While sodium-glucose cotransporter-2 (SGLT2) inhibitors have been used for the routine management of type 2 diabetes for several years, it is perhaps their natriuretic effects that are most important ...clinically. This natriuresis activates tubuloglomerular feedback, resulting in reduced glomerular hypertension and proteinuria, leading to renal protective effects in the EMPA-REG OUTCOME and CANVAS Program trials. In the cardiovascular system, it is likely that plasma volume contraction due to natriuresis in response to SGLT2 inhibition is at least in part responsible for the reduction in the risk of heart failure observed in these trials. We compare this mechanism of action with other antidiabetics. Importantly, other diuretic classes, including thiazide and loop diuretics, have not resulted in such robust clinical benefits in patients with type 2 diabetes, possibly because these older agents do not influence intraglomerular pressure directly. In contrast, SGLT2 inhibitors do have important physiological similarities with carbonic anhydrase inhibitors, which also act proximally, and have been shown to activate tubuloglomerular feedback.
Background
Diabetic kidney disease is the leading cause of chronic kidney disease (CKD) and end‐stage kidney disease (ESKD) worldwide. ESKD has a high prevalence in patients with diabetes mellitus ...(DM). CKD increases the chances of hypoglycaemia by different mechanisms, causes insulin resistance and a decrease in insulin metabolism. Both the “Kidney Disease: Improving Global Outcomes” (KDIGO) and “American Diabetes Association” (ADA) guidelines recommend the use of insulin as part of treatment, but the type of basal insulin is not specified.
Methods
We reviewed the literature to determine whether first‐ and second‐generation basal insulins are effective and safe in CKD patients. We reviewed specific pivotal studies conducted by pharmaceutical laboratories, as well as independent studies.
Conclusions
Basal insulins are safe and effective in patients with CKD and diabetes mellitus but we do not have specific studies. Given that CKD is one of the main complications of type 2 DM, and insulin specific treatment in the final stages, the absence of studies is striking. Real‐life data are also important since trials such as pivotal studies do not fully represent actual patients. Treatment should be individualized until we have specific trials in this type of population.
Objectives
To investigate the use of once-weekly semaglutide in a real population of people with type 2 diabetes mellitus (T2DM) in three Spanish hospitals.
Method
An observational, retrospective and ...multicenter clinical study was designed that included 166 participants with T2DM, distinguishing between a group naïve to GLP-1RA (n=72) and another switching from another GLP-1RA (n=94), all managed in the outpatient clinical setting. The primary endpoint was the change in HbA1c from baseline to the end of the study. The secondary endpoints included changes in body weight and the proportion of people with T2DM, achieving HbA1c <7.0% and body weight loss >5%.
Results
After 24 months of follow-up, the reductions in HbA1c were -0.91 ± 0.7% (p<0.001) in the total cohort, -1.13 ± 1.38% (p<0.019) for GLP-1RA-naïve participants, and -0.74 ± 0.9% (p<0.023) for GLP-1RA-experienced participants. Body weight reductions were -12.42 ± 9.1% in GLP-1RA-naïve participants vs. -7.65 ± 9.7% in GLP-1RA-experienced participants (p<0.001). In the total cohort, 77.1% reached the objective of an HbA1c level <7%, and 12.7% reached between 7.1% and 7.5%. Additionally, 66.9% achieved a weight reduction ≥5%. Of all cohort, 90% received 1 mg of semaglutide once a week. The reported adverse events were consistent with the known safety profile of semaglutide.
Conclusions
In routine clinical practice in Spain, the use of semaglutide once a week was associated with statistically significant and clinically relevant improvements in HbA1c and body weight in a wide range of adults with T2DM, without notable adverse effects, which supports real-world use.
The dopaminergic system can adapt to the different physiological or pathological situations to which the kidneys are subjected throughout life, maintaining homeostasis of natriuresis, extracellular ...volume, and blood pressure levels. The role of renal dopamine receptor dysfunction is clearly established in the pathogenesis of essential hypertension. Its associations with other pathological states such as insulin resistance and redox balance have also been associated with dysfunction of the dopaminergic system. The different dopamine receptors (D1-D5) show a protective effect against hypertension and kidney disorders. It is essential to take into account the various interactions of the dopaminergic system with other elements, such as adrenergic receptors. The approach to therapeutic strategies for essential hypertension must go through the blocking of those elements that lead to renal vasoconstriction or the restoration of the normal functioning of dopamine receptors. D1-like receptors are fundamental in this role, and new therapeutic efforts should be directed to the restoration of their functioning in many patients. More studies will be needed to allow the development of drugs that can be targeted to renal dopamine receptors in the treatment of hypertension.
Chorea in a diabetic patient with poor metabolic control Rodríguez, Míryam Moreta; Guerra, Javier Miguel Martín; Liaño, Héctor Avellón ...
Practical Diabetes International,
January/February 2022, 2022-01-00, 20220101, Letnik:
39, Številka:
1
Journal Article
Recenzirano
Odprti dostop
This report relates to an 81-year-old Spanish woman with a personal history of hypertension, a 20-year history of type 2 diabetes, dyslipidaemia, atrial fibrillation, and Crohn's disease. Her current ...treatment was mesalazine, folic acid, furosemide, sitagliptin, edoxaban, losartan, hydrochlorothiazide, and digoxin. Despite treatment with oral antidiabetics, good glycaemic control was not achieved and HbA1c was maintained at around 9–10% in recent years.The patient came to the hospital for involuntary choreoathetosic movements in the left upper limb. She also reported non-specific oral discomfort without associated sensory or motor disorder at other levels, without compromised language or other higher functions, and without cranial nerve alterations.
Trichoderma species are filamentous fungi that support plant health and confer improved growth, disease resistance, and abiotic stress tolerance. The objective of this study is to describe the ...physiological characteristics of the abundance and structure of Trichoderma model strains from arid zones and evaluate and describe their possible adaptation and modulation in alkaline pH. The presence of biotic factors such as phytopathogens forces farmers to take more actions such as using pesticides. In addition, factors such as the lack of water worldwide lead to losses in agricultural production. Therefore, the search for biocontrol microorganisms that support drought opens the door to the search for variations in the molecular mechanisms involved in these phenomena. In our case, we isolated 11 tested Trichoderma fungal strains from samples collected both from the rhizosphere and roots from two endemic plants. We probed their molecular markers to obtain their identity and assessed their resistance to alkaline conditions, as well as their response to mycoparasitism, plant growth promotion, and drought stress. The findings were worthy of being analyzed in depth. Three fungal taxa/species were grouped by phylogenetic/phenotypic characteristics; three T. harzianum strains showed outstanding capabilities to adapt to alkalinity stress. They also showed antagonistic activity against three phytopathogenic fungi. Additionally, we provided evidence of significant growth promotion in Sorghum bicolor seedlings under endemic agriculture conditions and a reduction in drought damage with Trichoderma infection. Finally, beneficial fungi adapted to specific ambient niches use various molecular mechanisms to survive and modulate their metabolism.
BACKGROUND:Although risk factors for atherosclerotic cardiovascular disease (ASCVD) in familial hypercholesterolemia (FH) have been described, models for predicting incident ASCVD have not been ...reported. Our aim was to use the SAFEHEART registry (Spanish Familial Hypercholesterolemia Cohort Study) to define key risk factors for predicting incident ASCVD in patients with FH.
METHODS:SAFEHEART is a multicenter, nationwide, long-term prospective cohort study of a molecularly defined population with FH with or without previous ASCVD. Analyses to define risk factors and to build a risk prediction equation were developed, and the risk prediction equation was tested for its ability to discriminate patients who experience incident ASCVD from those who did not over time.
RESULTS:We recruited 2404 adult patients with FH who were followed up for a mean of 5.5 years (SD, 3.2 years), during which 12 (0.5%) and 122 (5.1%) suffered fatal and nonfatal incident ASCVD, respectively. Age, male sex, history of previous ASCVD, high blood pressure, increased body mass index, active smoking, and low-density lipoprotein cholesterol and lipoprotein(a) levels were independent predictors of incident ASCVD from which a risk equation with a Harrell C index of 0.85 was derived. The bootstrap resampling (100 randomized samples) of the original set for internal validation showed a degree of overoptimism of 0.003. Individual risk was estimated for each person without an established diagnosis of ASCVD before enrollment in the registry by use of the SAFEHEART risk equation, the modified Framingham risk equation, and the American College of Cardiology/American Heart Association ASCVD Pooled Cohort Risk Equations. The Harrell C index for these models was 0.81, 0.78, and 0.8, respectively, and differences between the SAFEHEART risk equation and the other 2 were significant (P=0.023 and P=0.045).
CONCLUSIONS:The risk of incident ASCVD may be estimated in patients with FH with simple clinical predictors. This finding may improve risk stratification and could be used to guide therapy in patients with FH.
CLINICAL TRIAL REGISTRATION:URLhttp://clinicaltrials.gov. Unique identifierNCT02693548.
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