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Prescribe an SGLT2 inhibitor for heart failure in the absence of diabetes?
Koenigsberger, D, Marquez, A, Hughes, PR
The Journal of family practice. 2021;(6):E7-E9
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Abstract
An RCT demonstrates that dapagliflozin produces better cardiovascular outcomes than placebo for heart failure patients with and without diabetes.
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2.
Clinical manifestation of non-ketotic hyperglycemia chorea: A case report and literature review.
Wang, W, Tang, X, Feng, H, Sun, F, Liu, L, Rajah, GB, Yu, F
Medicine. 2020;(22):e19801
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Abstract
INTRODUCTION Chorea is considered a special complication of diabetes mellitus. Here we report a case of chorea associated with non-ketotic hyperglycemia (NKH). PATIENT CONCERNS The patient was a 79-year-old Asian woman. She had a history of type 2 diabetes mellitus more than 30 years, but with a poor control of blood sugar. She complained of acute onset of right limb involuntary activities, and being admitted to neurology department. DIAGNOSIS The patient was then diagnosed with NKH chorea. INTERVENTIONS Intravenous infusion of insulin was given to reduce blood glucose. Haloperidol was used to control motor symptoms. OUTCOMES Her symptoms improved quickly after treatment. In the past year, the patient's blood sugar was well controlled and her chorea did not recur. LESSONS If there are sudden abnormal movements in patients, in addition to thinking of chorea, hepatolenticular degeneration and other diseases, we should also pay attention to blood sugar, especially in diabetic patients with poor blood sugar control and negative ketone, we should consider the possibility of NKK chorea. CONCLUSIONS NKH chorea is a special complication of diabetes.
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Plant-based Diet for HbA1c Reduction in Type 2 Diabetes Mellitus: an Evidence-based Case Report.
Utami, DB, Findyartini, A
Acta medica Indonesiana. 2018;(3):260-267
Abstract
BACKGROUND diabetes has become a major public health concern with an estimated 180 million cases worldwide. Nutritional changes are one of the key aspects in the management of type 2 diabetes mellitus. Previous studies have suggested an association between vegetarian diets and improvements in glycemic control in type 2 diabetes mellitus, however the relationship is not well established. The aim of this report is to perform a critical appraisal to analyze whether plant-based diet reduces the HbA1c level compared to conventional diet. METHODS a comprehensive computer-based literature search was performed on June 20, 2016 using PubMed, Ovid, EBSCO, and the Cochrane Library. All abstracts and titles from the initial search results were screened, reviewed, and appraised using critical appraisal worksheets by Center of Evidence-Based Medicine, University of Oxford. RESULTS one systematic review and two RCTs met the inclusion criteria and were considered eligible for this case report. In patients with type 2 diabetes mellitus, HbA1c significantly yielded greater reduction in the plant-based group compared to conventional diet group after 22 weeks of follow up. Similarly, there was a statistically greater reduction in HbA1c level in the plant-based group after 72 weeks. Furthermore, consumption of plant-based diet was associated with a significant reduction in HbA1c. CONCLUSION in patients with type 2 diabetes mellitus, HbA1c reduction was greater in patients with plant-based diet compared to patients with conventional diet. Further research should be conducted with larger sample size and longer follow-up period.
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[About the choice between a DPP-4 inhibitor and a SGLT 2 inhibitor tor treating type 2 diabetes].
Scheen, AJ, Paquot, N
Revue medicale de Liege. 2016;(12):579-585
Abstract
Two new classes of oral antidiabetic agents play an increasing role in the management of type 2 diabetes, dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) and sodiumglucose cotransporters type 2 (SGLT2) inhibitors (gliflozins). After failure of a monotherapy with metformin (first pharmacological choice in type 2 diabetes), both may offer an alternative to the add-on of a sulphonylurea, especially in patients at risk of hypoglycaemia. However, the choice between a DPP-4 inhibitor and a SGLT2 inhibitor is not easy and should be oriented based upon the individual patient characteristics. The arguments in favour of one or another pharmacological class are discussed, considering a clinical case of a patient with coronary heart disease and type 2 diabetes not well controlled with metformin.
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Acute painful diabetic neuropathy: an uncommon, remittent type of acute distal small fibre neuropathy.
Tran, C, Philippe, J, Ochsner, F, Kuntzer, T, Truffert, A
Swiss medical weekly. 2015;:w14131
Abstract
INTRODUCTION Acute painful diabetic neuropathy (APDN) is a distinctive diabetic polyneuropathy and consists of two subtypes: treatment-induced neuropathy (TIN) and diabetic neuropathic cachexia (DNC). The characteristics of APDN are (1.) the small-fibre involvement, (2.) occurrence paradoxically after short-term achievement of good glycaemia control, (3.) intense pain sensation and (4.) eventual recovery. In the face of current recommendations to achieve quickly glycaemic targets, it appears necessary to recognise and understand this neuropathy. METHODS AND RESULTS Over 2009 to 2012, we reported four cases of APDN. Four patients (three males and one female) were identified and had a mean age at onset of TIN of 47.7 years (±6.99 years). Mean baseline HbA1c was 14.2% (±1.42) and 7.0% (±3.60) after treatment. Mean estimated time to correct HbA1c was 4.5 months (±3.82 months). Three patients presented with a mean time to symptom resolution of 12.7 months (±1.15 months). One patient had an initial normal electroneuromyogram (ENMG) despite the presence of neuropathic symptoms, and a second abnormal ENMG showing axonal and myelin neuropathy. One patient had a peroneal nerve biopsy showing loss of large myelinated fibres as well as unmyelinated fibres, and signs of microangiopathy. CONCLUSIONS According to the current recommendations of promptly achieving glycaemic targets, it appears necessary to recognise and understand this neuropathy. Based on our observations and data from the literature we propose an algorithmic approach for differential diagnosis and therapeutic management of APDN patients.
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Evidence-based case report: acute diabetic complication risks of Ramadan fasting in type 2 diabetics.
Iskandar, WJ, Handjaja, CT, Salama, N, Anasy, N, Ardianto, MF, Kusumadewi, D
Acta medica Indonesiana. 2013;(3):235-9
Abstract
AIM: to investigate causal relationship between Ramadan fasting and acute diabetic complications in adult controlled type 2 diabetics. METHODS a Pubmed's Clinical Queries and Embase search was conducted and resulted in 2 useful articles: 1 systematic review and 1 cohort study to be critically appraised. RESULTS the incidence of acute diabetic complications is higher during Ramadan, with the relative risk for adult type 2 diabetics who fast during Ramadan is 1.36 and number needed to harm 50. CONCLUSION Ramadan fasting was related with acute diabetic complications in adult controlled type 2 diabetics, but the risk was only slightly higher. It is acceptable for type 2 diabetics to fast during Ramadan.
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Clinical case study: achieving long-term control of insulin resistance.
Cornell, SA
Journal of managed care pharmacy : JMCP. 2007;(2 Suppl B):S11-5
Abstract
BACKGROUND A total of 20.8 million people in the United States have diabetes, including 10.3 million adults over the age of 60 years, and more than 6 million people remain undiagnosed. Although diabetes is widely recognized as a prevalent and serious disease in managed care, current care is suboptimal, with less than 2% of American adults with diabetes receiving optimal quality of care. OBJECTIVE To review the various treatment interventions available in diabetes care, including the use of pay for performance (P4P) initiatives. SUMMARY In an effort to improve the current state of diabetes care, the NCQA's Health Plan Employer Data and Information Set (HEDIS) diabetes measure was developed as a means to better promote monitoring of various clinical markers in patients with this disease. This measure has been employed in P4P initiatives across the country by granting incentives to providers who have a prespecified proportion of their patients with diabetes meeting the measure. Likewise, to improve outcomes, many experimental and recently approved treatment options for diabetes target different processes in the course of the disease. CONCLUSIONS An effective program for the management of a diabetes patient population must be multidisciplinary, coordinating the efforts of many different levels of health care providers. Furthermore, components commonly incorporated in P4P initiatives, such as patient self-management education, provider contact, and the use of the American Diabetes Association standards of care measures for screening and lab levels, are imperative to the success of a diabetes management program.
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Keeping the diabetic heart healthy.
Harris, M, Wan, Q
Australian family physician. 2005;(6):441-5
Abstract
BACKGROUND Cardiovascular disease (CVD) is an important and preventable complication and major cause of death in diabetes. OBJECTIVE This article outlines the prevention and early detection of CVD in people with type 2 diabetes. DISCUSSION Diabetes is a major risk factor for CVD, both independently and because it tends to occur in association with other behavioural and physiological risk factors. There is good evidence that careful control of these risk factors can significantly delay the development of heart disease, and that this is possible to achieve in general practice. Key interventions are smoking cessation; diet and physical activity; targeted use of medications to achieve glycaemic, blood pressure and lipid control; and aspirin. Interventions require a whole practice approach involving practice staff, practice systems and links with other care providers.