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By T C
Devina Willard, Jagriti Upadhyay, Chan Kim, Devin Steenkamp
CONTEXT: Type B insulin resistance syndrome is a rare disease which occurs due to the development of autoantibodies to the insulin receptor and can result in either severe insulin resistance and hyperglycemia or conversely hypoglycemia. Diabetes mellitus is often severe, usually transient and poorly responsive to exogenous insulin. Diabetic ketoacidosis is an unusual consequence of this most severe form of transient diabetes mellitus. CASE DESCRIPTION: A 39 year old Nigerian woman presented with significant weight loss, severe diabetic ketoacidosis and severe insulin resistance requiring massive doses of exogenous insulin...
September 16, 2016: Journal of Clinical Endocrinology and Metabolism
Anne E de Leeuw, Rudolf A de Boer
Diabetes is a growing epidemic worldwide characterized by an elevated concentration of blood glucose, associated with a high incidence of cardiovascular disease and mortality. Although in general reduction of hyperglycaemia is considered a therapeutic goal, hypoglycaemic therapies do not necessarily reduce cardiovascular mortality and may even aggravate cardiovascular risk factors, such as body weight. A new class of antidiabetic drugs acts by inhibition of the sodium-glucose cotransporter 2 (SGLT2), which (partially) prevents reabsorption of glucose from the renal filtrate...
October 2016: European Heart Journal. Cardiovascular Pharmacotherapy
David Pham, Natalia De Albuquerque Rocha, Darren K McGuire, Ian J Neeland
Heart failure (HF) is a common disease with increased risk for mortality and morbidity among patients with type 2 diabetes mellitus (T2DM). Optimal glycemic control in this patient population is challenging as many available therapies can potentially exacerbate symptoms of HF. Empagliflozin is one in a novel class of agents, the sodium glucose co-transporter 2 (SGLT2) inhibitors, that lowers blood glucose by increasing urinary glucose excretion and improves glycemic control and lowers body weight and blood pressure...
August 4, 2016: Trends in Cardiovascular Medicine
V Bril, J England, G M Franklin, M Backonja, J Cohen, D Del Toro, E Feldman, D J Iverson, B Perkins, J W Russell, D Zochodne
OBJECTIVE: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). METHODS: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: "What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" RESULTS AND RECOMMENDATIONS: Pregabalin is established as effective and should be offered for relief of PDN (Level A)...
May 17, 2011: Neurology
Antonio Ceriello, Stefano Genovese, Edoardo Mannucci, Edoardo Gronda
Increased levels of glucagon in type 2 diabetes are well known and, until now, have been considered deleterious. However, glucagon has an important role in the maintenance of both heart and kidney function. Moreover, in the past, glucagon has been therapeutically used for heart failure treatment. The new antidiabetic drugs, dipeptidyl peptidase-4 inhibitors and sodium-glucose co-transporter-2 inhibitors, are able to decrease and to increase glucagon levels, respectively, while contrasting data have been reported regarding the glucagon like peptide 1 receptors agonists...
2016: Cardiovascular Diabetology
Samuel Adamsson Eryd, Soffia Gudbjörnsdottir, Karin Manhem, Annika Rosengren, Ann-Marie Svensson, Mervete Miftaraj, Stefan Franzén, Staffan Björck
OBJECTIVES:  To compare the risk associated with systolic blood pressure that meets current recommendations (that is, below 140 mm Hg) with the risk associated with lower levels in patients who have type 2 diabetes and no previous cardiovascular disease. DESIGN:  Population based cohort study with nationwide clinical registries, 2006-12. The mean follow-up was 5.0 years. SETTING:  861 Swedish primary care units and hospital outpatient clinics...
2016: BMJ: British Medical Journal
Steven P Marso, Gilbert H Daniels, Kirstine Brown-Frandsen, Peter Kristensen, Johannes F E Mann, Michael A Nauck, Steven E Nissen, Stuart Pocock, Neil R Poulter, Lasse S Ravn, William M Steinberg, Mette Stockner, Bernard Zinman, Richard M Bergenstal, John B Buse
BACKGROUND: The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown. METHODS: In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome in the time-to-event analysis was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke...
July 28, 2016: New England Journal of Medicine
Jagdeep S S Singh, Amir Fathi, Keeran Vickneson, Ify Mordi, Mohapradeep Mohan, J Graeme Houston, Ewan R Pearson, Allan D Struthers, Chim C Lang
BACKGROUND: Heart failure (HF) and diabetes (DM) are a lethal combination. The current armamentarium of anti-diabetic agents has been shown to be less efficacious and sometimes even harmful in diabetic patients with concomitant cardiovascular disease, especially HF. Sodium glucose linked co-transporter type 2 (SGLT2) inhibitors are a new class of anti-diabetic agent that has shown potentially beneficial cardiovascular effects such as pre-load and after load reduction through osmotic diuresis, blood pressure reduction, reduced arterial stiffness and weight loss...
2016: Cardiovascular Diabetology
William B White, Craig A Wilson, George L Bakris, Richard M Bergenstal, Christopher P Cannon, William C Cushman, Simon K Heller, Cyrus R Mehta, Steven E Nissen, Faiez Zannad, Stuart Kupfer
Activation of the sympathetic nervous system when there is dipeptidyl peptidase 4 inhibition in the presence of high-dose angiotensin-converting enzyme (ACE) inhibition has led to concerns of potential increases in cardiovascular events when the 2 classes of drugs are coadministered. We evaluated cardiovascular outcomes from the EXAMINE (Examination of Cardiovascular Outcomes With Alogliptin versus Standard of Care) trial according to ACE inhibitor use. Patients with type 2 diabetes mellitus and a recent acute coronary syndrome were randomly assigned to receive the dipeptidyl peptidase 4 inhibitor alogliptin or placebo added to existing antihyperglycemic and cardiovascular prophylactic therapies...
September 2016: Hypertension
(no author information available yet)
No abstract text is available yet for this article.
July 28, 2016: New England Journal of Medicine
Zoe A Stewart, Malgorzata E Wilinska, Sara Hartnell, Rosemary C Temple, Gerry Rayman, Katharine P Stanley, David Simmons, Graham R Law, Eleanor M Scott, Roman Hovorka, Helen R Murphy
BACKGROUND: In patients with type 1 diabetes who are not pregnant, closed-loop (automated) insulin delivery can provide better glycemic control than sensor-augmented pump therapy, but data are lacking on the efficacy, safety, and feasibility of closed-loop therapy during pregnancy. METHODS: We performed an open-label, randomized, crossover study comparing overnight closed-loop therapy with sensor-augmented pump therapy, followed by a continuation phase in which the closed-loop system was used day and night...
August 18, 2016: New England Journal of Medicine
Francesco Franchi, Fabiana Rollini, Niti Aggarwal, Jenny Hu, Megha Kureti, Ashwin Durairaj, Valeria E Duarte, Jung Rae Cho, Latonya Been, Martin M Zenni, Theodore A Bass, Dominick J Angiolillo
BACKGROUND: Patients with diabetes mellitus (DM) are at increased risk of atherothrombotic events, underscoring the importance of effective platelet inhibiting therapies. Prasugrel and ticagrelor reduce thrombotic complications to a greater extent than clopidogrel. Subgroup analyses of pivotal clinical trials testing prasugrel and ticagrelor versus clopidogrel showed DM patients to have benefits that were consistent with the overall trial populations, although the magnitude of the ischemic risk reduction appeared to be enhanced with prasugrel...
September 13, 2016: Circulation
Hiddo J L Heerspink, Bruce A Perkins, David H Fitchett, Mansoor Husain, David Z I Cherney
Sodium-glucose cotransporter-2 (SGLT2) inhibitors, including empagliflozin, dapagliflozin, and canagliflozin, are now widely approved antihyperglycemic therapies. Because of their unique glycosuric mechanism, SGLT2 inhibitors also reduce weight. Perhaps more important are the osmotic diuretic and natriuretic effects contributing to plasma volume contraction, and decreases in systolic and diastolic blood pressures by 4 to 6 and 1 to 2 mm Hg, respectively, which may underlie cardiovascular and kidney benefits...
September 6, 2016: Circulation
Paige V Bauer, Frank A Duca
The rising global rates of type 2 diabetes and obesity present a significant economic and social burden, underscoring the importance for effective and safe therapeutic options. The success of glucagon-like-peptide-1 receptor agonists in the treatment of type 2 diabetes, along with the potent glucose-lowering effects of bariatric surgery, highlight the gastrointestinal tract as a potential target for diabetes treatment. Furthermore, recent evidence suggests that the gut plays a prominent role in the ability of metformin to lower glucose levels...
September 2016: Journal of Endocrinology
Nitesh D Kuhadiya, Husam Ghanim, Aditya Mehta, Manisha Garg, Salman Khan, Jeanne Hejna, Barrett Torre, Antoine Makdissi, Ajay Chaudhuri, Manav Batra, Paresh Dandona
CONTEXT: It is imperative that novel approaches to treatment of type 1 diabetes (T1D) are devised. OBJECTIVE: The objective of the study was to investigate whether addition of dapagliflozin to insulin and liraglutide results in a significant reduction in glycemia and body weight. DESIGN: This was a randomized clinical trial. SETTING: The study was conducted at a single academic medical center. PARTICIPANTS: Participants included T1D patients on liraglutide therapy for at least last 6 months...
September 2016: Journal of Clinical Endocrinology and Metabolism
U Anyanwagu, I Idris, R Donnelly
Abnormalities of glucose metabolism and glucose tolerance, either because of a reduction in tissue sensitivity to insulin (e.g., in liver, skeletal muscle, and adipose tissues) and/or a reduction in pancreatic insulin secretion, are associated with a number of unwanted health outcomes. Even small increases in circulating glucose levels (often described as dysglycemia or prediabetes) may confer an increased risk of cardiovascular (CV) disease and progression to overt type 2 diabetes. A number of drug therapies, many of them used long term in chronic disease management, have adverse effects on glucose metabolism, diabetes risk, and glycemic control among patients with preexisting diabetes...
April 2016: Clinical Pharmacology and Therapeutics
David Fitchett, Bernard Zinman, Christoph Wanner, John M Lachin, Stefan Hantel, Afshin Salsali, Odd Erik Johansen, Hans J Woerle, Uli C Broedl, Silvio E Inzucchi
AIMS: We previously reported that in the EMPA-REG OUTCOME(®) trial, empagliflozin added to standard of care reduced the risk of 3-point major adverse cardiovascular events, cardiovascular and all-cause death, and hospitalization for heart failure in patients with type 2 diabetes and high cardiovascular risk. We have now further investigated heart failure outcomes in all patients and in subgroups, including patients with or without baseline heart failure. METHODS AND RESULTS: Patients were randomized to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo...
May 14, 2016: European Heart Journal
Eberhard Standl, Oliver Schnell, Darren K McGuire
Prevalent and incident heart failure (HF) is increased in people with type 2 diabetes mellitus, with risk directly associated with the severity of hyperglycemia. Furthermore, in patients with type 2 diabetes mellitus, mortality is increased ≈10-fold in patients with versus without HF. Reducing HF with antihyperglycemic therapies, however, has been unsuccessful until recently. In fact, HF as an important outcome in patients with type 2 diabetes mellitus seems to be heterogeneously modulated by antihyperglycemic medications, as evidenced by results from cardiovascular outcome trials (CVOTs) and large observational cohort studies...
May 27, 2016: Circulation Research
Matthew J Levine
Sodium glucose cotransporter 2 (SGLT2) inhibitors have a unique mechanism of action leading to excretion of glucose in the urine and subsequent lowering of plasma glucose. This mechanism is independent of β-cell function; thus, these agents are effective treatment for type 2 diabetes mellitus (T2DM) at theoretically any disease stage. This class should not confer an additional risk of hypoglycemia (unless combined with insulin or an insulin secretagogue) and has the potential to be combined with other classes of glucose-lowering agents...
June 13, 2016: Current Diabetes Reviews
James J Chamberlain, Andrew S Rhinehart, Charles F Shaefer, Annie Neuman
DESCRIPTION: The American Diabetes Association (ADA) published the 2016 Standards of Medical Care in Diabetes (Standards) to provide clinicians, patients, researchers, payers, and other interested parties with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. METHODS: The ADA Professional Practice Committee performed a systematic search on MEDLINE to revise or clarify recommendations based on new evidence. The committee assigns the recommendations a rating of A, B, or C, depending on the quality of evidence...
April 19, 2016: Annals of Internal Medicine
2016-07-25 01:17:38
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