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Patient with Healthcare Nurse



Combination Therapy: Impact on Cardiovascular Disease


By Prof. Ralph DeFronzo

Petri Dish

Proceedings of the Guideline Workshop 2019 –Strategies for the optimization of guideline

processes in diabetes, cardiovascular diseases and 

kidney diseases


Nikolaus Marx, Lars Ryde´n , Frank Brosius , Antonio Ceriello , Michael Cheung , Francesco Cosentino , Jennifer Green , Monika Kellerer , Susan Koob ,

Mikhail Kosiborod , Prashant Nedungadi , Helena W. Rodbard , Per Olav Vandvikm, Eberhard Standl , Oliver Schnell n

The Guideline Workshop 2019, held in October 2019 in Munich, Germany, had the purpose of facilitating discussion on strategies for optimization of guideline processes in diabetes amongst a group of representatives of renown national and international societies in the field of diabetes, cardiology, and nephrology.


Impact of Acarbose on Incident

Diabetes and Regression to

Normoglycemia in People With

Coronary Heart Disease and

Impaired Glucose Tolerance:

Insights From the ACE Trial


Hertzel C. Gerstein, Ruth L. Coleman,

Charles A.B. Scott, Shishi Xu,

Jaakko Tuomilehto, Lars Ryd´en, and

Rury R. Holman,2

We examined the impact of acarbose, an a-glucosidase inhibitor, on incident

diabetes and regression to normoglycemia in 6,522 Acarbose Cardiovascular Evaluation trialparticipants in China who had impaired glucose tolerance (IGT) and coronary heart disease (CHD).

Test Tubes

Impact of Regulatory Guidance on Evaluating Cardiovascular Risk of New Glucose-Lowering Therapies to Treat Type 2 Diabetes Mellitus: Lessons Learned and Future Directions

Sharma A, Pagidipati NJ, Califf RM, McGuire DK, Green JB, Demets D, George JT, Gerstein HC, Hobbs T, Holman RR, Lawson FC, Leiter LA, Pfeffer MA, Reusch J, Riesmeyer JS, Roe MT, Rosenberg Y, Temple R, Wiviott S, McMurray J, Granger C. 

Responding to concerns about the potential for increased risk of adverse cardiovascular outcomes, specifically myocardial infarction, associated with certain glucose-lowering therapies, the US Food and Drug Administration and the Committee for Medicinal Products for Human Use of the European Medicines Agency issued guidance to the pharmaceutical industry in 2008. Glucose-lowering therapies were granted regulatory approval primarily from smaller studies that have demonstrated reductions in glycated hemoglobin concentration.

Home Nurse Examining Patient

 The vicious circle of left ventricular dysfunction and diabetes: from pathophysiology to emerging treatments 

 Ilaria Cavallari, MD, Ernesto Maddaloni, MD, Silvia Pieralice, MD, Maria Tea Mulè,MD, Raffaella Buzzetti, MD, Gian Paolo Ussia, MD, Paolo Pozzilli, MD, FrancescoGrigioni, MD

Context. Diabetes and heart failure (HF) are two deadly and strictly related epidemic disorders. Aim of this review is to present an updated discussion of the epidemiology, pathophysiology, clinical presentation and treatment options for HF in diabetes. 

Evidence Acquisition. Relevant references published up to February 2020 were identified through searches in PubMed. Quality was graded using the Newcastle-Ottawa score in observational studies and the Cochrane Collaboration’s tool in randomized studies. 

Female Scientist Using Microscope

Paradigm Shift in the management of DM & CVD- Preventing The Next CV Event

Yehuda Handelsman, Zachary Bloomgarden 

Over the past four years we have witnessed cardiovascular outcome trials (CVOTs) relevant to the treatment of type 2 diabetes for 9 different medications from 5 classes: proprotein convertase

subtilisin/kexin type 9 (PCSK9) inhibitors , glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose co-transporter-2 (SGLT2) inhibitors, the omega 3- fatty acid icosapent ethyl (IPE) ,

and pioglitazone. These findings bring great news to health care., However, they have created confusion among health care professionals not knowing which drug would be more appropriate to their

patients with diabetes who are at high risk for events, whether atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD), or mortality


Glucose Variability and Diabetic

Complications: Is It Time to Treat?


By Antonio Ceriello

Increasing evidence is supporting the

role of glucose variability (GV) in the

development of diabetic complications,

particularly cardiovascular (CV) ones.


Treatment paradigm shifting implications of recent 

cardiovascular outcome trials: Core insights on the brink of the 2020ies


Eberhard Standl *, Oliver Schnell

Based on cardiovascular (CV) outcome trials (CVOTs) being available on the brink of the 2020ies, CV safety assessed by major adverse CV event outcomes has been established for the classes of glucagon-like-peptide-1 receptor agonists (GLP1 RAs), sodium-glucoseco-

transporter-2 inhibitors (SGLT2-is), and dipeptidyl-peptidase-4 inhibitors (DPP4is) in patients at very high CV risk

Routine Checkup

24-h urinary sodium excretion and the risk of adverse outcomes

Matti A. Vuoria, Kennet Harald, Antti Julab, Liisa Valsta, Tiina Laatikainen, Veikko Salomaa , Jaakko Tuomilehto, Pekka Jousilahti and Teemu J. Niiranena

Compared with the individuals with the highest salt intake, persons with the lowest had 1.5 times lower incidence of cardiovascular disease (CVD) and coronary heart disease, and almost twice the lower incidence of diabetes mellitus.


Ticagrelor in Patients with Stable Coronary Disease and Diabetes

Steg PG, Bhatt DL, Simon T, Fox K, Mehta SR, Harrington RA, Held C, Andersson M, Himmelmann A, Ridderstråle W, Leonsson-Zachrisson M, Liu Y, Opolski G, Zateyshchikov D, Ge J, Nicolau JC, Corbalán R, Cornel JH, Widimský P, Leiter LA; THEMIS Steering Committee and Investigators.N Engl J Med

Background: Patients with stable coronary artery disease and diabetes mellitus who have not had a myocardial infarction or stroke are at high risk for cardiovascular events. Whether adding ticagrelor to aspirin improves outcomes in this population is unclear.

Methods: In this randomized, double-blind trial, we assigned patients who were 50 years of age or older and who had stable coronary artery disease and type 2 diabetes mellitus to receive either ticagrelor plus aspirin or placebo plus aspirin. 


Implications of the recent

CVOTs in type 2 diabetes

Which patients for GLP-1RA or SGLT-2 inhibitor?

 Angela Dardano, Roberto Miccoli, Cristina Bianchi, Giuseppe Daniele, Stefano Del Prato

Since the turn of the century the curve of cardiovascular (CV) morbidity and mortality among people with type 2 diabetes (T2DM) has been significantly and continuously declining.

Thus, the standardized incidence rate of hospitalization for CV disease has dropped from 380 events per 10,000 patient-yr in 1998-99 to about 180 events per 10,000 patient-yr in 2012–13

Vasculature of the Heart

Confirming the Bidirectional

Nature of the Association Between Severe Hypoglycemic and Cardiovascular Events in Type 2 Diabetes: Insights From EXSCEL


Eberhard Standl, Susanna R. Stevens,Yuliya Lokhnygina, M. Angelyn Bethel, John B. Buse, Stephanie M. Gustavson, Aldo P. Maggioni, Robert J. Mentz, Adrian F. Hernandez,2 and Rury R. Holman

We sought to confirm a bidirectional association between severe hypoglycemic events (SHEs) and cardiovascular (CV) event risk and to characterize individuals at dual risk.

Doctor's Clinic

High awareness of diabetes as a key cardiovascular risk factor among healthcare professionals but suboptimal treatment: Results from a survey of the European Association of Preventive



Dominique Hansen, Linda Mellbin, Francesco Cosentino, Dirk De Bacquer, Diederick Grobbee, Lisa Van Ryckeghem,

Eberhard Standl and Joline WJ Beulens

Currently, more than 400 m people worldwide are affected by diabetes mellitus and the prevalence is

expected to exceed 600 m people by 2045, which is particularly due to the rise in the number of patients with type 2 diabetes mellitus (T2DM)

Medicine Prescription

Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association

Arnold SV, Bhatt DL, Barsness GW, Beatty AL, Deedwania PC, Inzucchi SE, Kosiborod M, Leiter LA, Lipska KJ, Newman JD, Welty FK; American Heart Association Council on Lifestyle and Cardiometabolic Health and Council on Clinical Cardiology

Although cardiologists have long treated patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (T2DM), T2DM has traditionally been considered just a comorbidity that affected the development and progression of the disease. Over the past decade, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD


Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial

Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, Probstfield J, Riesmeyer JS, Riddle MC, Rydén L, Xavier D, Atisso CM, Dyal L, Hall S, Rao-Melacini P, Wong G, Avezum A, Basile J, Chung N, Conget I, Cushman WC, Franek E, Hancu N, Hanefeld M, Holt S, Jansky P, Keltai M, Lanas F, Leiter LA, Lopez-Jaramillo P, Cardona Munoz EG, Pirags V, Pogosova N, Raubenheimer PJ, Shaw JE, Sheu WH, Temelkova-Kurktschiev T; REWIND Investigators.Lancet. 

Background: Three different glucagon-like peptide-1 (GLP-1) receptor agonists reduce cardiovascular outcomes in people with type 2 diabetes at high cardiovascular risk with high glycated haemoglobin A1c (HbA1c) concentrations. We assessed the effect of the GLP-1 receptor agonist dulaglutide on major adverse cardiovascular events when added to the existing antihyperglycaemic regimens of individuals with type 2 diabetes with and without previous cardiovascular disease and a wide range of glycaemic control.

Methods: This multicentre, randomised, double-blind, placebo-controlled trial was done at 371 sites in 24 countries. 

Doctor and Patient

Prognostic Significance of Longterm HbA1c Variability for All- Cause Mortality in the ACCORD Trial

Chang-Sheng Sheng, Jingyan Tian, 

Ya Miao, Yi Cheng, Yulin Yang, Peter D. Reaven,  Zachary T. Bloomgarden, and Guang Ning 

OBJECTIVE: The association between high glycemic variability and all-cause mortality has been widely investigated in epidemiological studies but rarely validated in glucoselowering clinical trials. We aimed to identify the prognostic significance of visit-tovisit

HbA1c variability in treated patients in the Action to Control Cardiovascular Risk

in Diabetes (ACCORD) trial population.

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