Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association

Cardiologists vs Endocrinologists in Glycemic Control for Coronary Artery Disease Patients with Type 2 Diabetes: A Cross-Sectional Study

Background

The comorbidity of coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) presents significant challenges in clinical management, particularly regarding glycemic control. The clinical management of CAD complicated by T2DM requires coordinated glycemic control, as poor management can exacerbate cardiovascular risks and increase morbidity and mortality. While endocrinologists traditionally manage diabetes, cardiologists are increasingly involved due to the cardiovascular risks associated with poor glycemic control. This study explores the current practices of glycemic management by cardiologists and endocrinologists in patients with CAD and T2DM, focusing on treatment intensification in a Chinese hospital setting.

Methods

This cross-sectional study included 1,074 hospitalized patients with both CAD and T2DM, admitted to the Cardiology Department of Ruijin Hospital between January 2021 and December 2023. Data were retrospectively collected from electronic medical records, including demographic information, clinical characteristics, and treatment interventions. Patients were stratified by year, and differences in treatment strategies between cardiologists and endocrinologists were analyzed. Glycemic control was assessed using HbA1c levels, with treatment intensification defined by any adjustment in antidiabetic therapy and consideration for comprehensive cardiovascular risk factors.

Results

Endocrinologists were significantly more likely to initiate treatment intensification, especially in cases of severe hyperglycemia (HbA1c ≥9.0%), while cardiologists' role in glycemic management was limited, with a preference for outpatient endocrinology referrals over in-hospital adjustments. Despite improvements in glycemic control, the percentage of patients achieving comprehensive cardiovascular risk management targets remained low.

Conclusion

This study underscored the distinct yet complementary roles of cardiologists and endocrinologists in managing glycemic control among patients with CAD and T2DM, noting endocrinologists' more active involvement in treatment intensification. Future integrated care models should harness the unique expertise of both specialties to optimize patient outcomes, better address glycemic control needs, and enhance overall cardiovascular risk management in this high-risk patient population.

2-Fold More Cardiovascular Disease Events Decades Before Type 2 Diabetes Diagnosis: A Nationwide Registry Study

BACKGROUND

The risk of cardiovascular disease (CVD) is increased in individuals with type 2 diabetes mellitus (T2DM), but it remains uncertain how long an elevated CVD occurrence precedes diabetes diagnosis.

OBJECTIVES

The aim of this study was to investigate CVD occurrence 30 years before, and 5 years after, T2DM diagnosis compared with matched comparisons.

METHODS

This combined case-control and cohort study included all individuals diagnosed with T2DM in Denmark between 2010 and 2015, as well as general population comparisons matched by age and sex. CVD was defined as myocardial infarction or ischemic stroke. Conditional logistic regression was used to compute ORs for CVD prevalence in the 30-year period before T2DM diagnosis. Cox proportional hazards regression models were used to compute HRs for 5-year CVD incidence after T2DM diagnosis.

RESULTS

The study included 127,092 individuals with T2DM and 381,023 matched comparisons. In the 30-year period before T2DM diagnosis, 14,179 (11.2%) T2DM individuals and 17,871 (4.7%) comparisons experienced CVD. CVD prevalence was higher in those with T2DM than the comparisons in the entire period before T2DM diagnosis, with ORs ranging from 2.18 (95% CI: 1.91-2.48) in the earliest period (25-30 years before diagnosis) to 2.96 (95% CI: 2.85-3.08) in the latest period (<5 years before diagnosis). After T2DM diagnosis, 5-year CVD incidence was similarly increased in T2DM individuals vs comparisons (HR: 2.20; 95% CI: 2.12-2.27).

CONCLUSIONS

Individuals with T2DM had 2-fold more CVD events than matched comparisons starting 3 decades before T2DM diagnosis. This indicates that comprehensive preventive strategies may be initiated much earlier in individuals at risk of T2DM.

Incremental Prognostic Value of a Coronary Heart Disease Polygenic Risk Score in Type 2 Diabetes

OBJECTIVE

The recent availability of cardiovascular risk-reducing type 2 diabetes (T2D) therapies makes it imperative to optimally identify individuals who could derive benefit. Current clinical risk prediction may misclassify individuals as low risk and could be improved. Our aim was to determine the incremental prognostic value of a coronary heart disease (CHD) genome-wide polygenic risk score (PRS) to a clinical risk score in prediction of major adverse cardiovascular events (MACE) in patients with T2D.

RESEARCH DESIGN AND METHODS

We evaluated 10,556 individuals with T2D aged 40-79 years without a prior cardiovascular hospitalization. We calculated 10-year clinical cardiovascular risk at the date of recruitment using the Pooled Cohort Equation (PCE Risk) and constructed a CHD PRS. The primary outcome was time to first MACE incidence, and we assessed the additional incremental predictive value of the CHD PRS to the PCE risk.

RESULTS

At 10 years, there were 1,477 MACE. After adjustment for clinical risk, the CHD PRS was significantly associated with MACE (hazard ratio [HR] 1.69 per SD increase, 95% CI 1.60-1.79). Individuals with PCE Risk <7.5% but in the top quintile of CHD PRS had a significantly increased likelihood of MACE (HR 10.69, 95% CI 5.07-22.55) compared with those in the lowest. The addition of the PRS to the clinical risk score led to significant improvements in risk prediction, particularly in those at low clinical risk.

CONCLUSIONS

The addition of a CHD PRS to clinical assessment improved MACE prediction in T2D individuals without prior cardiovascular disease, particularly in those at low clinical risk.

The Role of Primary Care in Achieving Life's Essential 8: A Scientific Statement From the American Heart Association

To reduce morbidity and mortality rates of cardiovascular disease, an urgent need exists to improve cardiovascular health among US adults. In 2022, the American Heart Association issued Life's Essential 8, which identifies and defines 8 health behaviors and factors that, when optimized through a combination of primary prevention, risk factor management, and effective treatments, can promote ideal cardiovascular health. Because of its central role in patient care across the life span, primary care is in a strategic position to promote Life's Essential 8 and improve cardiovascular health in the United States. High-quality primary care is person-centered, team-based, community-aligned, and designed to provide affordable optimized health care. The purpose of this scientific statement from the American Heart Association is to provide evidence-based guidance on how primary care, as a field and practice, can support patients in implementing Life's Essential 8. The scientific statement aims to describe the role and functions of primary care, provide evidence for how primary care can be leveraged to promote Life's Essential 8, examine the role of primary care in providing access to care and mitigating disparities in cardiovascular health, review challenges in primary care, and propose solutions to address challenges in achieving Life's Essential 8.

Awareness of cardiovascular risk among persons with type 2 diabetes: a qualitative study

PURPOSE

To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D).

METHOD

A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory.

RESULT

The analysis identified the core category "Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it." Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management.

CONCLUSION

Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.

The association of glycaemic risk factors and diabetes duration with risk of heart failure in people with type 2 diabetes: A systematic review and meta-analysis

AIMS

To conduct a systematic review in order to better understand the association of glycaemic risk factors and diabetes duration with risk of heart failure (HF) in individuals with type 2 diabetes (T2D).

METHODS

We identified longitudinal studies investigating the association of glycaemic factors (glycated haemoglobin [HbA1c], HbA1c variability, and hypoglycaemia) and diabetes duration with HF in individuals with T2D. Hazard ratios and odds ratios were extracted and meta-analysed using a random-effects model where appropriate. Risk of bias assessment was carried out using a modified Newcastle-Ottawa Scale. Egger's test along with the trim-and-fill method were used to assess and account for publication bias.

RESULTS

Forty studies representing 4 102 589 people met the inclusion criteria. The risk of developing HF significantly increased by 15% for each percentage point increase in HbA1c, by 2% for each additional year of diabetes duration, and by 43% for having a history of severe hypoglycaemia. Additionally, variability in HbA1c levels was associated with a 20%-26% increased risk of HF for each unit increase in the metrics of variability (HbA1c standard deviation, coefficient of variation, and average successive variability). All included studies scored high in the risk of bias assessment. Egger's test suggested publication bias, with trim-and-fill analyses revealing a significant 14% increased risk of HF per percentage point increase in HbA1c.

CONCLUSIONS

Glycaemic risk factors and diabetes duration significantly contribute to the heightened risk of HF among individuals with T2D. A reduction in risk of HF is anticipated with better management of glycaemic risk factors.

Improved glycemic and weight control with Dulaglutide addition in SGLT2 inhibitor treated obese type 2 diabetic patients at high cardiovascular risk in a real-world setting. The AWARE-2 study

We evaluated the effects on glycemic control and body weight of a GLP1-RA in obese type 2 diabetic patients treated with SGLT2-inhibitors and other hypoglycemic agents and/or insulin, in a real-world setting. A cohort of 583 type 2 diabetic outpatients treated with a SGLT2 inhibitor and/or other anti-diabetic medications were examined. Because patients had suboptimal glycemic control, the GLP1-RA Dulaglutide was added to ongoing medications. At 6 months, 334 patients had a follow-up visit. Patients were classified in terms of cardiovascular risk (CVR) employing the ESC-EASD 2019 criteria, with the AWARE app. The study's primary endpoints were changes in: 1) HbA1c level, 2) BMI, and 3) body weight after six months of treatment. Secondary endpoints were evaluation of Dulaglutide addition in type 2 diabetic patients: 1) with more or less than ten years of T2DM; 2) more or less than 75 years of age and in different subgroups of CVR. In the 334 patients which had a 6 months follow-up visit, age was 65,9+9,8; 33.5 % (112) were females and 66.5 % (222) were males. After six months of Dulaglutide treatment, we found a significant reduction in HbA1c levels (8.0+10.5 mmol/mol; p<0.0001) and in body mass index (1.1+1.1 kg/m2; p<0.0001). Efficacy of Dulaglutide was not affected by different CVD risk categories, age and T2DM duration. This real world study provides evidence for significant reductions in HbA1c level, body mass index and body weight in obese type 2 diabetic patients who received add-on treatment with the weekly GLP-1RA, Dulaglutide.

Diabetes Mellitus and Cardiovascular Disease: Exploring Epidemiology, Pathophysiology, and Treatment Strategies

Diabetes mellitus (DM) affects 537 million people as of 2021, and is projected to rise to 783 million by 2045. This positions DM as the ninth leading cause of death globally. Among DM patients, cardiovascular disease (CVD) is the primary cause of morbidity and mortality. Notably, the prevalence rates of CVD is alarmingly high among diabetic individuals, particularly in North America and the Caribbean (46.0%), and Southeast Asia (42.5%). The predominant form of CVD among diabetic patients is coronary artery disease (CAD), accounting for 29.4% of cases. The pathophysiology of DM is complex, involving insulin resistance, β-cell dysfunction, and associated cardiovascular complications including diabetic cardiomyopathy (DCM) and cardiovascular autonomic neuropathy (CAN). These conditions exacerbate CVD risks underscoring the importance of managing key risk factors including hypertension, dyslipidemia, obesity, and genetic predisposition. Understanding the genetic networks and molecular processes that link diabetes and cardiovascular disease can lead to new diagnostics and therapeutic interventions. Imeglimin, a novel mitochondrial bioenergetic enhancer, represents a promising medication for diabetes with the potential to address both insulin resistance and secretion difficulties. Effective diabetes management through oral hypoglycemic agents (OHAs) can protect the cardiovascular system. Additionally, certain antihypertensive medications can significantly reduce the risk of diabetes-related CVD. Additionally, lifestyle changes, including diet and exercise are vital in managing diabesity and reducing CVD risks. These interventions, along with emerging therapeutic agents and ongoing clinical trials, offer hope for improved patient outcomes and long-term DM remission. This study highlights the urgent need for management strategies to address the overlapping epidemics of DM and CVD. By elucidating the underlying mechanisms and risk factors, this study aims to guide future perspectives and enhance understanding of the pathogenesis of CVD complications in patients with DM, thereby guiding more effective treatment strategies.

Association between waist circumference or weight change after smoking cessation and incidence of cardiovascular disease or all-cause death in Korean adults with type 2 diabetes

Objective

To investigate the association among smoking cessation, weight or waist circumference change post-cessation, and cardiovascular disease (CVD) or all-cause death among patients with type 2 Diabetes (T2D).

Materials and methods

This retrospective cohort study included 32,142 patients with T2D classified according to changes in smoking status, post-cessation weight, and waist circumference. Especially for recent or long-term quitters, participants who changed from current to none/former smoker or from non-smoker to former smoker were defined as recent quitters, and those who changed from former to none/former smoker were defined as long-term quitters. CVD or all-cause death risk was evaluated.

Results

A total of 5,845 participants were newly diagnosed with CVD, and 3,723 died during follow-up. After adjusting for potential confounding factors, compared with current smokers, the hazard ratios (HRs) for CVD were 0.94 (95% confidence interval [CI]: 0.85-1.03), 0.82 (95% CI: 0.74-0.90), and 0.82 (95% CI: 0.75-0.90) for recent quitters, long-term quitters, non-smokers, respectively; 0.88 (95% CI: 0.78-0.99), 0.68 (95% CI: 0.57-0.81), and 0.82 (95% CI: 0.67-1.00) for long-term quitters with no waist circumference gain, long-term quitters with waist circumference gain of 0.1-5.0 cm, and long-term quitters with waist circumference gain ≥5.0 cm, respectively; and 0.79 (95% CI: 0.71-0.89), 0.85 (95% CI: 0.74-0.98), and 0.84 (95% CI: 0.60-1.17) for long-term quitters with no weight gain, long-term quitters with weight gain of 2-5 kg, and long-term quitters with weight gain ≥5 kg, respectively. Similar associations were observed for all-cause death.

Conclusions

Patients with T2D should maintain their weight and waist circumference after long-term smoking cessation to prevent CVD. It is more important for them to maintain weight rather than waist circumference to prevent all-cause death.

TIWMFLP: Two-Tier Interactive Weighted Matrix Factorization and Label Propagation Based on Similarity Matrix Fusion for Drug-Disease Association Prediction

Accurately identifying new therapeutic uses for drugs is crucial for advancing pharmaceutical research and development. Matrix factorization is often used in association prediction due to its simplicity and high interpretability. However, existing matrix factorization models do not enable real-time interaction between molecular feature matrices and similarity matrices, nor do they consider the geometric structure of the matrices. Additionally, efficiently integrating multisource data remains a significant challenge. To address these issues, we propose a two-tier interactive weighted matrix factorization and label propagation model based on similarity matrix fusion (TIWMFLP) to assist in personalized treatment. First, we calculate the Gaussian and Laplace kernel similarities for drugs and diseases using known drug-disease associations. We then introduce a new multisource similarity fusion method, called similarity matrix fusion (SMF), to integrate these drug/disease similarities. SMF not only considers the different contributions represented by each neighbor but also incorporates drug-disease association information to enhance the contextual topological relationships and potential features of each drug/disease node in the network. Second, we innovatively developed a two-tier interactive weighted matrix factorization (TIWMF) method to process three biological networks. This method realizes for the first time the real-time interaction between the drug/disease feature matrix and its similarity matrix, allowing for a better capture of the complex relationships between drugs and diseases. Additionally, the weighted matrix of the drug/disease similarity matrix is introduced to preserve the underlying structure of the similarity matrix. Finally, the label propagation algorithm makes predictions based on the three updated biological networks. Experimental outcomes reveal that TIWMFLP consistently surpasses state-of-the-art models on four drug-disease data sets, two small molecule-miRNA data sets, and one miRNA-disease data set.

Age at type 2 diabetes diagnosis and the risk of mortality among US population

To examine the relationship between age at diagnosis of type 2 diabetes (T2DM) with cardiovascular and all-cause mortality in the U.S. population. Data was used from NHANES 1999 ~ 2018, which were screened to include a total of 8,654 participants with a diagnosis of diabetes for the study. We estimated the association between age at diagnosis and cardiovascular and all-cause mortality using weighted multivariate Cox regression analyses. Subgroup analyses and sensitivity analyses were performed to ensure the robustness of the data analysis. The number of participants diagnosed with diabetes at ages < 40, between 40 and 59, and > 60 are 1,492, 3,970, and 3,192, respectively, with median ages of 44.04, 57.59, and 72.24. Among patients diagnosed with T2DM, the relative risk of all-cause mortality increased with younger age at diagnosis: compared to patients with late-onset diabetes (age at type 2 diabetes diagnosis ≥ 60), the hazard ratio for all-cause mortality was 2.72 (95% CI 1.83-4.05) in those with early-onset diabetes (age at type 2 diabetes diagnosis < 40). Similarly, the risk of cardiovascular disease death was observed to be a higher relative risk with younger age at diagnosis. Exposure-effect analysis indicated that younger age at diagnosis is associated with higher risk of all-cause mortality. Subgroup analysis found that the association between age at diagnosis and cardiovascular and all-cause mortality was stronger in the current smokers and hypertensive population. The results of this study suggest that younger age at diagnosis of T2DM is associated with higher risk of death in patients. Younger patients diagnosed with T2DM had a higher risk of cardiovascular and all-cause mortality. These findings strengthen the understanding of the risk of death from T2DM and emphasize the importance of early prevention of diabetes.

Neem seed oil ameliorates diabetic phenotype by suppressing redox imbalance, dyslipidaemia and pro-inflammatory mediators in a rodent model of type 2 diabetes

The neem plant (Azadirachta indica) has popular ethnomedicinal applications. The anti-diabetic potential and mechanism of neem seed oil (NSO) in a rodent model of type 2 diabetes mellitus was evaluated in the present study. Experimentally-induced diabetic animals were administered NSO (200 and 400 mg/kg) or metformin (150 mg/kg) orally for 30 days, with some animals serving as positive and negative controls. NSO significantly (p < .05) reversed diabetes-induced impaired glucose metabolism, dyslipidaemia, and oxido-inflammatory imbalances typified by changes in the NADH/NAD+ ratio (p < .001) and increases in the mRNA or protein levels of C-reactive protein, 4-hydroxynonenal, and pro-inflammatory cytokines (TNF-α and Il-1β) among others in the hepatic or pancreatic tissues of diabetic animals. The histological evaluation of the pancreatic tissue corroborated the protective effect of NSO. The findings showed that the antidiabetic effect of NSO proceeded through its hypolipidemic effect and modulation of redox and inflammatory signalling events in the tissues of animals.

Digital, Social Micro-Interventions to Promote Physical Activity Among Midlife Adults With Elevated Cardiovascular Risk: An Ambulatory Feasibility Study With Momentary Randomization

BACKGROUND

Although regular physical activity (PA) mitigates the risk for cardiovascular disease (CVD) during midlife, existing PA interventions are minimally effective. Harnessing social influences in daily life shows promise: digital micro-interventions could effectively engage these influences on PA and require testing.

PURPOSE

This feasibility study employed ecological momentary assessment with embedded micro-randomization to activate two types of social influences (i.e., comparison, support; NCT04711512).

METHODS

Midlife adults (N = 30, MAge = 51, MBMI = 31.5 kg/m2, 43% racial/ethnic minority) with ≥1 CVD risk conditions completed four mobile surveys per day for 7 days while wearing PA monitors. After 3 days of observation, participants were randomized at each survey to receive 1 of 3 comparison micro-interventions (days 4-5) or 1 of 3 support micro-interventions (days 6-7). Outcomes were indicators of feasibility (e.g., completion rate), acceptability (e.g., narrative feedback), and potential micro-intervention effects (on motivation and steps within-person).

RESULTS

Feasibility and acceptability targets were met (e.g., 93% completion); ratings of micro-intervention helpfulness varied by intervention type and predicted PA motivation and behavior within-person (srs=0.16, 0.27). Participants liked the approach and were open to ongoing micro-intervention exposure. Within-person, PA motivation and behavior increased from baseline in response to specific micro-interventions (srs=0.23, 0.13), though responses were variable.

CONCLUSIONS

Experimental manipulation of social influences in daily life is feasible and acceptable to midlife adults and shows potential effects on PA motivation and behavior. Findings support larger-scale testing of this approach to inform a digital, socially focused PA intervention for midlife adults.

Mechanistic insights and therapeutic potential of astilbin and apigenin in diabetic cardiomyopathy

Diabetic cardiomyopathy (DCM) represents a critical complication of Diabetes mellitus (DM), characterized by structural and functional changes in the myocardium independent of coronary artery disease or hypertension. Emerging evidence highlights the significant roles of phytochemicals, particularly astilbin and apigenin, in modulating key molecular pathways implicated in DCM. This review synthesizes current mechanistic insights and therapeutic potential of these compounds, focusing on their interactions with AMP-activated protein kinase (AMPK), peroxisome proliferator-activated receptors (PPARs), O-linked N-acetylglucosamine (O-GlcNAc), sodium-glucose co-transporter 2 (SGLT2), protein kinase C (PKC), nuclear factor kappa B (NF-κB), mitogen-activated protein kinase (MAPK), and c-Jun N-terminal kinase (JNK) pathways. Astilbin and apigenin have demonstrated the ability to improve cardiac function, mitigate oxidative stress, and reduce inflammatory responses in diabetic conditions. By activating AMPK and PPARs, these flavonoids enhance glucose uptake and fatty acid oxidation, contributing to improved metabolic homeostasis. Their inhibition of O-GlcNAcylation, SGLT2 activity, and PKC signaling further attenuates hyperglycemia-induced cellular damage. Additionally, suppression of NF-κB, MAPK, and JNK pathways by astilbin and apigenin results in reduced pro-inflammatory cytokine production and apoptotic cell death. Collectively, these interactions position astilbin and apigenin as promising therapeutic agents for ameliorating DCM, offering novel avenues for treatment strategies aimed at modulating multiple pathogenic pathways.

Colchicine prevents accelerated atherosclerosis in TET2-mutant clonal haematopoiesis

BACKGROUND AND AIMS

Somatic mutations in the TET2 gene that lead to clonal haematopoiesis (CH) are associated with accelerated atherosclerosis development in mice and a higher risk of atherosclerotic disease in humans. Mechanistically, these observations have been linked to exacerbated vascular inflammation. This study aimed to evaluate whether colchicine, a widely available and inexpensive anti-inflammatory drug, prevents the accelerated atherosclerosis associated with TET2-mutant CH.

METHODS

In mice, TET2-mutant CH was modelled using bone marrow transplantations in atherosclerosis-prone Ldlr-/- mice. Haematopoietic chimeras carrying initially 10% Tet2-/- haematopoietic cells were fed a high-cholesterol diet and treated with colchicine or placebo. In humans, whole-exome sequencing data and clinical data from 37 181 participants in the Mass General Brigham Biobank and 437 236 participants in the UK Biobank were analysed to examine the potential modifying effect of colchicine prescription on the relationship between CH and myocardial infarction.

RESULTS

Colchicine prevented accelerated atherosclerosis development in the mouse model of TET2-mutant CH, in parallel with suppression of interleukin-1β overproduction in conditions of TET2 loss of function. In humans, patients who were prescribed colchicine had attenuated associations between TET2 mutations and myocardial infarction. This interaction was not observed for other mutated genes.

CONCLUSIONS

These results highlight the potential value of colchicine to mitigate the higher cardiovascular risk of carriers of somatic TET2 mutations in blood cells. These observations set the basis for the development of clinical trials that evaluate the efficacy of precision medicine approaches tailored to the effects of specific mutations linked to CH.

Engineering Supramolecular Nanofiber Depots from a Glucagon-Like Peptide-1 Therapeutic

Diabetes and obesity have emerged as major global health concerns. Glucagon-like peptide-1 (GLP-1), a natural incretin hormone, stimulates insulin production and suppresses glucagon secretion to stabilize and reduce blood glucose levels and control appetite. The therapeutic use of GLP-1 receptor agonists (e.g., semaglutide) has transformed the standard of care in recent years for treating type 2 diabetes and reversing obesity. The native GLP-1 sequence has a very short half-life, and therapeutic advances have come from molecular engineering to alter the pharmacokinetic profile of synthetic GLP-1 receptor agonists to enable once-weekly administration, reduce the frequency of injection, and improve adherence. Efforts to further extend this profile would offer additional convenience or enable entirely different treatment modalities. Here, an injectable GLP-1 receptor agonist depot is engineered through integration of a prosthetic self-assembling peptide motif to enable supramolecular nanofiber formation and hydrogelation. This supramolecular GLP-1 receptor agonistic (PA-GLP1) offers sustained release in vitro for multiple weeks, supporting long-lasting therapy. Moreover, in a rat model of type 2 diabetes, a single injection of the supramolecular PA-GLP1 formulation achieved sustained serum concentrations for at least 40 days, with an overall reduction in blood glucose levels and reduced weight gain, comparing favorably to daily injections of semaglutide. The general and modular approach is also extensible to other next-generation peptide therapies. Accordingly, the formation of supramolecular nanofiber depots offers a more convenient and long-lasting therapeutic option to manage diabetes and treat metabolic disorders.

Systematic review and meta-analysis assessing the status of carotid intima-media thickness and lipid profiles in type 2 diabetes mellitus

OBJECTIVES

Carotid intima-media thickness (CIMT) is a measurement for subclinical atherosclerosis and has been associated with overall cardiovascular diseases, especially in type 2 diabetes mellitus (T2DM). We aimed to assess the status of carotid health and lipid profile in T2DM.

DESIGN

This systematic review and meta-analysis synthesised data published from clinical studies.

DATA SOURCES

Google Scholar, PubMed and Scopus were searched from inception to 18 January 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies conducted in patients with T2DM and those without T2DM were included. Studies conducted in T2DM adults evaluating carotid status and lipid profile were considered.

DATA EXTRACTION AND SYNTHESIS

Two authors independently used standardised methods to comprehensively search, screen and extract data from all relevant studies. The risk of bias was assessed using the Newcastle-Ottawa checklist. Meta-analysis was conducted using Review Manager and metaHun through random effects models. The random effect model was used due to high heterogeneity.

RESULTS

Evidence was analysed from 57 studies with a sample size of 29 502 (8254 T2DM and 21 248 people without T2DM). There was a significantly higher CIMT, with a standardised mean difference (SMD) of 1.01 (95% CI 0.75, 1.26, p<0.00001). Additionally, there was an elevated triglyceride (TG) (SMD=1.12, 95% CI 0.82, 1.41, p<0.00001), total cholesterol (TC), (SMD=0.24, 95% CI 0.02, 0.46, p=0.03) and low-density lipoprotein-cholesterol (LDL-C), (SMD=0.35, 95% CI 0.11, 0.59, p=0.004) in patients with T2DM compared with those without T2DM. Furthermore, a significant decrease in high-density lipoprotein cholesterol (HDL-C) was observed in the T2DM compared with people without T2DM, SMD=-0.79, 95% CI -0.96, -0.62, p<0.00001). Age, body mass index and hypertension were associated with increased CIMT and TG and decreased HDL-C in T2DM. Additionally, age, gender and hypertension were associated with an increased LDL-C in T2DM.

CONCLUSION

Our findings suggest that an increased CIMT is accompanied by increased TG, TC, LDL-C and HDL-C reduction in patients with T2DM.

PROSPERO REGISTRATION NUMBER

CRD42023451731.

Metformin associates with higher myocardial perfusion reserve and survival in type 2 diabetes mellitus patients

Metformin is an antihyperglycemic used to treat type 2 diabetes mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular disease. We explored the association between metformin use and cardiovascular magnetic resonance (CMR) derived stress myocardial blood flow (MBF), myocardial perfusion reserve (MPR) and major adverse cardiovascular events (MACE; all cause death, MI, stroke, heart failure hospitalisation and coronary revascularisation) in patients with T2DM. Multi-centre study of patients with T2DM, and healthy controls, underwent quantitative myocardial perfusion CMR using an artificial intelligence supported process. Multivariable regression analysis, and cox proportional hazard models of propensity score weighted patients quantified associations between metformin use, MBF, MPR, all cause death and MACE. Analysis included 572 patients with T2DM (68% prescribed metformin) with median follow-up 851 days (IQR 935 - 765). Metformin use was associated with an increase of MPR of 0.12 [0.08-0.40], p = 0.004. There were 82 MACE events (14.3%) including 25 (4.4%) deaths of which 16 were in those not prescribed metformin (8.7%), compared to 9 in patients prescribed metformin (2.3%): adjusted hazard ratio 0.24 (95% CI 0.08-0.70, p = 0.009). MACE events were similar between groups. This multicentre, inverse probability weighting propensity score analysis study showed that in patients with T2DM, metformin use is associated with higher MPR and improved all cause survival.

Prescription Fills Among Patients With Type 2 Diabetes After Hospitalization for Acute Coronary Syndrome

Importance

Individuals with type 2 diabetes (T2D) have high rates of mortality following myocardial infarction (MI). Hospitalization is an opportunity to initiate or continue evidence-based treatment to reduce risk in individuals with T2D and acute coronary syndrome (ACS).

Objective

To determine patterns of evidence-based medication use during the period of transition from admission to discharge after hospitalization for MI or coronary revascularization among individuals with T2D and ACS.

Design, Setting, and Participants

This retrospective cohort study used data from the Centers for Medicare & Medicaid Services (CMS) for January 1, 2018, to June 30, 2020. Medicare beneficiaries older than 18 years with T2D with a qualifying hospitalization were included. Individuals were followed before admission (90 days prior), at discharge (≤90 days), and after discharge (91-180 days after) from a hospitalization for MI or coronary revascularization. Data analysis was performed in June 2023.

Exposures

Demographic data (race, sex, rural vs urban location of care, and comorbidities) were abstracted from CMS data using Master Beneficiary and Summary Files and International Statistical Classification of Diseases, Tenth Revision codes.

Main Outcome and Measures

Medicare Part D prescription fill records were examined for the following agents: (1) angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs); (2) β-blockers; (3) platelet adenosine diphosphate receptor inhibitors (P2Y12Is); (4) statins or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9Is); and (5) glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium glucose cotransporter 2 inhibitors (SGLT2Is). Logistic regression analysis was used to examine the association between covariates and lack of prescription fills in the postdischarge period.

Results

A total of 188 651 eligible Medicare beneficiaries with T2D and hospitalization for MI or coronary revascularization were identified. Their median age was 73.0 (IQR, 67.0-79.0) years, and more than half (111 982 [59.4%]) were men; 18 383 (9.7%) were Black and 153 461 (81.3%) were White. Not filling a cardiovascular medication after hospitalization was associated with not filling that medication at the time of discharge (adjusted risk ratio, 0.27 [95% CI, 0.27-0.28] for ACEIs, ARBs, or ARNIs; 0.24 [0.24-0.25] for β-blockers; 0.20 [0.19-0.20] for P2Y12Is; 0.31 [0.31-0.32] for statins or PCSK9Is; and 0.27 [0.26-0.28] for SGLT2Is or GLP-1RAs).

Conclusions and Relevance

In this cohort study of Medicare beneficiaries with T2D, longer-term medication use following hospitalization for MI was associated with medication use at the time of discharge. These findings highlight the critical importance of this period to optimize preventive care for these high-risk individuals. Further implementation science research is needed to develop strategies to improve use of these evidence-based medications.

Evaluating Risk Factors and the Burden of Silent Myocardial Ischemia Among Diabetic Patients

INTRODUCTION

Silent myocardial ischemia (SMI) is a significant concern for diabetic patients, often remaining undetected until severe complications arise. Prolonged hyperglycemia, poor glycemic control, and lifestyle factors contribute to its risk, with older adults and those with long-standing diabetes particularly vulnerable.

OBJECTIVE

To assess the prevalence and predictors of SMI in adults with diabetes, emphasizing long-term management and monitoring.

METHODOLOGY

A longitudinal observational study was conducted at Nishtar Medical University, Multan, from October 2020 to September 2022, involving 388 adults with diabetes for at least five years. Patients with significant cardiovascular diseases or recent medication-affecting biomarkers were excluded. Data collection included demographics, medical history, and clinical assessments such as HbA1c levels, 12-lead resting ECGs, and treadmill exercise stress tests, with myocardial perfusion imaging (MPI) for those unable to perform stress tests. Statistical analyses using IBM SPSS (version 22) incorporated univariate and multivariate logistic regression to identify predictors of SMI, adjusting for confounders such as age, sex, smoking, and blood pressure. Thresholds included microalbuminuria at 30-300 mg/24 hours and HbA1c ≥7%, with missing data addressed through multiple imputations.

RESULTS

Among the participants, the prevalence of SMI was 48%, increasing to 58% in those with microalbuminuria. Significant predictors included the duration of diabetes (OR 1.28, 95% CI: 1.08-1.52, p=0.001), HbA1c levels (OR 1.75, 95% CI: 1.42-2.16, p<0.001), age (OR 1.05, 95% CI: 1.01-1.09, p=0.035), and smoking status (OR 1.42, 95% CI: 1.05-1.92, p=0.025). Smoking status was based on self-report. Notably, microalbuminuria showed a strong association with SMI (OR 2.89, 95% CI: 2.10-3.98, p<0.001). The distribution of participants was balanced in terms of age and gender, with a mean age of 58 years (SD 9.4), and 52% were male. No unexpected findings were observed, and the results aligned with the anticipated relationships between the variables.

CONCLUSION

This study highlights a concerning prevalence of SMI among diabetic patients, emphasizing the importance of monitoring diabetes duration and glycemic control, particularly in individuals with microalbuminuria. Regular follow-up care, including routine ECGs, stress tests, and biomarker assessments, is crucial for improving cardiovascular outcomes in this high-risk population. Limitations such as the observational design and potential self-report bias in smoking status may affect the generalizability of the findings. Future research should focus on large-scale, multicenter studies to validate these findings and explore interventions that could reduce the burden of SMI in diabetic patients.

5-Year effects of a novel continuous remote care model with carbohydrate-restricted nutrition therapy including nutritional ketosis in type 2 diabetes: An extension study

AIMS

This study assessed the five-year effects of a continuous care intervention (CCI) delivered via telemedicine, counseling people with type 2 diabetes (T2D) on a very low carbohydrate diet with nutritional ketosis.

METHODS

Participants with T2D were enrolled in a 2-year, open-label, non-randomized study comparing CCI and usual care (UC). After 2 years, 194 of the 262 CCI participants were approached for a three-year extension. Of these, 169 consented, and 122 remained in the study for five years. Primary outcomes were changes in diabetes status assessed using McNemars' test, including remission and HbA1c < 6.5 % on no glucose lowering medication or only on metformin at 5 years. Changes in body mass, glycemia, and cardiometabolic markers from baseline to 5 years were assessed using linear mixed-effects models.

RESULTS

Twenty percent (n = 24) of the five-year completers achieved remission, with sustained remission observed over three years in 15.8 % (n = 19) and four years in 12.5 % (n = 15). Reversal to HbA1c < 6.5 % without medication or only metformin was seen in 32.5 % (n = 39). Sustained improvements were noted in body mass (-7.6 %), HbA1c (-0.3 %), triglycerides (-18.4 %), HDL-C (+17.4 %), and inflammatory markers, with no significant changes in LDL-C and total cholesterol.

CONCLUSIONS

Over five years, the very low carbohydrate intervention showed excellent retention and significant health benefits, including diabetes remission, weight loss, and improved cardiometabolic markers.

Plant-Based Diets and Phytochemicals in the Management of Diabetes Mellitus and Prevention of Its Complications: A Review

Diabetes mellitus (DM) is currently regarded as a global public health crisis for which lifelong treatment with conventional drugs presents limitations in terms of side effects, accessibility, and cost. Type 2 diabetes (T2DM), usually associated with obesity, is characterized by elevated blood glucose levels, hyperlipidemia, chronic inflammation, impaired β-cell function, and insulin resistance. If left untreated or when poorly controlled, DM increases the risk of vascular complications such as hypertension, nephropathy, neuropathy, and retinopathy, which can be severely debilitating or life-threatening. Plant-based foods represent a promising natural approach for the management of T2DM due to the vast array of phytochemicals they contain. Numerous epidemiological studies have highlighted the importance of a diet rich in plant-based foods (vegetables, fruits, spices, and condiments) in the prevention and management of DM. Unlike conventional medications, such natural products are widely accessible, affordable, and generally free from adverse effects. Integrating plant-derived foods into the daily diet not only helps control the hyperglycemia observed in DM but also supports weight management in obese individuals and has broad health benefits. In this review, we provide an overview of the pathogenesis and current therapeutic management of DM, with a particular focus on the promising potential of plant-based foods.

Bibliometric and visual analysis of SGLT2 inhibitors in cardiovascular diseases

Background

Cardiovascular diseases (CVD) pose a significant threat to human health due to their high mortality and morbidity rates. Despite advances in treatments, the prevalence and impact of cardiovascular disease continue to increase. Sodium-glucose transporter 2 inhibitors (SGLT2i), initially approved for the treatment of type 2 diabetes, have important research value and promising applications in reducing CVD risk, especially in heart failure (HF) and atherosclerosis patients with cardiovascular disease (ASCVD). This study aims to comprehensively review the latest progress, research trends, cutting-edge hot spots, and future development directions of SGLT2i in the field of CVD through bibliometric analysis.

Methods

Articles related to MSCs in cardiovascular diseases were sourced from the Web of Science. The bibliometric analysis was conducted using CiteSpace and VOSviewer, and a knowledge map was created based on the data obtained from the retrieved articles.

Results

In this article, we screened 3,476 relevant studies, including 2,293 articles and 1,183 reviews. The analysis found that the number of papers related to the application of SGLT2i in CVD has generally increased, peaking in 2022. The United States and China contributed the largest number of papers, with the United States accounting for 36.97% of the total and also ranking first in terms of the number of citations. However, China's high-quality papers are slightly lacking and need further improvement. Keyword analysis showed that empagliflozin, dapagliflozin, diabetes, and heart failure were the most common terms, reflecting the main research interests in currently published papers in this field.

Conclusion

Bibliometric analysis showed a robust and growing interest in the application of SGLT2i for treating CVD. By summarizing the latest progress of SGLT2i in the field of CVD, exploring research hotspots, and looking forward to future research development trends, this article provides valuable insights for thinking about research prospects.

Effects of glucagon-like peptide-1 receptor agonists on cardiovascular outcomes in high-risk type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been shown to provide cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM). However, their cardiovascular protective efficacy in high-risk T2DM patients, particularly those with a history of cardiovascular events or severe chronic kidney disease, remains uncertain.

METHODS

A comprehensive search was conducted in PubMed, Embase, Web of Science, and The Cochrane Library to identify randomized controlled trials (RCTs) that evaluated the effects of GLP-1 RAs on cardiovascular outcomes in high-risk patients with T2DM. A random-effects model was used to calculate pooled hazard ratios (HRs) for cardiovascular outcomes. Subgroup analyses and GRADE assessment were also performed.

RESULTS

Nine RCTs involving 63,613 patients were included. GLP-1 RAs significantly reduced the risk of the primary composite outcome (HR: 0.86, 95% CI: 0.80-0.92), cardiovascular death (HR: 0.85, 95% CI: 0.78-0.93), all-cause death (HR: 0.87, 95% CI: 0.82-0.93), myocardial infarction (HR: 0.90, 95% CI: 0.82-0.98), stroke (HR: 0.85, 95% CI: 0.77-0.95), and heart failure (HF) hospitalization (HR: 0.90, 95% CI: 0.83-0.97). No significant difference in unstable angina (UA) hospitalization was observed (HR: 1.04, 95% CI: 0.95-1.15). Subgroup analyses indicated greater benefits with combination therapy, particularly in patients with chronic kidney disease. The quality of evidence was rated as "High" for six outcomes and "Moderate" for UA hospitalization.

CONCLUSIONS

GLP-1 RAs significantly reduce cardiovascular risk in high-risk T2DM patients, especially with combination therapy and in those with chronic kidney disease. However, further research is needed to confirm their long-term effects.

Recent trends of low-density lipoprotein cholesterol control and lipid-lowering therapy in patients with atherosclerotic cardiovascular disease in Taiwan: 2015-2020

OBJECTIVE

This study aimd to assess recent trends in the control of low-density lipoprotein cholesterol (LDL-C) and the utilization of lipid-lowering drugs (LLD) among patients with atherosclerotic cardiovascular disease (ASCVD) in Taiwan.

METHODS

Patients with ASCVD and without a history of hemorrhagic stroke were identified from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. ASCVD patients were stratified into four categories: those who ever had acute coronary syndrome (ACS), those who underwent percutaneous coronary intervention or coronary artery bypass grafting (PCI/CABG) without ACS, those who ever had an ischemic stroke (IS) without ACS or PCI/CABG, and other ASCVD cases. We assessed their latest recorded LDL-C levels for the periods 2015-16, 2017-18, and 2019-20. LLD therapy patterns were presented as monotherapy, dual therapy, or combination therapy of three or more drugs, with statin use classified by intensity.

RESULTS

We identified 3831 ASCVD patients in 2015-16, 3531 in 2017-18, and 1231 in 2019-20. LLD utilization rose from 58.4% in 2015-16 to 73.2% in 2019-20. The proportions of patients achieving LDL-C goals in 2015-16, 2017-18, and 2019-20 were 21.5%, 25.8%, and 33.3% in the ACS cohort (goal <70 mg/dL); 20.4%, 26.1%, and 39.0% in the PCI/CABG cohort (goal <70 mg/dL); 54.4%, 58.5%, and 58.9% in the IS cohort (goal <100 mg/dL); and 60.0%, 65.5%, and 67.0% in the other ASCVD cohort (goal <100 mg/dL), respectively. Over half of the patients were prescribed moderate-intensity statins. Statin use, age, history of diabetes mellitus, and hypertension were important factors for attaining LDL-C goal in ACS patients.

CONCLUSION

Despite improvements in LDL-C management observed over recent years, significant gaps remain in guideline adherence, especially for patients with ACS or PCI/CABG in Taiwan, with over 60% not meeting LDL-C targets. Intensifying efforts to align clinical practice with guidelines are imperative.

Joint effects of physical frailty and traditional cardiovascular risk factor control on cardiovascular disease in patients with diabetes

OBJECTIVES

Physical frailty has been found to increase the risk of multiple adverse outcomes including cardiovascular disease (CVD) in diabetic patients, but whether this could be modified by traditional risk factor control remains unknown. We aimed to explore the joint and interaction effects of frailty and traditional risk factor control on the risk of CVD.

DESIGN

A population-based cohort study.

SETTING AND PARTICIPANTS

We included 15,753 participants with type 2 diabetes at baseline from UK Biobank.

MEASUREMENTS

Physical frailty was assessed by Fried criteria's frailty phenotype. The degree of risk factor control was determined by the numbers of the following factors controlled within the target range, including glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, smoking, and kidney condition. Incident CVD included coronary heart disease, stroke, or heart failure. Cox proportional hazard models were used to assess the individual and joint effects of frailty and risk factor control on the risk of CVD.

RESULTS

After a median follow-up of 13.5 years, 1129 incident CVD events were observed. Compared with non-frailty, both prefrailty and frailty were significantly associated with increased risk of CVD (HR 1.22, 95% CI [1.13, 1.31] for pre-frailty and 1.70 [1.53, 1.90] for frailty). For the joint effects, participants with frailty and a low degree of risk factor control (control of 0-1 risk factors) had the highest risk of CVD (2.92 [2.04, 4.17]) compared to those with non-frailty and optimal risk factor control (control of 4-5 risk factors). Moreover, a significant additive interaction between frailty and risk factor control was observed, with around 3.8% of CVD risk attributed to the interactive effects.

CONCLUSIONS

Both prefrailty and frailty were associated with a higher risk of CVD in participants with type 2 diabetes. Moreover, physical frailty could interact with the degree of risk factor control in an additive manner to increase the CVD risk.

The effect of blood flow-restrictive resistance training on the risk of atherosclerotic cardiovascular disease in middle-aged patients with type 2 diabetes: a randomized controlled trial

Introduction

The aim of this study was to investigate the effects of blood flow-restrictive resistance training (BFR-RT) on improving metabolic abnormalities, blood pressure (BP), obesity, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk in middle-aged patients with type 2 diabetes mellitus (T2DM).

Method

We conducted a parallel-group, single blind randomized controlled trial. Participants who met the inclusion criteria were randomly divided into control group, BFR-RT group and aerobic exercise (AE) group. Control group received health education and follow-up; Two exercise groups received supervised collective training for a period of six months, three times per week. AE group trained at moderate-intensity for 60 minutes each time, while BFR-RT group trained at low-intensity for 40 minutes each time. The primary outcomes were change in 10-year ASCVD risk index and level, and the secondary outcomes included changes in fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), blood lipids, BP, and obesity level within and across the three groups at baseline, the third and sixth months of intervention.

Result

Among 93 individuals (control group, n=31; AE, n=30; BFR-RT, n=32) were analyzed. At baseline, there were no significant differences in various indicators among the three groups (p>0.05). After intervention, the 10-year ASCVD risk index and risk level of both exercise groups significantly decreased compared to the control group and baseline (p<0.05), and the risk reduction became more pronounced over time. In the sixth month of intervention, the 10-year ASCVD risk index in the AE group decreased by 27.40%, and that in the BFR-RT group decreased by 26.78%. Meanwhile, apart from lipoprotein (a) and diastolic blood pressure, both exercise groups showed significant improvements in FPG, HbA1c, dyslipidemia, systolic blood pressure, and obesity indicators compared to the control group and baseline (p<0.05). There was no significant difference in various indicators between the two exercise groups (p>0.05).

Conclusion

BFR-RT could reduce the 10-year ASCVD risk in middle-aged T2DM patients for by improving metabolic abnormalities, BP and obesity, and its effect was similar to that of moderate-intensity AE.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=178886, identifier ChiCTR2300074357.

Protective effects of puerarin on metabolic diseases: Emphasis on the therapeutical effects and the underlying molecular mechanisms

Metabolic diseases (MetD) such as diabetes mellitus, obesity, and hyperlipidemia have become global health challenges. As a naturally occurring plant component, puerarin has been verified to possess a wide range of pharmacological effects including lowering blood glucose, improving insulin resistance, and regulating lipid metabolism, which has attracted extensive attention in recent years, and its potential in the treatment of MetD has been highly acclaimed. In addition, puerarin has exhibited antioxidant, anti-inflammatory, and cardiovascular protective effects, which are of great significance in the prevention and treatment of MetD. This article comprehensively summarizes the research progress of puerarin in the treatment of MetD and explores its pharmacological mechanisms, clinical applications, and future perspectives. More importantly, this review provided a list of the involved molecular mechanims in treating MetD of puerarin. Taking into account these conclusions, it may provide a strong foundation for the optimized use of puerarin in the treatment of patients suffering from MetD.

Determinants of and barriers to diabetes care among patients with serious mental illness: A scoping review with recommendations

AIM

We performed a scoping review to identify the diabetes care determinants and barriers in patients with serious mental illness (SMI), in view of limited evidence and clarity.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines. PubMed, EMBASE, and Scopus were searched from inception to September 2023 to identify eligible studies. Observational studies that reported the determinants of and barriers to diabetes care among SMI patients were considered. A narrative synthesis of review results was performed to gather evidence. Recommendations were framed in the context of this evidence.

RESULTS

Of the 8727 non-duplicate records, only 10 studies that met the inclusion criteria were considered for this review. Of these, four were cohort, two were case-control, and four were cross-sectional in design. All 10 studies were observed to have robust methodologies. Diabetes measures examined in these studies included not only the Healthcare Effectiveness Data and Information Set (HEDIS) measures (HbA1c, retinopathy, nephropathy, and blood pressure), but also lipid, foot, and BMI. Factors contributing to inadequate diabetes care can be attributed to the healthcare system, healthcare providers, and at the patient-level.

CONCLUSION

Currently, there is lack of evidence on determinants of quality diabetes care among SMI patients. Further, adequately powered long term follow-up studies are needed to understand the impact of diabetes care on their clinical outcomes.

Key results from observational studies and real-world evidence of sodium-glucose cotransporter-2 inhibitor effectiveness and safety in reducing cardio-renal risk

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, originally designed to manage blood sugar levels in individuals with type 2 diabetes (T2D), have emerged as a crucial class of drugs for managing cardio-renal diseases. These drugs work by targeting the SGLT2 protein in the kidneys, promoting the excretion of glucose and influencing metabolic pathways beyond glucose control. The relationship between cardio-renal diseases and SGLT2 inhibitors has been explored through landmark trials and real-world evidence (RWE) studies, demonstrating significant reductions in cardio-renal complications. This review discusses the importance of RWE studies alongside randomized controlled trials in understanding the real-world effectiveness and safety of SGLT2 inhibitors. It outlines the advantages and disadvantages of RWE compared to RCTs, highlighting their complementary roles in providing comprehensive insights into treatment outcomes. By examining a range of RWE studies, the review underscores the cardio-renal benefits of SGLT2 inhibitors across various patient populations. Safety assessments indicate that SGLT2 inhibitors are generally well tolerated, with severe adverse events being rare. Common issues, such as genital mycotic infections and urinary tract infections, are acknowledged, alongside less frequent but significant adverse events including diabetic ketoacidosis, lower-limb amputations, and bone fractures. In summary, SGLT2 inhibitors show promising cardio-renal protective effects in real-world scenarios across diverse populations in T2D, indicating their potential as early intervention measures. Continued research is essential for gaining a thorough understanding of their long-term effects and safety profiles.

Vegetarian and Vegan Dietary Patterns to Treat Adult Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Plant-based dietary patterns, including vegetarian and vegan dietary patterns, may help to manage type 2 diabetes (T2DM) by contributing to maintenance of a healthy body weight, improved glycemic control, and reduced risk of diabetes complications. Several diabetes clinical practice guidelines support the use of vegetarian dietary patterns, but there has not been a recently updated systematic review (SR) of evidence from randomized controlled trials (RCTs) to examine efficacy. The primary objective of this SR was to examine the effect of vegetarian dietary patterns compared with nonvegetarian dietary patterns in adults with T2DM. MEDLINE, CINAHL, Cochrane CENTRAL Database of Controlled Trials, Food Science Source, and SportsDiscus databases were searched for RCTs published from 1998 to May 2023. Two independent reviewers extracted data and assessed risk of bias using the Cochrane RoB 2 tool. Data were pooled using a DerSimonian-Laird random-effects model and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Full texts of 66 articles were reviewed, and 7 RCTs (n = 770 participants) were included in this SR. Vegetarian dietary patterns likely reduce hemoglobin A1c [MD (95% CI): -0.40% (-0.59, -0.21)] and body mass index [MD (95% CI): -0.96 kg/m2 (-1.58, -0.34)] (moderate certainty evidence); may allow for reduced diabetes medication (in 2 of 3 included studies) (low certainty); and may improve metabolic clearance of glucose (insulin sensitivity) [MD (95% CI): 10% (1.86, 18.14)] (very low certainty), compared with nonvegetarian dietary patterns. There were no effects of vegetarian dietary patterns on fasting blood glucose, fasting insulin, or low-density lipoprotein cholesterol concentrations. These findings support the inclusion of vegetarian or vegan dietary patterns as options in nutrition care plans for adults with T2DM. PROSPERO REGISTRATION: CRD42023396453.

Temporal Trend in Maternal Morbidity and Comorbidity

OBJECTIVE

 This study aimed to examine the temporal trends of severe maternal morbidity (SMM) in the U.S. population in relation to trends in maternal comorbidity.

STUDY DESIGN

 We performed a repeated cross-sectional analysis of data from individuals at 20 weeks' gestation or greater using U.S. birth certificate data from 2011 to 2021. Our primary outcome was SMM defined as the occurrence of intensive care unit admission, eclampsia, hysterectomy, uterine rupture, and blood product transfusion. We also examined the proportions of maternal comorbidity. Outcomes of the adjusted incidence rate ratio (IRR) with 99% confidence intervals (99% CIs) for 2021 m12 compared with 2011 m1 were calculated using negative binomial regression, controlling for predefined confounders.

RESULTS

 There were 42,504,125 births included in the analysis. From 2011 m1 to 2021 m12, there was a significant increase in the prevalence of advanced maternal age (35-39 [45%], 40-44 [29%], and ≥45 [43%] years), morbid obesity (body mass index 40-49.9 [66%], 50-59.9 [91%], and 60-69.9 [98%]), previous cesarean delivery (14%), chronic hypertension (104%), pregestational diabetes (64%), pregnancy-associated hypertension (240%), gestational diabetes (74%), and preterm delivery at 34 to 36 weeks (12%). There was a significant decrease in the incidence of multiple gestation (9%), preterm delivery at 22 to 27 weeks (9%), and preterm delivery at 20 to 21 weeks (22%). From 2011 m1 to 2021 m12, the incidence of SMM increased from 0.7 to 1.0% (crude IRR 1.60 [99% CI 1.54-1.66]). However, the trend was no longer statistically significant after controlling for confounders (adjusted IRR 1.01 [95% CI 0.81-1.27]). The main comorbidity that was associated with the increase in SMM was pregnancy-associated hypertension.

CONCLUSION

 The rise in the prevalence of comorbidity in pregnancy seems to fuel the rise in SMM. Interventions to prevent SMM should include the management and prevention of pregnancy-associated hypertension.

KEY POINTS

· The rise in maternal mortality is related to morbidity.. · Pregnancy-associated hypertension increases morbidity.. · There were increasing trends in age, body mass index, and medical conditions..

Risk stratification for cardiovascular disease based on prior coronary artery disease, cerebrovascular disease and type 2 diabetes mellitus

AIMS/INTRODUCTION

History of coronary artery disease (CAD), cerebrovascular disease (CeVD), type 2 diabetes and their combined effect on cardiovascular disease are essential for cardiovascular risk management. We investigated the association of prior CAD, prior CeVD, type 2 diabetes and their combination with the risk of cardiovascular disease.

MATERIALS AND METHODS

This is a historical cohort study including 342,033 participants (aged 18-72 years) followed up for ≥5 years between 2008 and 2016. Participants were classified into eight groups (with or without prior CAD, prior CeVD and type 2 diabetes). Type 2 Diabetes was defined by fasting plasma glucose and glycated hemoglobin levels, and antidiabetic drug prescription. Prior and subsequent CAD and CeVD were identified according to claims using International Classification of Diseases 10th Revision codes, medical procedures and questionnaires. Cox regression models were used to evaluate the risk of cardiovascular events.

RESULTS

The median follow-up period was 6.4 years. The incidence of composite cardiovascular events of CAD and CeVD in the CAD-/CeVD-, CAD+/CeVD-, CAD-/CeVD+ and CAD+/CeVD+ groups were 1.92 and 6.94, 25.14 and 31.98 per 1,000 person-years in non-diabetes participants, and 8.66, 18.04, 39.98 and 60.72 in type 2 diabetes patients, respectively. Hazard ratios of cardiovascular events compared with CAD-/CeVD-/non-diabetes were 1.66 (95% confidence interval 1.55-1.78) in CAD-/CeVD-/type 2 diabetes and 1.84 (1.56-2.18) in CAD+/CeVD-/non-diabetes. CeVD+ was linked to a 4-7-fold increase in the risk of cardiovascular events regardless of CAD+ or type 2 diabetes.

CONCLUSIONS

Type 2 diabetes increased the risk of cardiovascular disease as high as a history of CAD, whereas prior CeVD alone increased the risk of future CeVD without additional effects by type 2 diabetes.

The Silent Threat: A Retrospective Cohort Study on the Impact of Prediabetes on ST-Elevation Myocardial Infarction Survival-A Call to Action!

Background: Prediabetes is frequently underdiagnosed and undertreated, yet it poses significant cardiovascular risks. This study investigates the impact of prediabetes on short- and long-term survival outcomes in patients who experienced ST-elevation myocardial infarction (STEMI). Methods: In this retrospective, single-center cohort study, we evaluated 725 STEMI patients stratified into non-diabetic, prediabetic, and diabetic groups based on HbA1c levels at presentation. A Kaplan-Meier survival analysis was employed to compare long-term outcomes over a three-year follow-up period. Cardiovascular risk factors, including hypertension and dyslipidemia, were analyzed across the groups. The discriminatory power of HbA1c for predicting all-cause mortality was assessed using an Area Under the Receiver Operating Characteristic (AUROC) analysis. Results: Of the 725 patients, 407 (56.1%) were non-diabetic, 184 (25.4%) were prediabetic, and 134 (18.5%) were diabetic. Prediabetic patients exhibited significant additional cardiovascular risk factors, such as arterial hypertension (67.4%) and dyslipidemia (78.3%), with prevalence rates between those of non-diabetic and diabetic patients. The Kaplan-Meier analysis revealed that at a three-year follow-up, prediabetic patients faced a survival disadvantage, with a significant decrease in survival rates compared to non-diabetic patients (log-rank p = 0.016); their survival outcomes approached those of diabetic patients (p = 0.125). The AUROC analysis demonstrated that HbA1c was a significant predictor of short- and long-term mortality, with a cut-off value of 5.75% and an Area Under the Curve (AUC) of 0.580-0.617 (95% CI: 0.458-0.721), indicating a moderate ability to predict survival in patients with STEMI. Conclusions: Prediabetes significantly worsens survival outcomes following STEMI, nearly approaching the risk level of diabetes. Integrating rigorous cardiovascular risk management strategies for prediabetic individuals, including lifestyle interventions and potentially pharmacological treatments, could prevent the progression to diabetes and mitigate associated cardiovascular risks.

Inhibition of de novo ceramide synthesis by sirtuin-1 improves beta-cell function and glucose metabolism in type 2 diabetes

AIMS

Obesity and type 2 diabetes (T2D) are major risk factors for cardiovascular (CV) diseases. Dysregulated pro-apoptotic ceramide synthesis reduces β-cell insulin secretion, thereby promoting hyperglycaemic states that may manifest as T2D. Pro-apoptotic ceramides modulate insulin sensitivity and glucose tolerance while being linked to poor CV outcomes. Sirtuin-1 (SIRT1) is a NAD + -dependent deacetylase that protects against pancreatic β-cell dysfunction; however, systemic levels are decreased in obese-T2D mice and may promote pro-apoptotic ceramide synthesis and hyperglycaemia. Herein, we aimed to assess the effects of restoring circulating SIRT1 levels to prevent metabolic imbalance in obese and diabetic mice.

METHODS AND RESULTS

Circulating SIRT1 levels were reduced in obese-diabetic mice (db/db) as compared to age-matched non-diabetic db/+ controls. Restoration of SIRT1 plasma levels with recombinant murine SIRT1 for 4 weeks prevented body weight gain and improved glucose tolerance, insulin sensitivity, and vascular function in mice models of obesity and T2D. Untargeted lipidomics revealed that SIRT1 restored insulin secretory function of β-cells by reducing synthesis and accumulation of pro-apoptotic ceramides. Molecular mechanisms involved direct binding to and deacetylation of Toll-like receptor 4 (TLR4) by SIRT1 in β-cells, thereby decreasing the rate-limiting enzymes of sphingolipid synthesis SPTLC1/2 via AKT/NF-κB. Among patients with T2D, those with high baseline plasma levels of SIRT1 prior to metabolic surgery displayed restored β-cell function (HOMA2-β) and were more likely to have T2D remission during follow-up.

CONCLUSION

Acetylation of TLR4 promotes β-cell dysfunction via ceramide synthesis in T2D, which is blunted by systemic SIRT1 replenishment. Hence, restoration of systemic SIRT1 may provide a novel therapeutic strategy to counteract toxic ceramide synthesis and mitigate CV complications of T2D.

High proportion of undiagnosed diabetes in patients surgically treated for infrarenal abdominal aortic aneurysm: findings from the multicentre Norwegian Aortic Aneurysm and Diabetes (ABANDIA) Study

BACKGROUND

The aim was to investigate the total prevalence of known and undiagnosed diabetes mellitus (DM), and the association of DM with perioperative complications following elective, infrarenal, open surgical (OSR) or endovascular (EVAR), Abdominal Aortic Aneurysm (AAA) repair.

METHODS

In this Norwegian prospective multicentre study, 877 patients underwent preoperative screening for DM by HbA1c measurements from November 2017 to December 2020. Diabetes was defined as screening detected HbA1c ≥ 48 mmol/mol (6.5%) or previously diagnosed diabetes. The association of DM with in-hospital complications, length of stay, and 30-day mortality rate were evaluated using adjusted and unadjusted logistic regression models.

RESULTS

The total prevalence of DM was 15% (95% CI 13%,17%), of which 25% of the DM cases (95% CI 18%,33%) were undiagnosed upon admission for AAA surgery. The OSR to EVAR ratio was 52% versus 48%, with similar distribution among DM patients, and no differences in the prevalence of known and undiagnosed DM in the EVAR versus the OSR group. Total 30-day mortality rate was 0.6% (5/877). Sixty-six organ-related complications occurred in 58 (7%) of the patients. DM was not statistically significantly associated with a higher risk of in-hospital organ-related complications (OR 1.23, 95% CI 0.57,2.39, p = 0.57), procedure-related complications (OR 1.48, 95% CI 0.79,2.63, p = 0.20), 30-day mortality (p = 0.09) or length of stay (HR 1.06, 95% CI 0.88,1.28, p = 0.54). According to post-hoc-analyses, organ-related complications were more frequent in patients with newly diagnosed DM (n = 32) than in non-DM patients (OR 4.92; 95% CI 1.53,14.3, p = 0.005).

CONCLUSION

Twenty-five percent of all DM cases were undiagnosed at the time of AAA surgery. Based on post-hoc analyses, undiagnosed DM seems to be associated with an increased risk of organ related complications following AAA surgery. This study suggests universal DM screening in AAA patients to reduce the number of DM patients being undiagnosed and to improve proactive diabetes care in this population. The results from post-hoc analyses should be confirmed in future studies.

Modern Challenges in Type 2 Diabetes: Balancing New Medications with Multifactorial Care

Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder characterized by insulin resistance and progressive beta cell dysfunction, presenting substantial global health and economic challenges. This review explores recent advancements in diabetes management, emphasizing novel pharmacological therapies and their physiological mechanisms. We highlight the transformative impact of Sodium-Glucose Cotransporter 2 inhibitor (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA), which target specific physiological pathways to enhance glucose regulation and metabolic health. A key focus of this review is tirzepatide, a dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors. Tirzepatide illustrates how integrating innovative mechanisms with established physiological pathways can significantly improve glycemic control and support weight management. Additionally, we explore emerging treatments such as glimins and glucokinase activators (GKAs), which offer novel strategies for enhancing insulin secretion and reducing glucose production. We also address future perspectives in diabetes management, including the potential of retatrutide as a triple receptor agonist and evolving guidelines advocating for a comprehensive, multifactorial approach to care. This approach integrates pharmacological advancements with essential lifestyle modifications-such as dietary changes, physical activity, and smoking cessation-to optimize patient outcomes. By focusing on the physiological mechanisms of these new therapies, this review underscores their role in enhancing T2DM management and highlights the importance of personalized care plans to address the complexities of the disease. This holistic perspective aims to improve patient quality of life and long-term health outcomes.

The Value of Pressure Indexes in Predicting the Outcome of Diabetic Foot Ulcers as a Guide to Further Management

INTRODUCTION

Diabetic foot ulcers (DFUs) stand out as a prevalent and debilitating condition. Furthermore, the progression of diabetes-related hyperglycemia and associated conditions such as peripheral arterial disease exacerbates the risks of DFUs, including complications like infection and gangrene. Given the significant burden of DFUs, there is a pressing need to improve preventive and therapeutic strategies. This study investigates the clinical profiles of patients with DFUs, including the importance of smoking and intermittent claudication, evaluates management strategies based on the vascular status assessed through Doppler scans, and provides insights into the importance of ankle-brachial pressure index (ABPI) and toe brachial index (TBI) values, which play a vital role in predicting and managing ulcer healing outcomes, highlighting the importance of vascular assessment in treatment planning.

AIM

The study aims to assess the clinical profile of patients with DFUs based on their vascularity status using Doppler scans, predict the outcome of the ulcer using indexes like ABPI and TBI values, and decide on further management.

MATERIALS AND METHODS

This prospective study was conducted over 24 months, from August 2022 to July 2024, at the Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. The study included 50 patients presenting with DFUs. Approval was obtained from the Institutional Ethics Committee, and informed consent was obtained from all participants. A detailed history was taken, including the history of smoking and intermittent claudication, and a thorough examination of the ulcer was performed. HbA1c levels were measured, Doppler scans of the lower limbs were done, and the ABPI and TBI values were calculated. Management strategies were determined based on the assessed vascular status, leading to either medical or surgical interventions.

RESULTS

Twenty-one (42%) patients who presented with DFUs had a positive history of intermittent claudication, demonstrating a significant association between the history of intermittent claudication and the Doppler findings. Thirty-seven (74%) patients gave a positive history of smoking, which revealed a significant association between the history of smoking and Doppler findings. Thirty-eight (76%) patients had an ABPI of <0.9, out of which 33 (66%) patients showed an improved outcome of the ulcer after necessary management. There is also a statistically significant association between the ABPI and Doppler findings. Sixteen (32%) of patients had a TBI of <0.65, of which all showed an improvement. There is a highly significant association between TBI and the Doppler findings.

CONCLUSION

This study concludes that integrated routine assessment of ABPI and TBI into DFU management protocols is necessary to guide treatment decisions and monitor response to therapy. Treatment and prevention of diabetes-related complications affecting the lower extremities require a dedicated interdisciplinary approach.

Control for multiple risk factors and incident heart failure and mortality in patients with diabetes mellitus: Insights from the Kailuan cohort study

BACKGROUND

This study evaluated the relationship between controlling multiple risk factors and diabetes-related heart failure and all-cause mortality, and the extent to which the excess risk can be reduced.

METHODS

17,676 patients with diabetes and 69,493 matched non-diabetic control subjects were included in the Kailuan study, with a median follow-up of 11.19 years. The risk factor control was defined by the attainment of target values for systolic blood pressure, body mass index, low-density lipoprotein cholesterol, fasting blood glucose, high-sensitive C-reactive protein and smoking. Fine-Gray and Cox models were used to estimate associations between the degree of risk factor control and risk of heart failure and all-cause mortality respectively.

RESULTS

Among diabetes patients, there was a gradual reduction in the risk of outcomes as the degree of risk factor control increased. For each additional risk factor that was controlled, there was an associated 16 % decrease in heart failure risk and a 10 % decrease in all-cause mortality risk. Among diabetes patients with ≥5 well-controlled risk factors, the adjusted hazard ratio compared to controls for heart failure and all-cause mortality was 1.25 (95 %CI: 0.99-1.56) and 1.17(95 %CI: 1.05-1.31) respectively. The protective effect of comprehensive risk factor control on the risk of heart failure was more pronounced in men and those using antihypertensive medications.

CONCLUSIONS

Control for multiple risk factors is associated with reduced heart failure and all-cause mortality risks in a cumulative and sex-specific manner. However, despite optimization of risk factor control, diabetes patients still face increased risks compared to the general population.

Demographic Differences in Insomnia and Anxiety and the Association with Cardiovascular Risk Factors among Jordanian Healthy Adult

Background

Prior studies showed that anxiety and insomnia are both associated with Cardiovascular Disease (CVD). There is a lack of literature related to the prevalence of insomnia and anxiety among healthy adult populations in developing countries as in Jordan, Therefore, this study aimed to examine the association between the CVD risk factors and both insomnia and anxiety among healthy adults had one or more modifiable CVD risk factors.

Materials and Methods

A cross-sectional method was used to examine the prevalence of anxiety, insomnia, and demographical and clinical association with anxiety and insomnia among 1000 Jordanian adult participants using the Hamilton Anxiety Rating Scale and the insomnia severity index. Pearson's correlation was used to examine the correlation between anxiety and insomnia scores. Linear regression was used to examine predictors to anxiety and insomnia based on demographical and clinical details.

Results

The result of the current study showed that (30.20%) of participants had higher anxiety scores, (29.70%) had moderate to severe insomnia. Moreover, there was a significant positive correlation between anxiety and insomnia scores, p = 0.01. Based on the current study findings only marital status and anxiety were unique predictors of insomnia F(14,45) = 989, p = 0.001. Moreover, Predictors of anxiety were gender, hypertension, Diabetes mellitus, dyslipidemia, and insomnia F(19,89) = 989, p = 0.001.

Conclusions

Sleep and psychological well-being are important components of an adult's health and well-being. The study showed that marital status and anxiety are predictors of insomnia. Whereas, gender, hypertension, diabetes mellitus, dyslipidemia, and insomnia were predictors of anxiety. This study highlights the importance of the implementation of a primary prevention strategy for individuals with modifiable CVD risk factors to reduce anxiety and insomnia levels among adults.

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) as a predictor of all-cause and cardiovascular mortality in US adults with diabetes or prediabetes: NHANES 1999-2018

BACKGROUND

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) serves as a novel composite lipid indicator for atherosclerosis. However, the association between NHHR and mortality in patients with diabetes or prediabetes remains unclear. Consequently, the objective of this study was to investigate the relationship between NHHR and both all-cause and cardiovascular mortality in US adults with diabetes or prediabetes.

METHODS

This study included 12,578 adult participants with diabetes or prediabetes from the US National Health and Nutrition Examination Survey (1999-2018). Mortality outcomes were ascertained by linking to the National Death Index (NDI) record up to December 31, 2019. We employed a weighted multivariate Cox proportional hazards model and restricted cubic splines to assess the associations between NHHR and all-cause and cardiovascular mortality. A segmented Cox proportional hazards model was used for evaluating threshold effects. Furthermore, a competing risks analysis was performed to explore the relationship between NHHR and cardiovascular mortality.

RESULTS

During a median follow-up period of 8.08 years, 2403 participants encountered all-cause mortality, with 662 of them specifically succumbing to cardiovascular mortality. The restricted cubic splines revealed a U-shaped association between NHHR and all-cause mortality, while an L-shaped association was observed for cardiovascular mortality. The analysis of threshold effects revealed that the inflection points for NHHR and all-cause and cardiovascular mortality were 2.72 and 2.83, respectively. Specifically, when the baseline NHHR was below the inflection points, a negative correlation was observed between NHHR and both all-cause mortality (HR: 0.76, 95% CI: 0.68-0.85) and cardiovascular mortality (HR: 0.70, 95% CI: 0.57-0.85). Conversely, when the baseline NHHR exceeded the inflection points, a positive correlation was observed between NHHR and both all-cause mortality (HR: 1.11, 95% CI: 1.06-1.16) and cardiovascular mortality (HR: 1.08, 95% CI: 1.00-1.16).

CONCLUSIONS

Among US adults with diabetes or prediabetes, a U-shaped association was observed between NHHR and all-cause mortality, whereas an L-shaped association was identified with cardiovascular mortality. The inflection points for all-cause and cardiovascular mortality were 2.72 and 2.83, respectively.

Perivascular Adipose Tissue and Perivascular Adipose Tissue-Derived Extracellular Vesicles: New Insights in Vascular Disease

Perivascular adipose tissue (PVAT) is a special deposit of fat tissue surrounding the vasculature. Previous studies suggest that PVAT modulates the vasculature function in physiological conditions and is implicated in the pathogenesis of vascular diseases. Understanding how PVAT influences vasculature function and vascular disease progression is important. Extracellular vesicles (EVs) are novel mediators of intercellular communication. EVs encapsulate molecular cargo such as proteins, lipids, and nucleic acids. EVs can influence cellular functions by transferring the carried bioactive molecules. Emerging evidence indicates that PVAT-derived EVs play an important role in vascular functions under health and disease conditions. This review will focus on the roles of PVAT and PVAT-EVs in obesity, diabetic, and metabolic syndrome-related vascular diseases, offering novel insights into therapeutic targets for vascular diseases.

Cardiovascular-kidney-metabolic overlap in heart failure with preserved ejection fraction: Cardiac structure and function, clinical outcomes, and response to sacubitril/valsartan in PARAGON-HF

AIMS

Cardiovascular-kidney-metabolic (CKM) multimorbidity is prevalent among individuals with heart failure (HF), but whether cardiac structure and function, clinical outcomes, and treatment response to sacubitril/valsartan vary in relation to CKM status is unknown.

METHODS AND RESULTS

In this PARAGON-HF post-hoc analysis, we evaluated the impact of CKM multimorbidity (atherosclerotic cardiovascular [CV] disease, chronic kidney disease, and type 2 diabetes) on cardiac structure and function, clinical outcomes, and treatment effects of sacubitril/valsartan versus valsartan. The primary outcome was a composite of total HF hospitalizations and CV death. Secondary outcomes included the individual components of the primary outcome and a composite kidney outcome (sustained estimated glomerular filtration rate reduction of ≥50%, end-stage kidney disease, or kidney-related death). At baseline, 35.2% had one CKM condition, 33.3% had two, 15.9% had three, and only 15.6% had HF alone. CKM multimorbidity was associated with higher septal and posterior wall thickness, lower global longitudinal strain, higher E/e', and worse right ventricular function. Total HF hospitalizations or CV death increased with greater CKM multimorbidity, with the highest relative risk observed with three CKM conditions (rate ratio 3.06, 95% confidence interval 2.33-4.03), compared with HF alone. Treatment effects of sacubitril/valsartan were consistent irrespective of the number of CKM conditions for the primary endpoint (pinteraction = 0.75), CV death (pinteraction = 0.82), total HF hospitalizations (pinteraction = 0.67), and the composite kidney endpoint (pinteraction = 0.99).

CONCLUSIONS

Cardiovascular-kidney-metabolic multimorbidity was common in PARAGON-HF and associated with adverse changes in cardiac structure and function and with a stepwise increase in risk of clinical outcomes. Treatment effects of sacubitril/valsartan were consistent irrespective of CKM burden.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT01920711.

Strategies for Cardiovascular Disease Prevention in Type 1 Diabetes: A Comprehensive Review

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with type 1 diabetes (T1D), necessitating effective prevention strategies. This comprehensive review consolidates current knowledge and evidence on preventing CVD in T1D patients. It begins by exploring the pathophysiological mechanisms that link T1D to an increased risk of CVD, highlighting factors such as chronic hyperglycemia, hypertension, dyslipidemia, and inflammation. The review also examines the epidemiology and specific risk factors for CVD in this population, emphasizing the need for rigorous risk assessment and screening. Lifestyle modifications, including dietary interventions, regular physical activity, and smoking cessation, are evaluated for their effectiveness in reducing CVD risk. Additionally, the review discusses pharmacological interventions, such as insulin therapy for glycemic control, antihypertensive medications, lipid-lowering agents, and antiplatelet therapy, underscoring their critical role in CVD prevention. Emerging therapies and future research directions are explored, focusing on novel pharmacological agents, advances in insulin delivery systems, and personalized medicine approaches. The importance of integrated care models involving multidisciplinary teams and the use of technology is highlighted as essential for comprehensive management. Challenges and barriers to implementing these strategies, including healthcare system limitations, patient adherence, and socioeconomic factors, are also addressed. This review provides a detailed synthesis of current strategies and future directions for preventing CVD in individuals with T1D, serving as a valuable resource for clinicians, researchers, and policymakers dedicated to improving cardiovascular outcomes in this high-risk population.

The Gene Network Correlation Analysis of Obesity to Type 1 Diabetes and Cardiovascular Disorders: An Interactome-Based Bioinformatics Approach

The current study focuses on the importance of Protein-Protein Interactions (PPIs) in biological processes and the potential of targeting PPIs as a new treatment strategy for diseases. Specifically, the study explores the cross-links of PPIs network associated with obesity, type 1 diabetes mellitus (T1DM), and cardiac disease (CD), which is an unexplored area of research. The research aimed to understand the role of highly connected proteins in the network and their potential as drug targets. The methodology for this research involves retrieving genes from the NCBI online gene database, intersecting genes among three diseases (type 1 diabetes, obesity, and cardiovascular) using Interactivenn, determining suitable drug molecules using NetworkAnalyst, and performing various bioinformatics analyses such as Generic Protein-Protein Interactions, topological properties analysis, function enrichment analysis in terms of GO, and Kyoto Encyclopedia of Genes and Genomes (KEGG), gene co-expression network, and protein drug as well as protein chemical interaction network. The study focuses on human subjects. The results of this study identified 12 genes [VEGFA (Vascular Endothelial Growth Factor A), IL6 (Interleukin 6), MTHFR (Methylenetetrahydrofolate reductase), NPPB (Natriuretic Peptide B), RAC1 (Rac Family Small GTPase 1), LMNA (Lamin A/C), UGT1A1 (UDP-glucuronosyltransferase family 1 membrane A1), RETN (Resistin), GCG (Glucagon), NPPA (Natriuretic Peptide A), RYR2 (Ryanodine receptor 2), and PRKAG2 (Protein Kinase AMP-Activated Non-Catalytic Subunit Gamma 2)] that were shared across the three diseases and could be used as key proteins for protein-drug/chemical interaction. Additionally, the study provides an in-depth understanding of the complex molecular and biological relationships between the three diseases and the cellular mechanisms that lead to their development. Potentially significant implications for the therapy and management of various disorders are highlighted by the findings of this study by improving treatment efficacy, simplifying treatment regimens, cost-effectiveness, better understanding of the underlying mechanism of these diseases, early diagnosis, and introducing personalized medicine. In conclusion, the current study provides new insights into the cross-links of PPIs network associated with obesity, T1DM, and CD, and highlights the potential of targeting PPIs as a new treatment strategy for these prevalent diseases.

International guideline comparison of lifestyle management for acute coronary syndrome and type 2 diabetes mellitus: A rapid review

Acute coronary syndrome (ACS) is a life-threatening condition, with ACS-associated morbidity and mortality causing substantial human and economic challenges to the individual and health services. Due to shared disease determinants, those with ACS have a high risk of comorbid Type 2 diabetes mellitus (T2DM). Despite this, the two conditions are managed separately, duplicating workload for staff and increasing the number of appointments and complexity of patient management plans. This rapid review compared current ACS and T2DM guidelines across Australia, Canada, Europe, Ireland, New Zealand, the UK, and the USA. Results highlighted service overlap, repetition, and opportunities for integrated practice for ACS-T2DM lifestyle management across diet and nutrition, physical activity, weight management, clinical and psychological health. Recommendations are made for potential integration of ACS-T2DM service provision to streamline care and reduce siloed care in the context of the health services for ACS-T2DM and similar comorbid conditions.

How safe are proprotein convertase subtilisinekexin type 9 inhibitors in diabetes?

PURPOSE OF REVIEW

To examine the safety of proprotein convertase subtilisinekexin type 9 (PCSK9) inhibitors in patients with diabetes, specifically focusing on their impact on glucose metabolism.

RECENT FINDINGS

Patients with diabetes often require intensified lipid-lowering therapy. PCSK9 inhibitors can reduce low-density lipoprotein cholesterol (LDL-C) concentrations by approximately 60%, and significantly reduce cardiovascular risk when added to statin therapy. Some studies have suggested an association between low LDL-C levels and an increased risk of new-onset diabetes, and genetics has almost consistently shown an increased glucose concentration and risk of diabetes. Most clinical trials have not demonstrated a deterioration in glycaemic control in patients with diabetes after the use of PCSK9 inhibitors, and they do not lead to other significant treatment-emergent adverse events.

SUMMARY

Although the majority of patients with diabetes are undergoing background statin therapy, which may mask potential adverse effects of PCSK9 inhibitors on glycaemic control, current data suggest that the benefits outweigh the risks for diabetic patients using PCSK9 inhibitors. Considering the different nature of genetic studies and of clinical trials, close monitoring of glucose parameters is necessary, especially in individuals with prediabetes.