The lancet. Diabetes & endocrinology最新文献

{"title":"Dapagliflozin and new-onset type 2 diabetes in patients with chronic kidney disease or heart failure: pooled analysis of the DAPA-CKD and DAPA-HF trials.","authors":"Peter Rossing,&nbsp;Silvio E Inzucchi,&nbsp;Priya Vart,&nbsp;Niels Jongs,&nbsp;Kieran F Docherty,&nbsp;Pardeep S Jhund,&nbsp;Lars Køber,&nbsp;Mikhail N Kosiborod,&nbsp;Felipe A Martinez,&nbsp;Piotr Ponikowski,&nbsp;Marc S Sabatine,&nbsp;Scott D Solomon,&nbsp;David L DeMets,&nbsp;Olof Bengtsson,&nbsp;Magnus Lindberg,&nbsp;Anna Maria Langkilde,&nbsp;Mikaela Sjöstrand,&nbsp;Bergur V Stefansson,&nbsp;Cecilia Karlsson,&nbsp;Glenn M Chertow,&nbsp;Fan Fan Hou,&nbsp;Ricardo Correa-Rotter,&nbsp;Robert D Toto,&nbsp;David C Wheeler,&nbsp;John J V McMurray,&nbsp;Hiddo J L Heerspink","doi":"10.1016/S2213-8587(21)00295-3","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00295-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease and heart failure are insulin resistant states associated with a high incidence of diabetes. We assessed the effect of dapagliflozin on new-onset type 2 diabetes in a pooled analysis of patient-level data from the DAPA-CKD and DAPA-HF trials.</p><p><strong>Methods: </strong>This study is a pooled analysis of individual participant data from two phase 3, randomised, double-blind, placebo-controlled, multicentre, clinical trials. Participants with no history of diabetes and HbA_1c less than 6·5% (48 mmol/mol) at baseline were included in this pooled analysis. New-onset type 2 diabetes was a prespecified exploratory endpoint in both DAPA-CKD and DAPA-HF trials and is the focus of this analysis. New-onset type 2 diabetes was identified by serial trial measurements of HbA_1c (two consecutive values ≥6·5% [≥48 mmol/mol]) or following a clinical diagnosis of diabetes between trial visits. Time to new-onset type 2 diabetes was analysed in a Cox proportional Hazards model from random assignment to end of treatment.</p><p><strong>Findings: </strong>4003 participants (1398 [34·9%] from the DADA-CKD trial and 2605 [65·1%] from the DAPA-HF trial) were included in our analysis: 1995 (49·8%) had received dapagliflozin and 2008 (50·2%) had received placebo. Over a median follow-up of 21·2 months (IQR 16·0 to 25·4), 126 (6·3%) of 2008 patients in the placebo group (event rate 3·9 per 100 patient-years) and 85 (4·3%) of 1995 patients in the dapagliflozin group (event rate 2·6 per 100 patient-years) developed type 2 diabetes (hazard ratio 0·67 [95% CI 0·51 to 0·88]; p=0·0040). There was no heterogeneity between studies (p interaction 0·77) and there was no clear evidence that the effect of dapagliflozin varied in prespecified subgroups including sex, age, glycaemic status, BMI, glomerular filtration rate, systolic blood pressure, and baseline cardiovascular medication use. More than 90% of the participants who developed type 2 diabetes had prediabetes at baseline (HbA_1c 5·7% to 6·4% [39 to 46 mmol/mol]). Mean HbA_1c remained unchanged (placebo-adjusted change in the dapagliflozin group of -0·01% [95% CI -0·03 to 0·01], -0·1 mmol/mol [95% CI -0·3 to 0·1] at 12 months).</p><p><strong>Interpretation: </strong>Treatment with dapagliflozin reduced the incidence of new-onset type 2 diabetes in participants with chronic kidney disease and HF without a reduction in HbA_1c.</p><p><strong>Funding: </strong>AstraZeneca.</p>","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"24-34"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39685930","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}

{"title":"Diabetes and the WHO Model List of Essential Medicines.","authors":"Amulya Reddy","doi":"10.1016/S2213-8587(21)00320-X","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00320-X","url":null,"abstract":"","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"20-21"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39734965","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}

{"title":"Glycaemic management in diabetes: old and new approaches.","authors":"Antonio Ceriello,&nbsp;Francesco Prattichizzo,&nbsp;Moshe Phillip,&nbsp;Irl B Hirsch,&nbsp;Chantal Mathieu,&nbsp;Tadej Battelino","doi":"10.1016/S2213-8587(21)00245-X","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00245-X","url":null,"abstract":"<p><p>HbA_1c is the most used parameter to assess glycaemic control. However, evidence suggests that the concept of hyperglycaemia has profoundly changed and that different facets of hyperglycaemia must be considered. A modern approach to glycaemic control should focus not only on reaching and maintaining optimal HbA_1c concentrations as early as possible, but to also do so by reducing postprandial hyperglycaemia, glycaemic variability, and to extend as much as possible the time in range in near-normoglycaemia. These goals should be achieved while avoiding hypoglycaemia, which, should it occur, should be reverted to normoglycaemia. Modern technology, such as intermittently scanned glucose monitoring and continuous glucose monitoring, together with new drug therapies (eg, ultra-fast insulins, SGLT2 inhibitors, and GLP-1 receptor agonists), could help to change the landscape of glycaemia management based on HbA_1c in favour of a more holistic approach that considers all the different aspects of this commonly oversimplified pathophysiological feature of diabetes.</p>","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"75-84"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39636386","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}

{"title":"Access to insulin and diabetes care in the Philippines.","authors":"Michelle Ann B Eala,&nbsp;John Jefferson V Besa,&nbsp;Regiel Christian Q Mag-Usara,&nbsp;Anna Elvira S Arcellana,&nbsp;Cecilia A Jimeno","doi":"10.1016/S2213-8587(21)00309-0","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00309-0","url":null,"abstract":"","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"16"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39661232","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}

{"title":"Is the impact of add on heart failure therapy influenced by background therapy?","authors":"Lars Rydén,&nbsp;Giulia Ferrannini","doi":"10.1016/S2213-8587(21)00311-9","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00311-9","url":null,"abstract":"","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"3-5"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39689319","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}

{"title":"Telehealth for people with diabetes: poised for a new approach.","authors":"Korey K Hood,&nbsp;Jessie J Wong","doi":"10.1016/S2213-8587(21)00312-0","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00312-0","url":null,"abstract":"","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"8-10"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39672767","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}

{"title":"Correction to Lancet Diabetes Endocrinol 2022; 10: 58-74.","authors":"","doi":"10.1016/S2213-8587(21)00324-7","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00324-7","url":null,"abstract":"","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"e1"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39734968","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}

{"title":"Viswanathan Mohan: a dynasty of diabetology.","authors":"Carl Power","doi":"10.1016/S2213-8587(21)00316-8","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00316-8","url":null,"abstract":"","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"22"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39734967","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}

{"title":"Empagliflozin in the treatment of heart failure with reduced ejection fraction in addition to background therapies and therapeutic combinations (EMPEROR-Reduced): a post-hoc analysis of a randomised, double-blind trial.","authors":"Subodh Verma,&nbsp;Nitish K Dhingra,&nbsp;Javed Butler,&nbsp;Stefan D Anker,&nbsp;Joao Pedro Ferreira,&nbsp;Gerasimos Filippatos,&nbsp;James L Januzzi,&nbsp;Carolyn S P Lam,&nbsp;Naveed Sattar,&nbsp;Barbara Peil,&nbsp;Matias Nordaby,&nbsp;Martina Brueckmann,&nbsp;Stuart J Pocock,&nbsp;Faiez Zannad,&nbsp;Milton Packer","doi":"10.1016/S2213-8587(21)00292-8","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00292-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p&lt;sub&gt;interaction&lt;/sub&gt;=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p&lt;sub&gt;interaction&lt;/sub&gt;=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p&lt;sub&gt;interaction&lt;/sub&gt;=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Int","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"35-45"},"PeriodicalIF":44.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39689322","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}

{"title":"World Diabetes Day 2021: a time of reckoning.","authors":"The Lancet Diabetes Endocrinology","doi":"10.1016/S2213-8587(21)00297-7","DOIUrl":"https://doi.org/10.1016/S2213-8587(21)00297-7","url":null,"abstract":"","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"799"},"PeriodicalIF":44.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39714656","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}