Pub Date : 2017-10-31DOI: 10.33590/emjdiabet/10314289
T. Wehbe, Tatiana Hawat
Most public health statistics outline the rapidly exploding burden of Type 2 diabetes mellitus as a chronic endemic disease related to sedentary lifestyle and obesity. Tremendous efforts and resources are being invested in finding new medical treatments and alternative therapies through cell-based replacement strategies among other methods. Several types of cells continue to be under active research, including autologous islet cells, allogeneic cadaveric islet cells, embryonic and induced pluripotent stem cells, bone marrow-derived hematopoietic and mononuclear cells, and mesenchymal stem cells of different sources. The objective of this review is to bring the reader up to speed on the efforts being spent in this field with a clear and critical approach to the difficult and sometimes futile methodology undermining the results obtained.
{"title":"Type 2 Diabetes Mellitus and Stem Cell Therapy: A Review","authors":"T. Wehbe, Tatiana Hawat","doi":"10.33590/emjdiabet/10314289","DOIUrl":"https://doi.org/10.33590/emjdiabet/10314289","url":null,"abstract":"Most public health statistics outline the rapidly exploding burden of Type 2 diabetes mellitus as a chronic endemic disease related to sedentary lifestyle and obesity. Tremendous efforts and resources are being invested in finding new medical treatments and alternative therapies through cell-based replacement strategies among other methods. Several types of cells continue to be under active research, including autologous islet cells, allogeneic cadaveric islet cells, embryonic and induced pluripotent stem cells, bone marrow-derived hematopoietic and mononuclear cells, and mesenchymal stem cells of different sources. The objective of this review is to bring the reader up to speed on the efforts being spent in this field with a clear and critical approach to the difficult and sometimes futile methodology undermining the results obtained.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"53 71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117204413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-31DOI: 10.33590/emjdiabet/10314891
Kuan Hao Yee, S. Sanjay
Over the last decade, intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have been increasingly used in the management of various retinal diseases, especially diabetic macular oedema. Diabetic macular oedema is one of the leading causes of legal blindness among patients with diabetic retinopathy, meaning these patients are eligible for associated medical benefits. It is essential that diabetic macular oedema is managed with an effective and safe treatment for good long-term prognosis. Over the past decade, focal/grid laser photocoagulation has been the gold standard treatment. However, evidence supporting the superior clinical benefits and relative safety of anti-VEGF agents has driven a recent shift in treatment paradigm, favouring anti-VEGF over laser treatment. Previous studies involving systemic anti-VEGF treatment in cancers have identified an associated increased risk of arteriothrombotic events, such as myocardial infarction and stroke, which are potentially fatal. Hence, it is important to evaluate whether such risks, which will significantly alter the safety profile, persist with intravitreal administration. A comprehensive literature review was performed and concluded that no significant increase in risk of ocular or non-ocular adverse events, particularly arteriothrombotic events, were associated with anti-VEGF agents, predicting an overall favourable safety profile. A summary of some of the possible adverse events recorded in the various studies, albeit at relatively low rates, are also included. Additionally, it is briefly discussed how real-world concerns of cost and affordability can influence treatment choice, thereby affecting how clinical evidence is transferred into practice.
{"title":"Anti-Vascular Endothelial Growth Factor Therapy in Diabetic Macular Oedema: Is It Safe?","authors":"Kuan Hao Yee, S. Sanjay","doi":"10.33590/emjdiabet/10314891","DOIUrl":"https://doi.org/10.33590/emjdiabet/10314891","url":null,"abstract":"Over the last decade, intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have been increasingly used in the management of various retinal diseases, especially diabetic macular oedema. Diabetic macular oedema is one of the leading causes of legal blindness among patients with diabetic retinopathy, meaning these patients are eligible for associated medical benefits. It is essential that diabetic macular oedema is managed with an effective and safe treatment for good long-term prognosis. Over the past decade, focal/grid laser photocoagulation has been the gold standard treatment. However, evidence supporting the superior clinical benefits and relative safety of anti-VEGF agents has driven a recent shift in treatment paradigm, favouring anti-VEGF over laser treatment. Previous studies involving systemic anti-VEGF treatment in cancers have identified an associated increased risk of arteriothrombotic events, such as myocardial infarction and stroke, which are potentially fatal. Hence, it is important to evaluate whether such risks, which will significantly alter the safety profile, persist with intravitreal administration. A comprehensive literature review was performed and concluded that no significant increase in risk of ocular or non-ocular adverse events, particularly arteriothrombotic events, were associated with anti-VEGF agents, predicting an overall favourable safety profile. A summary of some of the possible adverse events recorded in the various studies, albeit at relatively low rates, are also included. Additionally, it is briefly discussed how real-world concerns of cost and affordability can influence treatment choice, thereby affecting how clinical evidence is transferred into practice.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122344625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-31DOI: 10.33590/emjdiabet/10313575
M. Stewart
Diabetic macular oedema (DMO) is the leading cause of vision loss in working aged individuals. Macular laser photocoagulation was the primary DMO treatment for several decades, but has recently been replaced by intravitreal injections of corticosteroids and drugs that inhibit the actions of vascular endothelial growth factor (VEGF). In Phase III trials, anti-VEGF drugs improve best corrected visual acuity by a mean of +12 letters, but up to 40% of patients have sub-optimal responses to therapy. The new anti-VEGF drugs abicipar and brolucizumab may possess extended durations of action in Phase III neovascular age-related macular degeneration trials, and DMO trials are being planned. Angiopoietin-2 inhibitors, both as co-formulations with anti-VEGF drugs and as bispecific antibodies, are in Phase II trials for DMO. Drugs that stimulate the Tie2 receptor are administered via subcutaneous injections. Intravenously administered antibodies that decrease diabetes-mediated inflammation, such as tocilizumab and teprotumumab, are entering early phase studies. Other drugs with topical (mecamylamine) and oral (minocycline) delivery routes are being developed. Several of these drugs may become available to patients within the next 5–10 years.
{"title":"Future Treatments of Diabetic Retinopathy: Pharmacotherapeutic Products Under Development","authors":"M. Stewart","doi":"10.33590/emjdiabet/10313575","DOIUrl":"https://doi.org/10.33590/emjdiabet/10313575","url":null,"abstract":"Diabetic macular oedema (DMO) is the leading cause of vision loss in working aged individuals. Macular laser photocoagulation was the primary DMO treatment for several decades, but has recently been replaced by intravitreal injections of corticosteroids and drugs that inhibit the actions of vascular endothelial growth factor (VEGF). In Phase III trials, anti-VEGF drugs improve best corrected visual acuity by a mean of +12 letters, but up to 40% of patients have sub-optimal responses to therapy. The new anti-VEGF drugs abicipar and brolucizumab may possess extended durations of action in Phase III neovascular age-related macular degeneration trials, and DMO trials are being planned. Angiopoietin-2 inhibitors, both as co-formulations with anti-VEGF drugs and as bispecific antibodies, are in Phase II trials for DMO. Drugs that stimulate the Tie2 receptor are administered via subcutaneous injections. Intravenously administered antibodies that decrease diabetes-mediated inflammation, such as tocilizumab and teprotumumab, are entering early phase studies. Other drugs with topical (mecamylamine) and oral (minocycline) delivery routes are being developed. Several of these drugs may become available to patients within the next 5–10 years.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"235 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115644494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-27DOI: 10.33590/emjdiabet/10310409
M. Stewart
Chorioretinal vascular diseases are among the leading causes of blindness in industrialised countries. The recent development and widespread adoption of intravitreal pharmacotherapy enables surgeons to not only stabilise disease in most cases, but also improve visual acuity (VA). Inhibitors of vascular endothelial growth factor (VEGF) have become first-line therapy for patients with neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO), and oedema due to retinal vein occlusions (RVO). The pivotal Phase III registration studies evaluated the efficacy and safety of monthly or bimonthly injections of anti-VEGF drugs, and remain the standard against which other treatments and injection regimens are compared. Adhering to a regimen of monthly drug injections requires considerable patient compliance and allocation of substantial healthcare resources, therefore most physicians use individualised treatment strategies. As-needed (PRN) and treat and extend (T&E) regimens reduce the number of clinic visits, intravitreal injections, or both, and are less expensive than monthly therapy. Both regimens reduce unwanted macular oedema and improve VA, but compared to monthly therapy over the course of 1 year, may be 1–3 letters less effective. Trials of 5-year duration suggest that PRN treatment modulates the severity of diabetic retinopathy (DR) and stabilises vision in patients with DR. Long-term data comparing these strategies in patients with nAMD and RVO are lacking, but VA frequently declines when observation periods and treatment intervals are extended beyond 4 weeks. Current observations suggest that aggressive long-term therapy with frequent injections may produce the best VA results in patients with nAMD and RVO.
{"title":"Treatment Strategies for Chorioretinal Vascular Diseases: Advantages and Disadvantages of Individualised Therapy","authors":"M. Stewart","doi":"10.33590/emjdiabet/10310409","DOIUrl":"https://doi.org/10.33590/emjdiabet/10310409","url":null,"abstract":"Chorioretinal vascular diseases are among the leading causes of blindness in industrialised countries. The recent development and widespread adoption of intravitreal pharmacotherapy enables surgeons to not only stabilise disease in most cases, but also improve visual acuity (VA). Inhibitors of vascular endothelial growth factor (VEGF) have become first-line therapy for patients with neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO), and oedema due to retinal vein occlusions (RVO). The pivotal Phase III registration studies evaluated the efficacy and safety of monthly or bimonthly injections of anti-VEGF drugs, and remain the standard against which other treatments and injection regimens are compared. Adhering to a regimen of monthly drug injections requires considerable patient compliance and allocation of substantial healthcare resources, therefore most physicians use individualised treatment strategies. As-needed (PRN) and treat and extend (T&E) regimens reduce the number of clinic visits, intravitreal injections, or both, and are less expensive than monthly therapy. Both regimens reduce unwanted macular oedema and improve VA, but compared to monthly therapy over the course of 1 year, may be 1–3 letters less effective. Trials of 5-year duration suggest that PRN treatment modulates the severity of diabetic retinopathy (DR) and stabilises vision in patients with DR. Long-term data comparing these strategies in patients with nAMD and RVO are lacking, but VA frequently declines when observation periods and treatment intervals are extended beyond 4 weeks. Current observations suggest that aggressive long-term therapy with frequent injections may produce the best VA results in patients with nAMD and RVO.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"83 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114135120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-27DOI: 10.33590/emjdiabet/10311885
N. Morris
Type 2 diabetes mellitus (T2DM) currently affects >8% of the world population. It is the leading cause of blindness, end-stage kidney disease, and neuropathy, and doubles the risk of developing cardiovascular disease. Until recently, the treatment of diabetes had broadly emphasised the management of hyperglycaemia as the key diagnostic criterion for T2DM. The pathophysiology of T2DM however is now understood to be rooted in the associated metabolic syndrome including intra-abdominal fat deposition, lipid abnormalities, high blood pressure, hypercoagulability, and macrovascular complications occurring in parallel with glucose dysregulation. Accordingly, closer attention to the medical management of these conditions is at the forefront of diabetologists’ treatment rationale in an attempt to prevent and mitigate both micro and macrovascular complications, especially in light of the recent positive data from cardiovascular outcome trials with both sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. This symposium included a discussion of the evolution of treatment for T2DM and presented the rationale for the use of novel agents and combination therapies for patients according to their individual disease progression. Several newer drug classes were highlighted, including GLP-1 receptor agonists, dipeptidyl-peptidase-4 inhibitors (DPP-4 inhibitors), and SGLT2 inhibitors. Finally, an overview of the exciting new fields of prevention and treatment for T2DM were discussed; including stem cell proliferation into pancreatic beta cells, the reprogramming of white adipose tissue into brown fat, mimicking physiological effects of bariatric surgery pharmacologically, and other approaches to make the treatment more targeted and personalised.
{"title":"Type 2 Diabetes Mellitus: Beyond the Beta Cell","authors":"N. Morris","doi":"10.33590/emjdiabet/10311885","DOIUrl":"https://doi.org/10.33590/emjdiabet/10311885","url":null,"abstract":"Type 2 diabetes mellitus (T2DM) currently affects >8% of the world population. It is the leading cause of blindness, end-stage kidney disease, and neuropathy, and doubles the risk of developing cardiovascular disease. Until recently, the treatment of diabetes had broadly emphasised the management of hyperglycaemia as the key diagnostic criterion for T2DM. The pathophysiology of T2DM however is now understood to be rooted in the associated metabolic syndrome including intra-abdominal fat deposition, lipid abnormalities, high blood pressure, hypercoagulability, and macrovascular complications occurring in parallel with glucose dysregulation. Accordingly, closer attention to the medical management of these conditions is at the forefront of diabetologists’ treatment rationale in an attempt to prevent and mitigate both micro and macrovascular complications, especially in light of the recent positive data from cardiovascular outcome trials with both sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. This symposium included a discussion of the evolution of treatment for T2DM and presented the rationale for the use of novel agents and combination therapies for patients according to their individual disease progression. Several newer drug classes were highlighted, including GLP-1 receptor agonists, dipeptidyl-peptidase-4 inhibitors (DPP-4 inhibitors), and SGLT2 inhibitors. Finally, an overview of the exciting new fields of prevention and treatment for T2DM were discussed; including stem cell proliferation into pancreatic beta cells, the reprogramming of white adipose tissue into brown fat, mimicking physiological effects of bariatric surgery pharmacologically, and other approaches to make the treatment more targeted and personalised.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114468045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-27DOI: 10.33590/emjdiabet/10313978
R. Rajput, D. Jain
Gestational diabetes mellitus (GDM) is a major public health problem with various complexities involved in its diagnosis. Traditionally an oral glucose tolerance test is used for the diagnosis of GDM, however the measurement of plasma glucose values both after fasting and the glucose challenge test has certain shortcomings, especially during pregnancy. The American Diabetes Association (ADA) in 2010 and the World Health Organization (WHO) in 2011 have accepted glycated haemoglobin (HbA1c) as a tool for diagnosing diabetes mellitus, however it is not currently recommended as a diagnostic tool for GDM. The estimation of HbA1c levels is likely to be more acceptable to pregnant women, as a single non-fasting blood sample is required for this investigation. Although various studies have shown different HbA1c cut-off values representing the best equilibrium between sensitivity and specificity for GDM, most of them conclude that an HbA1c level of >5.95% can be used to diagnose GDM in pregnant women with high specificity. This article reviews the present role and future place of measuring HbA1c levels in the diagnosis of GDM.
{"title":"Utility of Glycated Haemoglobin in Gestational Diabetes Mellitus: Present and Future","authors":"R. Rajput, D. Jain","doi":"10.33590/emjdiabet/10313978","DOIUrl":"https://doi.org/10.33590/emjdiabet/10313978","url":null,"abstract":"Gestational diabetes mellitus (GDM) is a major public health problem with various complexities involved in its diagnosis. Traditionally an oral glucose tolerance test is used for the diagnosis of GDM, however the measurement of plasma glucose values both after fasting and the glucose challenge test has certain shortcomings, especially during pregnancy. The American Diabetes Association (ADA) in 2010 and the World Health Organization (WHO) in 2011 have accepted glycated haemoglobin (HbA1c) as a tool for diagnosing diabetes mellitus, however it is not currently recommended as a diagnostic tool for GDM. The estimation of HbA1c levels is likely to be more acceptable to pregnant women, as a single non-fasting blood sample is required for this investigation. Although various studies have shown different HbA1c cut-off values representing the best equilibrium between sensitivity and specificity for GDM, most of them conclude that an HbA1c level of >5.95% can be used to diagnose GDM in pregnant women with high specificity. This article reviews the present role and future place of measuring HbA1c levels in the diagnosis of GDM.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121793632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-27DOI: 10.33590/emjdiabet/10310563
B. Tollo, D. Chougourou, Clovis Maurès Todohoue
Moringa oleifera leaf powder (MOLP) was incorporated into patient diets in order to study its effects on the levels of fasting blood glucose (FBG), glycated haemoglobin (HbA1c), serum triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and body weight (BW) in those at the early stages of Type 2 diabetes mellitus (T2DM). Two tablespoons (20 g) of the leaf powder were added to a basic diet of food served cold daily at lunch and dinner for a period of 3 months. Pre-diabetic control subjects were given the basic diet without MOLP. The supplementation of MOLP into the basic diet significantly (p<0.05) reduced the elevated FBG, HbA1c, TG, TC, and LDL cholesterol levels in the MOLP-diet group, while an increase in HDL cholesterol was also recorded. MOLP exerted more pronounced effects at the end of the study when compared with the control group. Overall, BW was reduced, with better results recorded in the MOLP group. Considering the changes when compared to each initial value, the efficacy of the MOLP diet on biochemical parameters was 3.55–24.79% greater. The introduction of the effective potential change revealed an efficacy induction of 8.85–36.83% due to the MOLP diet, with a relative performance factor ranging from 1.50–4.85 among the biochemical parameters. The findings suggest that MOLP possesses promising anti-hyperglycaemic, anti-hyperlipidaemic, and lipid profile regulatory properties in T2DM subjects.
{"title":"Home Diabetes Anti-Hyperglycaemic and Lipid Profile Regulatory Properties of Moringa…\u0000Anti-Hyperglycaemic and Lipid Profile Regulatory Properties of Moringa Oleifera in Subjects at Early Stages of Type 2 Diabetes Mellitus","authors":"B. Tollo, D. Chougourou, Clovis Maurès Todohoue","doi":"10.33590/emjdiabet/10310563","DOIUrl":"https://doi.org/10.33590/emjdiabet/10310563","url":null,"abstract":"Moringa oleifera leaf powder (MOLP) was incorporated into patient diets in order to study its effects on the levels of fasting blood glucose (FBG), glycated haemoglobin (HbA1c), serum triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and body weight (BW) in those at the early stages of Type 2 diabetes mellitus (T2DM). Two tablespoons (20 g) of the leaf powder were added to a basic diet of food served cold daily at lunch and dinner for a period of 3 months. Pre-diabetic control subjects were given the basic diet without MOLP. The supplementation of MOLP into the basic diet significantly (p<0.05) reduced the elevated FBG, HbA1c, TG, TC, and LDL cholesterol levels in the MOLP-diet group, while an increase in HDL cholesterol was also recorded. MOLP exerted more pronounced effects at the end of the study when compared with the control group. Overall, BW was reduced, with better results recorded in the MOLP group. Considering the changes when compared to each initial value, the efficacy of the MOLP diet on biochemical parameters was 3.55–24.79% greater. The introduction of the effective potential change revealed an efficacy induction of 8.85–36.83% due to the MOLP diet, with a relative performance factor ranging from 1.50–4.85 among the biochemical parameters. The findings suggest that MOLP possesses promising anti-hyperglycaemic, anti-hyperlipidaemic, and lipid profile regulatory properties in T2DM subjects.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122083336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-03DOI: 10.33590/emjdiabet/10310596
J. Davies
This symposium aimed to address the current issues in the management of patients with Type 2 diabetes (T2D) post-acute coronary syndrome (ACS), bringing together the views of both cardiologists and diabetologists. T2D increases the risk of ACS and is associated with a poorer prognosis for these patients. Although guidelines provide comprehensive recommendations for patients with ACS, specific guidance is lacking following hospital discharge for those with concomitant T2D. As a result, these patients receive suboptimal treatment compared with patients without T2D. The cardiovascular (CV) benefits of intensive glucose lowering alone for those with T2D are uncertain. However, knowledge of the CV safety profiles of available therapies helps diabetologists to provide individualised treatment for their patients. Currently, three studies have reported on the CV safety of dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with T2D. However, active inclusion of patients who are both post-ACS (15–90 days) and at high risk of CV disease (CVD) is rare. Only the DPP-4 alogliptin has been assessed in a CV safety outcome study in patients with this specific profile.
{"title":"Should Type 2 Diabetes Management Be More of a Priority in Post-Acute Coronary Syndrome Patients?","authors":"J. Davies","doi":"10.33590/emjdiabet/10310596","DOIUrl":"https://doi.org/10.33590/emjdiabet/10310596","url":null,"abstract":"This symposium aimed to address the current issues in the management of patients with Type 2 diabetes (T2D) post-acute coronary syndrome (ACS), bringing together the views of both cardiologists and diabetologists. T2D increases the risk of ACS and is associated with a poorer prognosis for these patients. Although guidelines provide comprehensive recommendations for patients with ACS, specific guidance is lacking following hospital discharge for those with concomitant T2D. As a result, these patients receive suboptimal treatment compared with patients without T2D. The cardiovascular (CV) benefits of intensive glucose lowering alone for those with T2D are uncertain. However, knowledge of the CV safety profiles of available therapies helps diabetologists to provide individualised treatment for their patients. Currently, three studies have reported on the CV safety of dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with T2D. However, active inclusion of patients who are both post-ACS (15–90 days) and at high risk of CV disease (CVD) is rare. Only the DPP-4 alogliptin has been assessed in a CV safety outcome study in patients with this specific profile.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114955499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-03DOI: 10.33590/emjdiabet/10313731
A. Abderrahmani
Pancreatic beta and neuronal cells share numerous similarities, including a key transcriptional mechanism of the differentiation programme. The mechanism involves the decrease or the extinction of the transcriptional repressor RE-1-silencing transcription factor (REST), also called neuron-restrictive silencer factor (NRSF), which leads to the expression of various genes encoding proteins required for mature beta and neuronal cell function. Abnormal expression and genetic variation in some of the REST/NRSF target genes have been reported in diabetes and neurodegenerative disorders, suggesting that common pathogenic mechanisms account for beta-cell decline and neuronal degeneration in the two diseases. In addition, some of the REST/NRSF target genes have been identified as potential therapeutic targets for improvement of beta-cell function in diabetes. This review sheds light on the neuronal and beta-cell REST/NRSF target genes that are potential future drug targets for the treatment of diabetes and neurodegeneration.
{"title":"REST/NRSF Target Genes in Neuronal and Beta Cells: Pathophysiological and Therapeutic Perspectives for Diabetes and Neurodegenerative Disorders","authors":"A. Abderrahmani","doi":"10.33590/emjdiabet/10313731","DOIUrl":"https://doi.org/10.33590/emjdiabet/10313731","url":null,"abstract":"Pancreatic beta and neuronal cells share numerous similarities, including a key transcriptional mechanism of the differentiation programme. The mechanism involves the decrease or the extinction of the transcriptional repressor RE-1-silencing transcription factor (REST), also called neuron-restrictive silencer factor (NRSF), which leads to the expression of various genes encoding proteins required for mature beta and neuronal cell function. Abnormal expression and genetic variation in some of the REST/NRSF target genes have been reported in diabetes and neurodegenerative disorders, suggesting that common pathogenic mechanisms account for beta-cell decline and neuronal degeneration in the two diseases. In addition, some of the REST/NRSF target genes have been identified as potential therapeutic targets for improvement of beta-cell function in diabetes. This review sheds light on the neuronal and beta-cell REST/NRSF target genes that are potential future drug targets for the treatment of diabetes and neurodegeneration.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124417802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-03DOI: 10.33590/emjdiabet/10312465
P. Nilsson
Arterial ageing is a process that can be quantified, at least to some degree, by measurement of pulse wave velocity along the aorta, the largest elastic artery, as a marker of arterial stiffness. In recent years the new concept of early vascular ageing (EVA) has been developed by a group of mostly European researchers and some reviews have been published. Based on a lecture given at the European Association for the Study of Diabetes (EASD) Meeting in Vienna 2014, this review was written to describe recent developments in research dedicated to EVA and new emerging aspects found in studies of families at high cardiovascular (CV) risk. This brings new perspectives related to genetics, telomere biology, and the role of gut microbiota. Even if EVA has been described in general terms there is still no unifying definition available and no direct treatment, only recommendations for conventional CV risk factor control. However, a new intervention study (SPARTE) is ongoing in France with a randomised design to treat arterial stiffness in patients with hypertension versus conventional treatment strategies. Results are expected in a few years and will be of importance in defining the role of arterial stiffness, a core feature of EVA, as a target for treatment.
{"title":"The Concept of Early Vascular Ageing – An Update in 2015","authors":"P. Nilsson","doi":"10.33590/emjdiabet/10312465","DOIUrl":"https://doi.org/10.33590/emjdiabet/10312465","url":null,"abstract":"Arterial ageing is a process that can be quantified, at least to some degree, by measurement of pulse wave velocity along the aorta, the largest elastic artery, as a marker of arterial stiffness. In recent years the new concept of early vascular ageing (EVA) has been developed by a group of mostly European researchers and some reviews have been published. Based on a lecture given at the European Association for the Study of Diabetes (EASD) Meeting in Vienna 2014, this review was written to describe recent developments in research dedicated to EVA and new emerging aspects found in studies of families at high cardiovascular (CV) risk. This brings new perspectives related to genetics, telomere biology, and the role of gut microbiota. Even if EVA has been described in general terms there is still no unifying definition available and no direct treatment, only recommendations for conventional CV risk factor control. However, a new intervention study (SPARTE) is ongoing in France with a randomised design to treat arterial stiffness in patients with hypertension versus conventional treatment strategies. Results are expected in a few years and will be of importance in defining the role of arterial stiffness, a core feature of EVA, as a target for treatment.","PeriodicalId":418035,"journal":{"name":"EMJ Diabetes","volume":"30 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123487565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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