Usage Pattern of Fixed Dose Combinations of Glimepiride, Voglibose, and Metformin in T2DM – An Observational Study
Paramesh Shamanna
This observational study explores the usage patterns of fixed-dose combinations (FDC) of glimepiride, metformin, and voglibose in patients with Type 2 Diabetes Mellitus (T2DM) in India. The most frequently prescribed regimen was found to be glimepiride 1mg, metformin 500 mg, and voglibose 0.2 mg, administered once daily for 1 to 3 months. This prescription pattern was observed across both newly diagnosed and long-standing diabetes patients, showcasing the popularity of this FDC in routine Indian clinical settings.
Prescription and Impact of ACE-Inhibitors to Patients with Type 2 Diabetes and Hypertension in Primary Health Care
Dima Kawas
This retrospective cohort study explores the prescription patterns of angiotensin-converting enzyme inhibitors (ACEi) upon the diagnosis of primary hypertension (HT) in patients with Type 2 Diabetes Mellitus (T2DM) in Qatar. Despite international guidelines recommending ACEi for T2DM patients with HT, the study reveals suboptimal prescription rates (43.5%). Patients prescribed with ACEi demonstrated greater reductions in blood pressure and lower incidences of cardiovascular disease (CVD) and chronic kidney disease (CKD). Identified patient characteristics associated with ACEi prescription may guide future interventions to improve adherence to guidelines.
Diabetic Foot and Vitamin D Levels: Time to Put the Best ‘Foot’ Forward
Ashish Bajaj
The escalating global prevalence of diabetes mellitus (DM) has heightened concerns about its complications, particularly diabetic foot ulcers (DFUs), impacting quality of life. Vitamin D (Vit D) plays a crucial role in blood sugar control and DM-related complications. In diabetic neuropathy (DN), Vit D deficiency is correlated with neurological deficits and parasympathetic dysfunction. DFUs, often precipitated by DN, significantly contribute to limb amputation risk. Introducing oral Vit D supplementation alongside standard treatment has shown promising results in alleviating symptoms and improving glycemic control in DN patients, emphasizing the potential for preventive strategies and interdisciplinary collaboration to mitigate adverse outcomes.
Dapagliflozin for Remission of Type 2 Diabetes: A Multicenter Randomized Placebo-controlled Trial
Yeujun Liu
This randomized, double-blind, placebo-controlled study, titled “REmission of type 2 Diabetes (READ study),” investigated the impact of dapagliflozin plus intensive lifestyle intervention on diabetes remission and cardiometabolic risk factors in overweight or obese patients with type 2 diabetes (T2D). The study, conducted across multiple centers, included 328 patients randomly assigned to receive dapagliflozin or placebo alongside intensive lifestyle intervention. The primary outcome revealed a significant increase in diabetes remission (43.0% vs. 26.4%) in the dapagliflozin group, demonstrating its effectiveness in achieving diabetes remission. Additionally, improvements in body weight, HOMA-IR, body fat, blood pressure, and metabolic risk factors were observed, emphasizing the potential of oral glucose-lowering pharmacotherapy in managing T2D.
Diabetes and COVID-19: A Two-way Relationship
M.Ghazali
In this retrospective study involving 398 COVID-19 patients, the intricate relationship between diabetes, COVID-19, and cardiovascular risk was explored. The research unveiled that diabetes significantly increased the risk of severe forms of COVID-19 and mortality. Predictors of mortality in diabetic patients included age, hyperglycemia, hyperleukocytosis, elevated CRP, D-dimer, and hyperfibrinogenemia. The study underscored the formidable impact of the combination of diabetes and COVID-19, emphasizing the need for stringent adherence to guidelines and the management of additional risk factors. The findings highlighted the intricate interplay of cardiovascular risk, glycemic imbalance, and inflammatory states in this challenging clinical scenario.
Evolution of Eye Screening Technology
Mr. David Kerr
The study presented at IDF 2023 discussed the evolution of eye screening technology. Digital imaging showed <0.03% face-to-face time with a professional. Less than 50% of PWDs adhere to the recommendation of annual screening. Traditional screening requires an in-person visit which is not achievable by working-aged individuals or those from remote areas. The majority of patients don’t show signs of disease and only a small portion will require intervention. Artificial Intelligence (AI) identifies the hidden features that are often not humanly detectable, bypasses manual feature extraction, and can discover novel features correlated with a certain outcome in the training dataset. AI and smartphones provide access, trust, numeracy, literacy, understanding, and relevance. AI screens for disease, offload mundane tasks/feeds the EHR, answers question guides clinicians, and monitors patients at home.
Evidence for Weight Loss with Newer Regimens or Higher Doses
Dr. David D’Alessio
The presentation spoke about the evolution of drug used for weight loss and new drug Tirzepatide. The rate of obesity has increased steadily since 1980. A lot of drugs have been developed for weight loss over the years, and 5-10% weight loss is on the edge of clinical effectiveness. In 2023, Tirzepatide was developed which activates satiety and nausea centres in the CNS 15-20%. The GLP-1R system has turned out to be a great drug target. A greater understanding of the biology of incretin signaling has translational promise. Expanding the accessibility of incretin-based drugs has the potential to bend the obesity/diabetes curve.
Effect of Weight Loss Medications on Cardiovascular Risk Factors/ Outcomes and Ongoing Trials
Dr. Darren McGuire
The presentation discussed the trials conducted on weight loss medications and its cardiovascular effects. The STEP-HFpEF trial reported that Semaglutide (2.4 mg) led to greater weight loss than placebo. The SELECT trial evaluated effect of Semaglutide on 17,604 individuals with BMI ≥27 kg/m2 and HbA1c < 6.5% with prior MI, stroke, or PAD. The SELECT trial reported Semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 40 months. Several medications are on the market/ in development with > 10% average achieved weight loss which rekindles hope to be able to demonstrate improvements in clinical outcomes with targeted weight reduction. 2 completed trials have demonstrated benefits on CV clinical and patient-reported outcomes. A major challenge remains affordability, to patients, and to society.
Characteristics and Cardiovascular Risks in Prediabetes
Prof Anoop Misra
The study discussed the characteristics and cardiovascular risks in prediabetes. Prediabetes is a growing global health issue. It is important to identify prediabetes to impede conversion to T2D, decrease CV risk, detect early since it is asymptomatic, avert microvascular complications, and increase longevity. Asians especially in India are at a higher risk as the conversion of prediabetes to diabetes is more common in Asians. The reversal to normoglycemia is less frequent compared to white populations. Prediabetes elevates the risk of cardiovascular diseases, CV mortality, and stroke. It is associated with the risk of heart failure (HF). Impaired Glucose Tolerance (IGT) presents a higher risk of CVD and mortality compared to Impaired Fasting Glucose (IFG). Lifestyle changes and Metformin can improve myocardial metabolism and Coronary Artery Calcium, respectively. Further studies are required to understand prediabetes’s effects on longevity. Prediabetes is not a benign state and requires aggressive management.
Management Options in Prediabetes
Prof. Jonathan Shaw
The speaker discussed the management options for prediabetes. For preventing type 2 diabetes the management options include intensive lifestyle, target diet, and exercise. Highly successful in old and young individuals, males and females, and a variety of ethnic groups. The American DPP reported that lifestyle interventions showed a 58% reduction in preventing diabetes in people with Impaired Glucose Tolerance (IGT). A study in Japan that evaluated the benefit of lifestyle intervention in IGT people showed the risk of developing diabetes was reduced by 67%. Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG) have different pathophysiologies. The pharmacological CV prevention in prediabetes includes the use of statin/anti-HT should be based on absolute CV risk. Avoid beta-blockers and thiazides as first-line anti-hypertensives. SGLT2i/GLP-1RA if other indications are present (HF,CKD, and obesity).
