Effects of dapagliflozin in the progression of atherosclerosis in patients with type 2 diabetes: a meta-analysis of randomized controlled trials

Dapagliflozin modulates hepatic lipid metabolism through the proprotein convertase subtilisin/kexin type 9/low density lipoprotein receptor pathway

BACKGROUND

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is mainly secreted by the liver, and plays a crucial role in lipid metabolism disorder. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) can regulate lipid metabolism through various pathways, including reducing visceral fat accumulation, modulating serum lipoprotein levels and alleviating hepatic steatosis. However, the specific regulatory mechanisms remain unclear.

METHODS

We built a model of glucose and lipid metabolism disorder in vivo and in vitro, and explored the regulatory mechanism of dapagliflozin in regulating liver lipid metabolism.

RESULTS

We found that the SGLT2i dapagliflozin significantly reduced serum levels of PCSK9, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) in high-fat diet (HFD)-fed mice, while also improving hepatic steatosis. In vitro studies confirmed that dapagliflozin increased LDL receptor (LDLR) expression in HepG2 cells, enhancing their ability to uptake LDL-C.

CONCLUSIONS

Further mechanistic studies revealed that the hepatocyte nuclear factor-1-alpha (HNF1α)/PCSK9/LDLR signalling pathway may be involved in dapagliflozin's regulation of lipid metabolism homeostasis.

Development and validation of a prognostic model for critically ill type 2 diabetes patients in ICU based on composite inflammatory indicators

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder, and critically ill patients with T2DM in intensive care unit (ICU) have an increased risk of mortality. In this study, we investigated the relationship between nine inflammatory indicators and prognosis in critically ill patients with T2DM to provide a clinical reference for assessing the prognosis of patients admitted to the ICU. Critically ill patients with T2DM were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and divided into training and testing sets (7:3 ratio). An external validation cohort was collected from a single center in China using identical criteria. Logistic and Cox regression analyses were used to evaluate the relationship between nine inflammatory indicators and ICU, 30-day, and 90-day mortality rates. Significant predictive variables were chosen using least absolute shrinkage selection operator (LASSO) regression from logistic regression results, and a prognostic prediction model was built with multivariate logistic regression. The model was validated in both test and external validation sets. A total of 4,783 patients were included for model development and testing; an additional 204 served as the external validation set. The levels of eight inflammatory indicators were significantly correlated with short-term prognosis in critically ill patients with T2DM (P < 0.05 for all). The prediction model showed excellent discrimination performance, with AUC values of 0.825 (95% CI, 0.785-0.864) in the test set and 0.741 (95% CI, 0.630-0.851) in the external validation set. Calibration curves demonstrated strong consistency in both sets. In addition, decision curve analysis showed a net clinical benefit within 1-60% threshold probability in the test set and 10-41% threshold probability in the external validation set. Eight inflammatory indicators were identified as independent risk factors for prognosis in critically ill patients with T2DM. The prediction model showed promising performance in both internal and external validation cohorts, highlighting its potential as a valuable tool for early risk stratification and prediction of the outcomes of personalized treatment strategies in ICU settings.

The effect of sodium-glucose co-transporter-2 inhibitors on markers of subclinical atherosclerosis

BACKGROUND

Despite the widespread use of classical cholesterol-lowering drugs to mitigate the adverse impacts of dyslipidaemia on atherosclerosis, many patients still face a substantial residual risk of developing atherosclerotic cardiovascular disease (CVD). This risk is partially attributed to non-traditional pathophysiological pathways. Latest evidence suggests that sodium glucose co-transporter-2 (SGLT2) inhibitors are beneficial for patients suffering from type 2 diabetes mellitus (T2DM) or established CVD by reducing morbidity and mortality. However, the underlying mechanisms of this benefit have not been clearly elucidated. It has been hypothesized that one possible mechanism could be the attenuation of subclinical atherosclerosis (SA) progression.

AIM

The objective of this narrative review is to examine the present evidence concerning the impact of SGLT2 inhibitors on markers of SA.

RESULTS

The current evidence on the efficacy of SGLT2 on SA, endothelial function and arterial stiffness remains controversial. Findings from observational and randomized studies are quite heterogeneous; however, they converge that the antiatherosclerotic activity of SGLT2 inhibitors is not strong enough to be widely used for prevention of atherosclerosis progression in patients with or without T2DM.

CONCLUSIONS

Further research is needed to investigate the underlying mechanisms and the possible beneficial impact of SGLT2i on primary and secondary CVD prevention through attenuation of premature atherosclerosis progression.

Closed or Unclosed Mesentery? A Meta-analysis of Internal Herniation After Laparoscopic Roux-en-Y Gastric Bypass

During the laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current meta-analysis aimed to compare the outcome of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass. Fifteen studies were included, enrolling 53,488 patients. Based on the outcome of analysis, regarding internal hernia, Petersen space's IH, jejunal mesenteric's IH, hospital days, and reoperation, closure of the mesentery was better than non-closure. Besides, small bowel obstruction, anastomosis ulcer, stenosis, leakage, bleeding, gastrointestinal perforation, and postoperative BMI of patients show no difference between non-closure and closure.

Effect of omentopexy/gastropexy on gastrointestinal symptoms after laparoscopic sleeve gastrectomy: A meta-analysis of randomized controlled trials and systematic review

INTRODUCTION

The increased prevalence of obesity worldwide and low incidence of postoperative complications make the laparoscopic sleeve gastrectomy (LSG) a clear public choice for obese-related individuals. Pre-existing studies reported contentious outcomes regarding the association with gastrointestinal symptoms after adding omentopexy (Ome) or gastropexy (Gas) to LSG. The present meta-analysis attempted to evaluate the pros and cons of operating Ome/Gas after LSG concerning gastrointestinal symptoms.

METHODS

The data extraction and study quality assessment were independently performed by two individuals. The PubMed, EMBASE, Scopus, and Cochrane Library databases were systematically searched up to October 1, 2022, using the keywords LSG, omentopexy, and gastropexy to identify randomized controlled trial studies.

RESULTS

Of the original 157 records, 13 studies with 3515 patients were included. LSG with Ome/Gas excels the LSG group in nausea (odds ratio [OR] = 0.57; 95% CI[0.46, 0.70]; P < .00001), reflux (OR = 0.57; 95% CI [0.46, 0.70]; P < .00001), vomiting (OR = 0.41; 95% CI [0.25, 0.67]; P = .0004) on gastrointestinal symptoms and bleeding (OR = 0.36; 95% CI [0.22, 0.59]; P < .0001), leakage (OR = 0.19; 95% CI [0.09, 0.43]; P < .0001), gastric torsion (OR = 0.23; 95% CI [0.07, 0.75]; P = .01) on post-LSG complications. Further, LSG with Ome/Gas was superior to LSG regarding the result of excess body mass index loss in 1 year after surgery (mean difference = 1.83; 95% CI [0.59, 3.07]; P = .004). However, no significant associations were shown between groups in wound infection and the resulting weight or body mass index 1 year after surgery. Of note, subgroup analysis indicated that gastroesophageal reflux disease can be alleviated by adding Ome/Gas post-LSG in those who used small bougies from 32 to 36 Fr (OR = 0.24; 95% CI [0.17, 0.34]; P < .00001) in contrast with large bougies over 36 Fr.

CONCLUSION

Most results elucidated the impact of adding Ome/Gas after LSG in reducing the incidence of gastrointestinal symptoms. Additionally, more studies should be conducted to find the relations between other indicators in the present analysis due to the poor cases.

Three months of combination therapy with nano-curcumin reduces the inflammation and lipoprotein (a) in type 2 diabetic patients with mild to moderate coronary artery disease: Evidence of a randomized, double-blinded, placebo-controlled clinical trial

Diabetes is one of the most common chronic diseases worldwide. Systemic inflammation (high-sensitivity C-reactive protein (hs-CRP)) and lipid metabolism disruption (lipoprotein A, LipoPr (a)) play a critical role in developing and progressing atherosclerosis and acute coronary syndrome in diabetic patients. The anti-oxidant and anti-inflammatory effects of curcumin have been emphasized previously. Therefore, we aimed to evaluate the impact of nano-curcumin on cardiovascular risk factors in type 2 diabetic patients with mild to moderate coronary artery disease (CAD). We performed a randomized, double-blinded, placebo-controlled clinical trial with type 2 diabetic patients (n = 64), and mild to moderate CAD (<70% stenosis in angiography). The patients received nano-curcumin (80 mg/day) or placebo along with optimal medications for 90 days. The biofactors, including hs-CRP and LipoPr (a), and lipid profile, were measured at the admission of patients and end of the study. Nano-curcumin significantly mitigated the hs-CRP and LipoPr (a) levels following 90 days of treatment (P < 0.001 and P = 0.043, respectively). In addition, the mean percentage of change (%Δ) in the hs-CRP and LipoPr (a) levels were meaningfully reduced in the nano-curcumin group compared to the placebo group (P < 0.001 and P = 0.007, respectively). Surprisingly, nano-curcumin notably propagated the number of patients with mild (34.35%) and moderate (62.5%) hs-CRP level category and strikingly diminished the number of patients with severe hs-CRP level category (3.125%) compared to the placebo group (P = 0.016). Nano-curcumin (80 mg/day) might prevent atherosclerosis progression and, in terms of attenuating hs-CRP levels as an inflammation index, succedent cardiovascular events in diabetic heart patients.