value each molecule and to translate results of clinical trials in daily clinical practise
The complex combination of COVID-19 and diabetes: pleiotropic changes in glucose metabolism
Full text linkPURPOSE: Angiotensin converting enzyme 2 (ACE2) is the door for SARS-CoV-2, expressed in critical metabolic tissues. So, it is rational that the new virus causes pleiotropic alterations in glucose metabolism, resulting in the complication of pre-existing diabetes's pathophysiology or creating new disease mechanisms. However, it seems that less attention has been paid to this issue. This review aimed to highlight the importance of long-term consequences and pleiotropic alterations in glucose metabolism following COVID-19 and emphasize the need for basic and clinical research in metabolism and endocrinology.RESULTS: SARS-CoV-2 shifts cellular metabolism from oxidative phosphorylation to glycolysis, which leads to a decrease in ATP generation. Together with metabolic imbalance, the impaired immune system elevates the susceptibility of patients with diabetes to this deadly virus. SARS-CoV-2-induced metabolic alterations in immune cells can result in hyper inflammation and a cytokine storm. Metabolic dysfunction may affect therapies against SARS-CoV-2 infection. The effective control of metabolic complications could prove useful therapeutic targets for combating COVID-19. It is also necessary to understand the long-term consequences that will affect patients with diabetes who survived COVID-19.CONCLUSIONS: Since the pathophysiology of COVID-19 is still mostly unknown, identifying the metabolic mechanisms contributing to its progression is essential to provide specific ways to prevent and improve this dangerous virus's detrimental effects. The findings show that the new virus may induce new-onset diabetes with uncertain metabolic and clinical features, supporting a potential role of COVID-19 in the development of diabetes
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