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Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update).
Rayman, G, Vas, P, Dhatariya, K, Driver, V, Hartemann, A, Londahl, M, Piaggesi, A, Apelqvist, J, Attinger, C, Game, F, et al
Diabetes/metabolism research and reviews. 2020;:e3283
Abstract
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. In conjunction with advice from internal and external reviewers and expert consultants in the field, this update is based on a systematic review of the literature centred on the following: the Population (P), Intervention (I), Comparator (C) and Outcomes (O) framework; the use of the SIGN guideline/Cochrane review system; and the 21 point scoring system advocated by IWGDF/EWMA. This has resulted in 13 recommendations. The recommendation on sharp debridement and the selection of dressings remain unchanged from the last recommendations published in 2016. The recommendation to consider negative pressure wound therapy in post-surgical wounds and the judicious use of hyperbaric oxygen therapy in certain non-healing ischaemic ulcers also remains unchanged. Recommendations against the use of growth factors, autologous platelet gels, bioengineered skin products, ozone, topical carbon dioxide, nitric oxide or interventions reporting improvement of ulcer healing through an alteration of the physical environment or through other systemic medical or nutritional means also remain. New recommendations include consideration of the use of sucrose-octasulfate impregnated dressings in difficult to heal neuro-ischaemic ulcers and consideration of the use of autologous combined leucocyte, platelet and fibrin patch in ulcers that are difficult to heal, in both cases when used in addition to best standard of care. A further new recommendation is the consideration of topical placental derived products when used in addition to best standard of care.
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Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update.
, , Lipscombe, L, Butalia, S, Dasgupta, K, Eurich, DT, MacCallum, L, Shah, BR, Simpson, S, Senior, PA
Canadian journal of diabetes. 2020;(7):575-591
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Special Article - The management of resistant hypertension: A 2020 update.
Carey, RM
Progress in cardiovascular diseases. 2020;(5):662-670
Abstract
Resistant hypertension (RH) induces higher morbidity and mortality due to cardiovascular disease and stroke than hypertension without treatment resistance. New guidelines define RH as blood pressure (BP) ≥130/80 mmHg in a patient taking ≥3 antihypertensive agents of different classes or BP <130/80 mmHg in a patient taking ≥4 antihypertensive drugs. According to the new definition, pseudo-resistance due to error in BP measurement, white coat effect and medication nonadherence must be excluded to make the diagnosis of RH. This 2020 update focuses on the lifestyle and antihypertensive drug management of RH and includes recent proof-of-principle trials of renal nerve ablation in hypertension. Stepwise evidence-based pharmacologic treatment of RH includes optimization of the 3-drug regimen, substitution of a thiazide-like for a thiazide diuretic and addition of a mineralocorticoid receptor antagonist as the fourth drug. Non-evidence-based recommendations include addition of a β-blocker as the fifth drug and switching to a minoxidil-based regimen as the final step in achieving BP control.
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Precision Medicine in Diabetes: A Consensus Report From the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
Chung, WK, Erion, K, Florez, JC, Hattersley, AT, Hivert, MF, Lee, CG, McCarthy, MI, Nolan, JJ, Norris, JM, Pearson, ER, et al
Diabetes care. 2020;(7):1617-1635
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Abstract
The convergence of advances in medical science, human biology, data science, and technology has enabled the generation of new insights into the phenotype known as "diabetes." Increased knowledge of this condition has emerged from populations around the world, illuminating the differences in how diabetes presents, its variable prevalence, and how best practice in treatment varies between populations. In parallel, focus has been placed on the development of tools for the application of precision medicine to numerous conditions. This Consensus Report presents the American Diabetes Association (ADA) Precision Medicine in Diabetes Initiative in partnership with the European Association for the Study of Diabetes (EASD), including its mission, the current state of the field, and prospects for the future. Expert opinions are presented on areas of precision diagnostics and precision therapeutics (including prevention and treatment), and key barriers to and opportunities for implementation of precision diabetes medicine, with better care and outcomes around the globe, are highlighted. Cases where precision diagnosis is already feasible and effective (i.e., monogenic forms of diabetes) are presented, while the major hurdles to the global implementation of precision diagnosis of complex forms of diabetes are discussed. The situation is similar for precision therapeutics, in which the appropriate therapy will often change over time owing to the manner in which diabetes evolves within individual patients. This Consensus Report describes a foundation for precision diabetes medicine, while highlighting what remains to be done to realize its potential. This, combined with a subsequent, detailed evidence-based review (due 2022), will provide a roadmap for precision medicine in diabetes that helps improve the quality of life for all those with diabetes.
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Prediction and early detection of cardiovascular disease in South Asians with diabetes mellitus.
Wander, GS, Bansal, M, Kasliwal, RR
Diabetes & metabolic syndrome. 2020;(4):385-393
Abstract
BACKGROUND Although diabetes mellitus (DM) is no longer considered "coronary heart disease risk equivalent", the risk remains sufficiently high, necessitating early recognition and management of cardiovascular disease (CVD) in these patients. Despite this understanding, the optimum strategy for prediction and early detection of CVD in DM remains debatable. METHODS Major societal guidelines for prediction and evaluation of CVD in subjects with or without DM were reviewed. Available evidence about various risk stratification strategies-their advantages, disadvantages and current role in clinical practice-were extensively reviewed. Special emphasis was placed on evidence from South Asian/Indian populations. RESULTS The inconsistency and variability inherent to the clinical risk algorithms, lack of consensus regarding the incremental value of subclinical atherosclerosis imaging and the lack of sufficient data to demonstrate the benefits of recognizing asymptomatic atherosclerotic disease are some of the reasons underlying prevailing uncertainty about the optimum approach for cardiovascular risk assessment in DM. These challenges notwithstanding, an evidence-based cardiovascular risk stratification strategy incorporating clinical risk algorithms, biomarkers, atherosclerosis imaging, and cardiac stress testing is proposed. CONCLUSIONS The proposed algorithm should help clinicians in optimizing cardiovascular evaluation and management of their patients with DM. However, this remains a dynamic field; further research into different risk assessment tools, esp. focusing on their impact on improving clinical outcomes, should help refine the evaluation strategy in future.
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Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update - The User's Guide.
, , Senior, PA, Houlden, RL, Kim, J, Mackay, D, Nagpal, S, Rabi, D, Sherifali, D, Bajaj, HS
Canadian journal of diabetes. 2020;(7):592-596
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Icosapent ethyl: Where will it fit into guideline-based medical therapy for high risk atherosclerotic cardiovascular disease?
Orringer, CE
Trends in cardiovascular medicine. 2020;(3):151-157
Abstract
Patients who are at high or very high risk for atherosclerotic cardiovascular disease (ASCVD) events derive the greatest benefit when clinicians prescribe evidence-based preventive therapies. The writing process used in the creation of the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol employed a thorough evaluation of the highest quality evidence, and synthesis of this evidence into actionable recommendations for ASCVD risk reduction. Clinical trials supporting the addition of ezetimibe, PCSK9 inhibitors, or both to evidence-based statins provide the basis for the updated recommendations for the preventive care of these patients. The publication in late 2018 of a randomized controlled trial supporting the net ASCVD risk reduction benefit of adding icosapent ethyl to statins in selected hypertriglyceridemic patients with clinical ASCVD and/or type 2 diabetes with multiple additional risk markers provides the rationale for incorporation of icosapent ethyl therapy into future ASCVD preventive care regimens.
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Screening for Atherosclerotic Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus: Controversies and Guidelines.
Raggi, P
Canadian journal of diabetes. 2020;(1):86-92
Abstract
If a disease state is highly prevalent and its consequences are severe, it may be appropriate to seek methods to identify it early to forestall its development and complications. Diabetes mellitus is a proven risk factor for the development of atherosclerosis, although its face and outcome are changing, as shown in contemporary clinical trials. In fact, decompensated heart failure seems to drive the hospitalization rate in patients with diabetes, and mortality from heart failure is reduced with modern hypoglycemic treatments. Nonetheless, atherosclerotic complications continue to be a major health concern in this segment of the population and cardiovascular imaging has been employed in an attempt to achieve a more accurate risk stratification. Although imaging for detection of obstructive coronary artery disease failed to reach such a goal, imaging for preclinical atherosclerosis may be more successful. In this review, we discuss the use of computed tomography and positron emission tomography to detect preclinical coronary atherosclerosis in asymptomatic patients with diabetes. Despite recent advances in the field, several questions remain to be answered as to the ultimate benefit of imaging for prevention in diabetes mellitus.
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The new European guidelines for prevention of cardiovascular disease are misleading.
Ravnskov, U, Alabdulgader, A, de Lorgeril, M, Diamond, DM, Hama, R, Hamazaki, T, Hammarskjöld, B, Harcombe, Z, Kendrick, M, Langsjoen, P, et al
Expert review of clinical pharmacology. 2020;(12):1289-1294
Abstract
Introduction: The European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) have recently published three major revisions of their guidelines for the management of chronic heart disease, blood lipids, and diabetes. Areas covered: We have scrutinized these guidelines in detail and found that the authors have ignored many studies that are in conflict with their conclusions and recommendations. Expert commentary: The authors of the guidelines have ignored that LDL-cholesterol (LDL-C) of patients with acute myocardial infarction is lower than normal; that high cholesterol is not a risk factor for diabetics; that the degree of coronary artery calcification is not associated with LDL-C; and that 27 follow-up studies have shown that people with high total cholesterol or LDL-C live just as long or longer than people with low cholesterol. They have also ignored the lack of exposure-response in the statin trials; that several of these trials have been unable to lower CVD or total mortality; that no statin trial has succeeded with lowering mortality in women, elderly people, or diabetics; and that cholesterol-lowering with statins has been associated with many serious side effects.
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Clinical Guideline Highlights for the Hospitalist: Management of Acute Pancreatitis in the Pediatric Population.
Wall, JM
Journal of hospital medicine. 2019;(12):762-763
Abstract
Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee DEVELOPER Review developed by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Pancreas Committee RELEASE DATE January 1, 2018 FUNDING SOURCE NASPGHAN and the National Institutes of Diabetes and Digestive and Kidney Diseases PRIOR VERSIONS N/A TARGET POPULATION Children with acute pancreatitis.