0

Tag: type 2 diabetes

SGLT-2 inhibitors Associated with Decreased HF Hospitalizations in Type 2 Diabetes

The management of patients with type 2 diabetes (T2D) and heart failure (HF) is challenging, and the optimal care for these patients is not very well defined. The coexistence of these two conditions increases morbidity and mortality. Patients with HF and T2D are at an increased risk for cardiovascular-related mortality and have higher rates of HF hospitalizations. Almost a quarter of all HF patients are readmitted to the hospital within 30 days of discharge; nearly half are hospitalized 4 or more times, and these patients often have cardiometabolic comorbidities—furthering the risks of hospitalization and readmission. Glycemic control in patients with T2D and HF can be complex for clinicians, for example, thiazolidinediones are known to increase HF risk. However, recent studies have suggested that newer antihyperglycemic medications, particularly SGLT-2 inhibitors, can improve HF risk and reduce hospitalizations for HF in T2D.

Data from the cardiovascular outcome trials (CVOTs) of antidiabetic drugs have not only revealed exciting information about cardiovascular and renal benefits of the newer drugs, but also about HF risk in T2D. A recent meta-analysis of nine CVOTs that included 87,162 subjects showed that SGLT-2 inhibitors are associated with a decreased risk of HF hospitalizations compared with placebo. In addition, GLP-1 agonists and DPP-4 inhibitors were not associated with a significant risk reduction in HF hospitalization rates. In a class ranking, the authors reported that with 99.6% probability, SGLT-2 inhibitors are the most effective drugs to reduce the risk of HF hospitalizations in patients with T2D, followed by GLP-1 agonist and DPP-4 inhibitors. The meta-analysis included SGLT-2 inhibitors empagliflozin and canagliflozin, GLP-1 agonists lixisenatide, liraglutide, semaglutide, and once-weekly exenatide, and DPP-4 inhibitors alogliptin, saxagliptin, and sitagliptin.

Read more

Obesity Yields Spike in Nonalcoholic Fatty Liver Disease

At the recent annual meeting of the American College of Physicians, it was declared that nonalcoholic fatty liver disease (NAFLD) is the 21st century epidemic in liver disease—given the extraordinary growth in the disease’s prevalence, due to the related epidemics of both obesity and type 2 diabetes mellitus. Statistics indicate that the global prevalence of NAFLD is 24%; almost three-quarters of patients with NAFLD are obese. Zobair M. Younossi, MD, a gastroenterologist who serves as professor and chairman of the department of medicine at the Inova Fairfax campus of Virginia Commonwealth University, conducted a recent meta-analysis of studies from 20 countries, and concluded that the prevalence of NAFLD in individuals with T2DM was 58%.

Quoted in a recent article published in MDedge.com, Dr. Younossi stated: “The prevalence of NAFLD in U.S. kids is about 10%. This is of course part of the coming tsunami because our kids are getting obese, diabetic, and they’re going to have problems with NASH [nonalcoholic steatohepatitis].” NASH, the type of NAFLD that has the strongest prognostic implications, can ultimately progress to cirrhosis, liver failure, or hepatocellular carcinoma. Additionally, findings have demonstrated that NASH is further associated with a significantly greater risk of both liver-related and all-cause mortality than that of non-NASH NAFLD, although NAFLD carries an increased risk of cardiovascular disease: the leading cause of death in that population.

Read more