Since 2002, AWMSG has acted as a national medicines optimisation committee in Wales. From the outset, pharmacists and clinical pharmacologists have collaborated closely and shared their complementary expertise to make a much greater contribution to the safe, effective, and cost‐effective use of medicines than either group could have achieved by working separately (British Journal of Clinical Pharmacology)
Diabetes News
Category: Medication
Approvals of type 2 diabetes drugs tested in cardiovascular outcome trials: a tripartite comparison
Regulatory authorities using identical trial data made substantially different decisions regarding both safety and efficacy of hypoglycemic drugs. The differences in initial indication wording between Japan and the other authorities suggest that trial data and T2D are interpreted differently in these regions (British Journal of Clinical Pharmacology)
Meta-analyses of Results From Randomized Outcome Trials Comparing Cardiovascular Effects of SGLT2is and GLP-1RAs in Asian Versus White Patients With and Without Type 2 Diabetes
Compared with Whites, Asians may derive greater CV death/HHF benefit from SGLT2is in patients with HFrEF, and MACE benefit from GLP-1RAs in patients with type 2 diabetes (Diabetes Care)
Low‐density lipoprotein cholesterol and lifespan: a Mendelian randomization study
This genetic evidence supports that higher LDL‐c levels reduce lifespan and longevity. In a general population that is not selected for increased cardiovascular risk, there is likely a net lifespan benefit of LDL‐c lowering therapies, particularly for PCSK9 inhibitors, although randomized controlled trials are necessary before modification of clinical practice (British Journal of Clinical Pharmacology)
Severe Hypoglycemia Risk With Long-Acting Insulin Analogs vs Neutral Protamine Hagedorn Insulin
In this cohort study, initiation of long-acting analogs was associated with a lower risk of ED visits or hospitalizations for hypoglycemia compared with NPH insulin in older patients with type 2 diabetes in Medicare. However, this association was not seen with concomitant prandial insulin use (JAMA)
GLP-1 receptor agonists and SGLT2 inhibitors for older people with type 2 diabetes: A systematic review and meta-analysis
In older adults with diabetes, GLP-1 RAs reduced MACE and its components. SGLT2 inhibitors reduced MACE, and heart failure and renal outcomes (Diabetes Research and Clinical Practice)
Sodium–Glucose Co-Transporter 2 Inhibitors (SGLT2i) Exposure and Outcomes in Type 2 Diabetes: A Systematic Review of Population-Based Observational Studies
In T2D, SGLT2is appear safe from the CV perspective and may have associated benefit in primary as well as secondary CVD prevention. For safety, they may be associated with an increased risk of GMI, LLA and DKA, although longer follow-up studies are needed (Diabetes Therapy)
Severe Hypoglycemia Risk With Long-Acting Insulin Analogs vs Neutral Protamine Hagedorn Insulin
In this cohort study, initiation of long-acting analogs was associated with a lower risk of ED visits or hospitalizations for hypoglycemia compared with NPH insulin in older patients with type 2 diabetes in Medicare. However, this association was not seen with concomitant prandial insulin use (JAMA)
Effect of empagliflozin on ectopic fat stores and myocardial energetics in type 2 diabetes: the EMPACEF study
EMPA effectively reduced liver fat in mice and humans without changing epicardial, myocardial fat or myocardial energetics, rebutting the thrifty substrate hypothesis for cardiovascular protection of SGLT2 inhibitors (Cardiovascular Diabetology)
Results of a 24-Week Trial of Technosphere Insulin Versus Insulin Aspart in Type 2 Diabetes
Both TI and IA resulted in significant and clinically meaningful HbA1C reductions. TI also resulted in significant and clinically meaningful weight reductions. These data support the use of inhaled insulin as a treatment option for individuals with type 2 diabetes (Endocrine Practice)
Trends in diabetes medication use in Australia, Canada, England, and Scotland: a repeated cross-sectional analysis in primary care
New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s (British Journal of General Practice)
Metformin Benefits: Another Example for Alternative Energy Substrate Mechanism?
These effects may be considered as being to some extent similar to those produced by SGLT2is, another class of glucose-lowering agents with proven cardiorenal protection. The metabolic effects of metformin and SGLT2is may indeed have some similarities (Diabetes Care)
SGLT2 Inhibition Does Not Affect Myocardial Fatty Acid Oxidation or Uptake, but Reduces Myocardial Glucose Uptake and Blood Flow in Individuals With Type 2 Diabetes
SGLT2 inhibition does not affect myocardial FFA oxidation or uptake, but induces a shift in myocardial substrate utilization from glucose toward other sources, possibly ketone bodies. However, this shift in myocardial substrate utilization is quantitatively of minor importance and does not appear to improve either MEE or myocardial oxygen consumption. Therefore, it is unlikely to explain the striking cardioprotective benefit of SGLT2 inhibition. Of interest, SGLT2 inhibition reduces resting MBF, even when adjusting for cardiac workload (Diabetes)
Changes in Cardiovascular Biomarkers Associated With the Sodium–Glucose Cotransporter 2 (SGLT2) Inhibitor Ertugliflozin in Patients With Chronic Kidney Disease and Type 2 Diabetes
The effects of ertugliflozin on natriuretic peptides and neurohormones are preserved in patients with moderate CKD and consistent with plasma volume reduction. The rise in HCT without a change in erythropoiesis supports the volume contraction mechanism of SGLT2 inhibitor therapy. These effects may be important physiologically and contribute to a lower risk of CVD with SGLT2 inhibitor treatment in people with type 2 diabetes (Diabetes Care)
Tirzepatide significantly reduced A1C and body weight in people with type 2 diabetes in two phase 3 trials from Lilly’s SURPASS program
Tirzepatide significantly reduced A1C and body weight in people with type 2 diabetes in two phase 3 trials from Lilly’s SURPASS program
Cardiovascular impact of new drugs (GLP-1 and gliflozins): the ABCD position statement
ABCD: The position statement is now on-line in The British Journal of Diabetes
Once-Weekly Semaglutide in Adults with Overweight or Obesity
In participants with overweight or obesity, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight (NEJM)
Sodium–glucose cotransporter 2 inhibitors reduce day‐to‐day glucose variability in patients with type 1 diabetes
SGLT2i improved day‐to‐day glucose variability and time in the target glucose range, without increasing frequency of hypoglycemia, in patients with type 1 diabetes, and reduced glycated hemoglobin, body mass and the required insulin dose (Journal of Diabetes Investigation)
Sodium–glucose cotransporter 2 inhibitor‐induced reduction in the mean arterial pressure improved renal composite outcomes in type 2 diabetes mellitus patients with chronic kidney disease: A propensity score‐matched model analysis in Japan
The degree of blood pressure reduction after SGLT2 inhibitor treatment influenced renal composite outcomes in Japanese type 2 diabetes mellitus patients with CKD, confirming the importance of blood pressure management in type 2 diabetes mellitus patients with CKD, even when they are under SGLT2 inhibitor treatment (Journal of Diabetes Investigation)
Use of Dipeptidyl Peptidase‐4 inhibitors and prognosis of COVID‐19 in hospitalized patients with type 2 diabetes: a propensity score analysis from the CORONADO study
These data support the safety of DPP‐4 inhibitors for diabetes management during the COVID‐19 pandemic and they should not be discontinued (Diabetes, Obesity and Metabolism)
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