Family Medicine | Page 17 of 374 | Links Medicus Content Curation & Alerts in Medicine

Review | Hypertension management in patients with cardiovascular comorbidities

27 Jun, 2023 | 13:39h | UTC

Hypertension management in patients with cardiovascular comorbidities – European Heart Journal

Commentary on Twitter

Hypertension management in patients with cardiovascular comorbidities. A State-of-the-Art review just published in #EHJ.@escardio @ESC_Journals #CardioTwitter #hypertension https://t.co/esgOEkxlta pic.twitter.com/xDRHSWn6sZ

— EHJ Editor-in-Chief (@ehj_ed) June 21, 2023

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050

26 Jun, 2023 | 01:00h | UTC

Summary: This systematic review analyzed the global burden of diabetes, including trends, projections, and attributions to risk factors. It considered data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), covering 204 countries and territories.

In 2021, an estimated 529 million people worldwide were living with diabetes. Regionally, the highest rates were observed in North Africa, the Middle East, and Oceania. Type 2 diabetes accounted for 96% of diabetes cases and 95.4% of diabetes DALYs (disability-adjusted life-years). More than half of global type 2 diabetes DALYs were attributable to high body mass index (BMI).

Predictions suggest that more than 1.31 billion people will have diabetes by 2050, with high prevalence rates in North Africa, the Middle East, and Latin America. The study notes the ongoing challenge of preventing and controlling type 2 diabetes, largely driven by increasing obesity. An understanding of disparities in risk profiles and disease burdens can inform strategies to control diabetes risk factors.

Article: Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021 – The Lancet

Editorial: Diabetes: a defining disease of the 21st century – The Lancet

News Release: Global diabetes cases to soar from 529 million to 1.3 billion by 2050 – Institute for Health Metrics and Evaluation

Commentary on Twitter (thread – click for more)

Today: More than 529 million people across the globe have diabetes

In the next 30 years: 1.3 billion people are projected to have diabetes
https://t.co/gh2O0K7RY0

— Institute for Health Metrics and Evaluation (IHME) (@IHME_UW) June 22, 2023

Phase 2 RCT | Orforglipron, an oral GLP-1 receptor agonist, significantly reduces weight in adults with obesity

26 Jun, 2023 | 00:58h | UTC

Summary: The article reports a phase 2, randomized, double-blind trial investigating the efficacy of the GLP-1 receptor agonist, orforglipron, as an oral weight loss treatment for adults with obesity or overweight plus at least one weight-related condition. The study involved 272 participants, who were administered orforglipron at varying doses or a placebo over a 36-week period.

The key findings of the study indicated significant weight reduction in individuals who were administered orforglipron. At 26 weeks, weight changes in the orforglipron group ranged from -8.6% to -12.6% compared to -2.0% in the placebo group. At 36 weeks, these figures were -9.4% to -14.7% for the orforglipron group and -2.3% for the placebo group. Furthermore, 46-75% of orforglipron recipients experienced a weight reduction of at least 10% by week 36, compared to 9% in the placebo group.

Improvements were also observed in all prespecified weight-related and cardiometabolic measures among orforglipron users. However, the treatment was associated with some mild to moderate gastrointestinal side effects, leading to discontinuation in 10-17% of participants. The safety profile was in line with other GLP-1 receptor agonists. These findings suggest that orforglipron could potentially be an effective oral treatment for weight reduction in adults with obesity, though further research is needed to corroborate these results and assess long-term effects.

Article: Daily Oral GLP-1 Receptor Agonist Orforglipron for Adults with Obesity – New England Journal of Medicine (link to abstract – $ for full-text)

Phase 2 RCT | Oral GLP-1 agonist Orforglipron outperforms dulaglutide and placebo in type 2 diabetes control

26 Jun, 2023 | 00:54h | UTC

Summary: In a 26-week, phase 2, double-blind, randomized trial spanning multiple centers in the USA, Hungary, Poland, and Slovakia, researchers examined the efficacy and safety of orforglipron, a non-peptide GLP-1 receptor agonist. The sample comprised 383 adults aged 18 and older with type 2 diabetes treated with diet and exercise, with or without metformin, and with a glycated hemoglobin (HbA1c) of 7.0–10.5%.

The study’s primary efficacy outcome revealed that orforglipron achieved a significantly higher mean reduction in HbA1c compared to both the placebo and dulaglutide (-2.10% vs -0.43% and -1.10%, respectively). Furthermore, orforglipron induced a change in mean body weight at week 26 of -10.1 kg, outperforming both the placebo and dulaglutide. Adverse events mostly encompassed mild to moderate gastrointestinal issues.

The study concluded that orforglipron at doses of 12 mg or higher could potentially serve as an effective alternative to injectable GLP-1 receptor agonists and oral semaglutide, for type 2 diabetes treatment. While the drug’s safety profile was consistent with other GLP-1 receptor agonists, there is a need for larger confirmatory studies and dose regimen optimization.

Article: Efficacy and safety of oral orforglipron in patients with type 2 diabetes: a multicentre, randomised, dose-response, phase 2 study – The Lancet (link to abstract – $ for full-text)

Commentary: Orforglipron Shows Promise as Weight Loss, Diabetes Agent in Phase 2 Trials – HCP Live

Phase 2 RCT | Comparative study on CagriSema, Semaglutide, and Cagrilintide in type 2 diabetes

26 Jun, 2023 | 00:52h | UTC

Summary: The study, a 32-week multicentre, randomized, double-blind, phase 2 trial, evaluated the combined effect of cagrilintide and semaglutide (CagriSema) on individuals with type 2 diabetes. 92 adults with type 2 diabetes and a BMI of 27 kg/m2 or higher were randomly assigned to one of three treatment groups: CagriSema, semaglutide, or cagrilintide.

The results indicated that the mean reduction in HbA1c was more pronounced with CagriSema than cagrilintide, but not semaglutide. The CagriSema group also showed greater weight loss versus both semaglutide and cagrilintide. In terms of safety, the most common adverse events were mild to moderate gastrointestinal events, with no fatal adverse events reported.

These findings suggest that CagriSema presents as a viable treatment option for type 2 diabetes, offering significant benefits in terms of weight loss and glycemic control. A potential limitation is the short duration of the study, which may not account for long-term effects and safety of the intervention. The authors conclude that these results support further investigation of CagriSema in larger, longer phase 3 trials.

Article: Efficacy and safety of co-administered once-weekly cagrilintide 2·4 mg with once-weekly semaglutide 2·4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial – The Lancet (link to abstract – $ for full-text)

Secondary analysis of a RCT | Bempedoic acid reduces CV events in statin-intolerant patients with high CV risk

26 Jun, 2023 | 00:49h | UTC

Summary: This secondary analysis of a Randomized Clinical Trial (RCT) evaluated the efficacy of bempedoic acid in primary prevention of cardiovascular events among statin-intolerant patients at high cardiovascular risk. From a total of 13,970 participants, 4206 met the criteria for primary prevention and were analyzed in this study. Those allocated to receive bempedoic acid showed a significant reduction in major cardiovascular events, reflected in a hazard ratio of 0.70.

The average age of this patient cohort was 68 years, and most participants (66%) were diagnosed with diabetes. Treatment with bempedoic acid also led to a significant 21.3% reduction in low-density lipoprotein cholesterol (LDL-C) levels and a 21.5% decrease in high-sensitivity C-reactive protein levels, suggesting improved cardiovascular health.

This study underscores the potential benefits of lipid-modulating therapy for primary prevention in high-risk patients, who are often undertreated. However, it is important to note the inherent limitations of this secondary analysis. The analysis was performed on a subgroup within a larger clinical trial, which could potentially lead to false-positive findings due to multiple testing. Furthermore, the results may not generalize to younger populations, those with lower pretreatment LDL-C levels, those without diabetes, or those with a lower baseline cardiovascular risk.

Article: Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients – JAMA (free for a limited period)

Editorial: Bempedoic Acid for High-Risk Primary Prevention of Cardiovascular Disease: Not a Statin Substitute but a Good Plan B – JAMA (free for a limited period)

See also: Visual Abstract

Commentary: Study Suggests Bempedoic Acid Could Find Role in Primary Prevention – HCP Live

Original Study: RCT | Bempedoic acid shows modest reduction in cardiovascular events for statin-intolerant patients

Cohort Study | Association of preterm birth with increased asthma and COPD risk in adulthood

26 Jun, 2023 | 00:45h | UTC

Summary: This population-based register study investigated the correlation between gestational ages (GA) and obstructive airway diseases like asthma and chronic obstructive pulmonary disease (COPD) in adulthood. The study used registry data from 706,717 individuals born between 1987-1998 in Finland (4.8% preterm), and 1,669,528 individuals born from 1967-1999 in Norway (5.0% preterm). The study observed care episodes of asthma and COPD using nationwide healthcare registers.

The results showed an increased risk of obstructive airway disease in adulthood for those born at <28 or 28–31 completed weeks of gestation. Even after adjustments, the risk remained 2-3 times greater compared to those who were born full term (at 39-41 completed weeks). Additionally, the risk for COPD at age 30–50 was significantly higher for those born at <28 weeks, with an odds ratio (OR) of 7.44. The study also identified that bronchopulmonary dysplasia (BPD) in infancy increased the odds of obstructive airway disease for those born at <28 and 28–31 weeks.

These findings suggest that preterm birth is a notable risk factor for asthma and COPD in adulthood, and this risk was observed across all gestational ages before full term. The study recommends diagnostic vigilance for adults born very preterm presenting with respiratory symptoms. However, the researchers also noted the potential limitations of using registry data, which might include residual confounding from unmeasured confounders and lack of data on certain prenatal or early life factors.

Article: Preterm birth and asthma and COPD in adulthood: a nationwide register study from two Nordic countries – European Respiratory Journal (free for a limited period)

Commentary on Twitter

In this population-based study of 2.4 million people from Finland and Norway, adults born preterm were at higher risk for asthma and COPD at ages 18–50 years. The risks were observed across all gestational ages before full term in a dose-response manner. https://t.co/bGsAOrwAxV pic.twitter.com/WmCoc6cPu2

— ERS publications (@ERSpublications) June 22, 2023

Review | Evaluation and management of diabetes-related foot infections

23 Jun, 2023 | 13:36h | UTC

Evaluation and Management of Diabetes-related Foot Infections – Clinical Infectious Diseases

Guideline | Management of adrenal incidentalomas

23 Jun, 2023 | 13:33h | UTC

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors – European Journal of Endocrinology

#377 Adrenal Incidentalomas with Dr. William Young – The Curbsiders

[Abstract Only] Meta-Analysis: Natural History of Adrenal Incidentalomas With and Without Mild Autonomous Cortisol Excess

Cohort Study | Increased depression risk observed in first two years of oral contraceptive use

23 Jun, 2023 | 13:19h | UTC

Population-based cohort study of oral contraceptive use and risk of depression – Epidemiology and Psychiatric Sciences

News Release: New study links contraceptive pills and depression – Uppsala University

Commentary: Depression Risk May Rise During First Two Years of Oral Contraceptive Use – Psychiatric News Alert

Commentary on Twitter

Population-based cohort study of oral #contraceptive use and risk of #depression suggests that the use of OCs, particularly during the first 2 years, increases the risk of depression.https://t.co/spWuqCMKfW @therese_johans #mentalhealth #epidemiology pic.twitter.com/xMO0yiqPvt

— Epidemiology & Psychiatric Sciences (@EpiPsychSci) June 19, 2023

Choosing Wisely | Recommendations for advance care planning

22 Jun, 2023 | 15:18h | UTC

Choosing Wisely: Canadian Neurological Society Recommendations for Advance Care Planning – Canadian Journal of Neurological Sciences

See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada

RCT | LMWH does not increase live birth rates in women with thrombophilia and recurrent miscarriage

21 Jun, 2023 | 13:39h | UTC

Heparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2): an international open-label, randomised controlled trial – The Lancet (link to abstract – $ for full-text)

News Release: Study recommends ending heparin use for women with recurrent miscarriage and inherited thrombophilia – National Institute for Health and Care Research

Commentary on Twitter (thread – click for more)

New study: Many women with recurrent miscarriage are tested for inherited thrombophilia. If confirmed positive, daily subcutaneous low-molecular-weight heparin (LMWH) is given.

This is despite an absence of evidence that such treatment is beneficial 🧵 https://t.co/0IuFhvjlZr

— The Lancet (@TheLancet) June 2, 2023

Review | Deadly drug rashes: early recognition and multidisciplinary care

21 Jun, 2023 | 13:28h | UTC

Deadly drug rashes: Early recognition and multidisciplinary care – Cleveland Clinic Journal of Medicine

Position statement | Gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy

21 Jun, 2023 | 13:22h | UTC

Position statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy – Indian Journal of Gastroenterology (if the link is paywalled, try this one)

The foot in diabetes – a reminder of an ever-present risk

21 Jun, 2023 | 13:10h | UTC

The foot in diabetes – a reminder of an ever-present risk – Clinical Medicine Journal

RCT | Thrice-weekly oral iron shows non-inferiority and fewer gastrointestinal effects in treating iron-deficiency anemia

20 Jun, 2023 | 12:48h | UTC

A randomized controlled trial of thrice-weekly versus thrice-daily oral ferrous fumarate treatment in adult patients with iron-deficiency anemia – Ann Hematol (if the link is paywalled, try this one)

Guidelines for the management of trigeminal neuralgia

20 Jun, 2023 | 12:43h | UTC

Guidelines for the management of trigeminal neuralgia – Cleveland Clinic Journal of Medicine

SR | Long‐acting muscarinic antagonist (LAMA) plus long‐acting beta‐agonist (LABA) vs. LABA plus inhaled corticosteroid (ICS) for COPD

20 Jun, 2023 | 12:26h | UTC

Long‐acting muscarinic antagonist (LAMA) plus long‐acting beta‐agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease – Cochrane Library

Summary: Which combination of inhaled medications are safe and effective for chronic obstructive pulmonary disease (COPD)? – Cochrane Library

RCT | Testosterone replacement does not appear to increase cardiovascular events in hypogonadal men at high risk

19 Jun, 2023 | 14:13h | UTC

Cardiovascular Safety of Testosterone-Replacement Therapy – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Cleveland Clinic-Led Trial Finds Testosterone-Replacement Therapy Does Not Increase Incidence of Major Adverse Cardiac Events for Men with Low Testosterone – Cleveland Clinic

Commentary on Twitter

Presented today at #ENDO2023: In the TRAVERSE study, a randomized trial involving men with hypogonadism and preexisting or a risk of cardiovascular disease, testosterone therapy was noninferior to placebo with respect to major adverse cardiac events. https://t.co/V3FTTsOLd1

— NEJM (@NEJM) June 16, 2023