EMJ Diabetes最新文献_第6页

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors: Efficacy and Safety in the Treatment of Hypercholesterolaemia 蛋白转化酶枯草杆菌素/可欣9型抑制剂:治疗高胆固醇血症的有效性和安全性

EMJ Diabetes Pub Date : 2018-11-20 DOI: 10.33590/emjdiabet/10311250

Z. Berberoğlu

引用次数: 0

Update on the Management of Diabetic Dyslipidaemia 糖尿病性血脂异常管理的最新进展

EMJ Diabetes Pub Date : 2018-11-20 DOI: 10.33590/emjdiabet/10312768

Iciar Martín-Timón, Cristina Sevillano-Collantes, M. García-Domínguez, Juan José Marín-Peñalver, B. Ugalde-Abiega, F. J. del Cañizo-Gómez

{"title":"Update on the Management of Diabetic Dyslipidaemia","authors":"Iciar Martín-Timón, Cristina Sevillano-Collantes, M. García-Domínguez, Juan José Marín-Peñalver, B. Ugalde-Abiega, F. J. del Cañizo-Gómez","doi":"10.33590/emjdiabet/10312768","DOIUrl":"https://doi.org/10.33590/emjdiabet/10312768","url":null,"abstract":"Diabetic dyslipidaemia (DD) comprises a complex group of potentially atherogenic lipid and lipoprotein abnormalities, including both quantitative and qualitative changes. It is characterised by low high-density lipoprotein cholesterol, elevated low-density lipoprotein cholesterol (LDL-C), and a higher prevalence of small, dense LDL particles, as well as elevated fasting and postprandial triglycerides. Patients with Type 2 diabetes mellitus have an increased prevalence of lipid abnormalities and controlling dyslipidaemia in these patients has a big impact on morbidity and mortality. Lifestyle changes are still the pillar of treatment for DD and statins are the drugs of choice that decrease LDL-C and reduce cardiovascular events and cardiovascular death, either in primary or secondary prevention, in diabetic patients. Pitavastatin has a number of pleiotropic effects that reduce the metabolic changes associated with adiposity and improve glucose metabolism, which distinguishes it from other statins. New treatments, such as PCSK9 inhibitors, have proven to be powerful LDL-C-lowering agents; however, the need for long-term safety studies and the high associated costs are the main challenges. Future treatments, such as an intracellular PCSK9 inhibitor, a dual proliferator-activated receptor-alpha/gamma agonist, and bempedoic acid, are in development. The aim of this article is to review the pathophysiology of DD and discuss its role in cardiovascular event risk and treatment, as well as to study the effects of lipid-lowering therapy on glucose metabolism and the outcomes of antidiabetic treatment on dyslipidaemia.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132986230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Growth Hormone and Metabolic Homeostasis 生长激素与代谢稳态

EMJ Diabetes Pub Date : 2018-11-20 DOI: 10.33590/emjdiabet/10313977

R. Nishad, D. Mukhi, R. Menon, A. Pasupulati

引用次数: 8

Real-World Challenges in Type 2 Diabetes Mellitus: Why a Paradigm Shift Is Needed 2型糖尿病的现实挑战:为什么需要范式转变

EMJ Diabetes Pub Date : 2018-01-11 DOI: 10.33590/emjdiabet/10314547

E. Blumson

{"title":"Real-World Challenges in Type 2 Diabetes Mellitus: Why a Paradigm Shift Is Needed","authors":"E. Blumson","doi":"10.33590/emjdiabet/10314547","DOIUrl":"https://doi.org/10.33590/emjdiabet/10314547","url":null,"abstract":"Despite the increasing range of treatment options for patients with Type 2 diabetes mellitus (T2DM), there are a number of real-world barriers that prevent many patients from achieving and maintaining glycaemic control. The objective of this symposium was to provide an overview of the challenges in T2DM treatment and to discuss novel strategies that may overcome these issues. The symposium started by exploring the key barriers that prevent patients from achieving glycaemic control, highlighting patient non-adherence to treatment as the major contributor to poor glycaemic control in a real-world setting. The speakers then explored the issue of non-adherence further, focussing on patient and physicianrelated contributing factors, including patient perceptions of treatment value and burden, fears of hypoglycaemia, and patient–physician interactions. The symposium ended with a presentation on potential strategies to improve treatment adherence and clinical outcomes in T2DM. Clinical evidence was presented suggesting that effective methods for helping patients to attain and maintain glycaemic control include both early treatment with intensive combination therapy and treatment with fixed-dose combinations of a glucagon-like peptide 1 (GLP-1) receptor agonist and a basal insulin analogue (iDegLira and iGlarLixi). Novel drug delivery methods were highlighted as a potential strategy for improving patient adherence and treatment success, with data presented on the efficacy and safety of ITCA 650 (Intarcia Therapeutics Inc., Boston, Massachusetts, USA), a subdermal osmotic mini-pump that provides continuous delivery of a GLP-1 receptor agonist. The symposium concluded with a summary of the main points, in which the need for new strategies to address the issue of non-adherence to therapy in T2DM was emphasised.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124677919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Session One: Basal Insulins: Still Innovating After All These Years 第一场:基础胰岛素:多年来仍在创新

EMJ Diabetes Pub Date : 2017-10-31 DOI: 10.33590/emjdiabet/10311215

Lisa Michel

{"title":"Session One: Basal Insulins: Still Innovating After All These Years","authors":"Lisa Michel","doi":"10.33590/emjdiabet/10311215","DOIUrl":"https://doi.org/10.33590/emjdiabet/10311215","url":null,"abstract":"Therapeutic basal insulin has evolved considerably over the past 90 years. A series of landmark innovations has led to the availability of therapies that closely mimic the physiological effects of endogenous insulin and serve as an invaluable addition to the treatment armamentarium for diabetes. Advances in basal insulin have led to the development of the newer basal insulin analogues, namely insulin degludec and insulin glargine 300 U/mL (Gla-300). The desirable pharmacokinetic (PK) and pharmacodynamic (PD) properties of these basal insulins, such as a prolonged duration of action (≥24 hours), may translate into a number of clinical benefits for the patient e.g., a simple, once-daily injection schedule and flexible injection timings.\u0000\u0000The technologies supporting patients with diabetes have also evolved considerably in recent years. Continuous glucose monitoring (CGM) can provide insights into some of the challenges faced by patients with diabetes, e.g., glycaemic excursions and the impact of injection time, and may become an alternative to the current gold standard glycated haemoglobin (HbA1c). Real-world evidence is also providing fresh perspectives on the effectiveness of basal insulins in clinical practice. Today, innovative methods for real-world evidence collection, analysis, and interpretation are helping to generate robust datasets with external validity. Taken together, these innovative approaches are generating an integrated evidence base that is improving our understanding of how basal insulin therapy can be optimised for the benefit of our patients with diabetes.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127157109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editor’s Pick: Addressing Hypertension in the Patient with Type 2 Diabetes Mellitus: Pathogenesis, Goals, and Therapeutic Approach 编者精选:解决2型糖尿病患者的高血压:发病机制，目标和治疗方法

EMJ Diabetes Pub Date : 2017-10-31 DOI: 10.33590/emjdiabet/10312697

A. Rizvi

{"title":"Editor’s Pick: Addressing Hypertension in the Patient with Type 2 Diabetes Mellitus: Pathogenesis, Goals, and Therapeutic Approach","authors":"A. Rizvi","doi":"10.33590/emjdiabet/10312697","DOIUrl":"https://doi.org/10.33590/emjdiabet/10312697","url":null,"abstract":"Hypertension is considered a powerful cardiovascular risk factor and is present in up to two-thirds of patients who suffer from diabetes. In the background of an established epidemiological association between lower blood pressure (BP) and improvement in long-term clinical outcomes, several large landmark trials and analyses have attempted to examine the possible benefit of tighter BP control in patients with Type 2 diabetes mellitus. Although aggressive BP targets in patients with diabetes have been advocated for a long time, currently accepted evidence from these studies has led to a general recommendation of systolic BP <140 mmHg and diastolic BP <90 mmHg. Therapy consists of lifestyle management, including weight loss if overweight or obese, a Dietary Approaches to Stop Hypertension (DASH)-style based nutrition counselling, and reduced sodium intake. Timely initiation and subsequent titration of antihypertensive medications to achieve individualised BP goals is recommended. A therapeutic agent that acts on the renin-angiotensin-aldosterone pathway, such as an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, should generally be included in the pharmacologic therapy for hypertension in patients with Type 2 diabetes mellitus. A multi-drug combination, particularly including a thiazide diuretic, is very often necessary and should be started early in the course of management. Finally, an accurate and standardised method of BP measurement in the outpatient setting is essential to ensure proper monitoring and gauge the effectiveness of treatment.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133369537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Session Two: Changing the Type 2 Diabetes Mellitus Management Paradigm with Fixed-Ratio Combinations 第二部分:用固定比例组合改变2型糖尿病的管理模式

EMJ Diabetes Pub Date : 2017-10-31 DOI: 10.33590/emjdiabet/10310975

Lisa Michel

{"title":"Session Two: Changing the Type 2 Diabetes Mellitus Management Paradigm with Fixed-Ratio Combinations","authors":"Lisa Michel","doi":"10.33590/emjdiabet/10310975","DOIUrl":"https://doi.org/10.33590/emjdiabet/10310975","url":null,"abstract":"Fixed-ratio combinations, the co-administration of two injectable therapies in a formulation that can be adjusted through titration, are changing the Type 2 diabetes mellitus management paradigm. Current treatment guidelines for glucose control rely heavily on a stepwise approach; however, that can be inconsistently followed and relatively indifferent to the complex pathophysiology of Type 2 diabetes mellitus. Fixed-ratio combinations have targeted actions that complement other treatments. Basal insulin plus a glucagon-like peptide 1 receptor agonist (GLP-1 RA) represent one such combination that offers an efficacious approach to control both fasting and postprandial glucose, key determinants of glycaemic and clinical outcomes.\u0000\u0000Two fixed-ratio combinations, insulin glargine 100 U/mL plus lixisenatide (iGlarLixi) and insulin degludec plus liraglutide (IDegLira), are currently available in the European Union (EU) and USA. Clinical evidence from pivotal, Phase III trials with iGlarLixi and IDegLira have demonstrated their robust glycated haemoglobin (HbA1c)-lowering effects, which are associated with mitigation of side effects commonly experienced with the individual components, including basal insulin-related body weight gain and GLP-1-related gastrointestinal adverse events. The spectrum of clinical benefits associated with these titratable fixed-ratio combinations may offer a more compelling case for earlier and effective use of these therapies that better addresses the complex underlying pathophysiology of Type 2 diabetes mellitus.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121476421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Role of Probiotics in Diabetes: A Review of Their Rationale and Efficacy 益生菌在糖尿病中的作用:其原理和疗效的综述

EMJ Diabetes Pub Date : 2017-10-31 DOI: 10.33590/emjdiabet/10310327

Neel Jayesh Shah, Onkar C Swami

{"title":"Role of Probiotics in Diabetes: A Review of Their Rationale and Efficacy","authors":"Neel Jayesh Shah, Onkar C Swami","doi":"10.33590/emjdiabet/10310327","DOIUrl":"https://doi.org/10.33590/emjdiabet/10310327","url":null,"abstract":"The commensal bacteria that are present in our body since infancy are known to play a role in metabolism, in health as well as disease. Diabetes is a growing epidemic, and a long-term solution that targets the disease at the molecular level is yet to be developed. In this article, we have reviewed the link between the body’s microbiota and disturbed glucose metabolism, as well as the reasons for bacterial dysbiosis and the mechanisms by which it causes inflammation. The link between dysbiosis and diabetes is convincing, particularly since probiotics have been shown to be of some benefit in normalising disturbed metabolism in diabetes patients. Probiotics have recently been found to have a wide application in diseases such as autoimmune, inflammatory, and allergic conditions. The efficacy of probiotics in diabetes has been proven by their ability to lower fasting glucose and insulin levels in a preclinical setting as well as in human trials. However, there is heterogeneity in these studies, including the species used, probiotic dosage, and the magnitude of efficacy. Based on the robust understanding of the benefits of probiotics in diabetes at the cellular level, in both animal studies and clinical trials, combined with their excellent tolerability, probiotics should be explored for their application in clinics.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116657918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 30

Session Three: Innovating Beyond Glucose Control in Diabetes Care 第三部分:糖尿病护理中超越血糖控制的创新

EMJ Diabetes Pub Date : 2017-10-31 DOI: 10.33590/emjdiabet/10314488

Lisa Michel

{"title":"Session Three: Innovating Beyond Glucose Control in Diabetes Care","authors":"Lisa Michel","doi":"10.33590/emjdiabet/10314488","DOIUrl":"https://doi.org/10.33590/emjdiabet/10314488","url":null,"abstract":"Advances in treatment offerings are moving beyond classical considerations around glucose control to focus on other aspects of the disease. Such advances include the development of treatments that address the high cardiovascular (CV) risk in patients with diabetes, or have novel mechanisms of action, and new technologies that will facilitate the future integration of care.\u0000\u0000The proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors represent a new therapeutic approach for managing CV risk in patients with diabetes. New clinical data recently generated from dedicated diabetes studies have established PCSK9 inhibitors as an efficacious and well-tolerated treatment option for patients with diabetes and persistently elevated low-density lipoprotein-cholesterol levels, despite optimised lipid-lowering therapy.\u0000\u0000Treatments with novel mechanisms of action are also being investigated. Sotagliflozin, a dual inhibitor of the sodium-glucose cotransporter 1 (SGLT1) and sodium-glucose cotransporter 2 (SGLT2), may offer additional clinical benefits beyond those of existing selective SGLT2 inhibitors in patients with Type 1 diabetes mellitus. The sotagliflozin inTandem Phase III programme will provide valuable insights regarding the potential role of dual SGLT1 and SGLT2 inhibitors as an adjunct to insulin therapy in patients with Type 1 diabetes mellitus.\u0000\u0000Furthermore, advances in diabetes devices, such as implantable drug delivery systems, non-invasive glucose monitoring, and closed-loop artificial pancreas systems, are fuelling the development of new models of patient care. While there will inevitably be other innovations, three major advances will dramatically change diabetes care over the next 10–20 years: 1) digital diabetes health technologies, 2) artificial intelligence and machine learning, and 3) virtual reality.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114739090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anti-Vascular Endothelial Growth Factor Therapy in Diabetic Macular Oedema: Is It Effective? 抗血管内皮生长因子治疗糖尿病黄斑水肿有效吗?

EMJ Diabetes Pub Date : 2017-10-31 DOI: 10.33590/emjdiabet/10313316

Kuan Hao Yee, S. Sanjay

{"title":"Anti-Vascular Endothelial Growth Factor Therapy in Diabetic Macular Oedema: Is It Effective?","authors":"Kuan Hao Yee, S. Sanjay","doi":"10.33590/emjdiabet/10313316","DOIUrl":"https://doi.org/10.33590/emjdiabet/10313316","url":null,"abstract":"Diabetic macular oedema (DMO) is a common ocular problem among patients with diabetic retinopathy, which is sight-threatening and leads to blindness. The gold standard treatment for DMO had been focal/grid laser photocoagulation that achieved stabilisation of disease progression. However, newer pharmacological treatment options have gradually been favoured, as studies demonstrate their superior efficacy with regard to significant visual improvements. In particular, use of anti-vascular endothelial growth factor (anti-VEGF) has become very popular, with promising evidence emerging from numerous trials regarding efficacy and safety. Based on the 2014 American Society of Retina Specialists (ASRS) Preferences and Trends survey, the current preferred first-line therapy for DMO is in fact an anti-VEGF agent. Studies have shown that VEGF plays a critical role in both the angiogenesis and inflammation processes that occur during development of DMO. Hence, this allows anti-VEGF agents to specifically target and treat the underlying pathology, signifying its importance, and possibly accounting for its efficacy. We evaluate the available literature documenting the efficacy of anti-VEGF treatment in DMO. A key clinical finding was that anti-VEGF, as a drug class, achieved superior resolution of macular oedema and visual improvements that were consistently sustainable over 3 years, with some evidence pointing towards 5-year sustainability too. Hence, with intravitreal anti-VEGF treatments increasingly available, better long-term prognosis and, crucially, reduced likelihood of progression to blindness can be expected in patients with DMO.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129730895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1