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Diabetes Type 2

Blood Sample
Hypoglycaemia and its management in primary care setting


Mahmoud Ibrahim, Jason Baker, Avivit Cahn, Robert H. Ecke, Nuha Ali El Sayed, Amy Hess Fischl, Peter Gaede, R. David Leslie, Silvia Pieralice, Dario Tuccinardi, Paolo Pozzilli, Bjørn Richelsen, Eytan Roitman, Eberhard Stand, Yoel Toledano, Jaakko Tuomilehto, Sandra L. Weber, Guillermo E. Umpierrez

Hypoglycaemia is common in patients with type 1 diabetes and type 2 diabetes and constitutes a major limiting factor in achieving glycaemic control among people with diabetes. While hypoglycaemia is defined as a blood glucose level under 70 mg/dL

(3.9 mmol/L), symptoms may occur at higher blood glucose levels in individuals with poor glycaemic control.


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. 

Drug and Syringe

Insulin resistance: looking back, looking forward

Zachary Bloomgarden

Understanding the role of insulin resistance in diabetes has followed a fascinating path, with more than 20 000

matches in the PubMed (https://www.ncbi.nlm.nih.

gov/pubmed/) database having “insulin resistance” as a title term, increasing progressively from the early 1940s


Early prevention of diabetes microvascular complications in people with hyperglycaemia

in Europe. ePREDICE randomized trial. Study protocol, recruitment and selected baseline data


Rafael Gabriel, Nisa Boukichou Abdelkader, Tania AcostaAleksandra Gilis-Januszewska, Ricardo Go´mez-Huelgas, Konstantinos Makrilakis,

Zdravko Kamenov, Bernhard Paulweber, Ilhan Satman, Predrag Djordjevic,

Abdullah Alkandari, Asimina Mitrakou, Nebojsa Lalic, Stephen Colagiuri,

Jaana Lindstro¨m, Jesu´ s Egido, Andrea Natali, J. Carlos Pastor, Yvonne Teuschl, Marcus Lind, Luis Silva, Ruy Lo´ pez-Ridaura, Jaakko Tuomilehto


Objectives: To assess the effects of early management of hyperglycaemia with antidiabetic drugs plus lifestyle intervention compared with lifestyle alone, on microvascular function in adults withpre-diabetes.

Home Continuous Glucose Monitoring Train

Hypoglycaemia and its management in primary care setting

Mahmoud Ibrahim, Jason Baker, Avivit Cahn, Robert H. Eckel, Nuha Ali El Sayed, Amy Hess Fischl, Peter Gaede, R. David Leslie, Silvia Pieralice, Dario Tuccinardi, Paolo Pozzilli, Bjørn Richelsen, Eytan Roitman, Eberhard Standl, Yoel Toledano, Jaakko Tuomilehto, Sandra L. Weber, Guillermo E. Umpierrez17

The American Diabetes Association (ADA) defined hypoglycaemia in

diabetes as any episode of an abnormally low plasma glucose concentration that exposes the individual to potential harm.2 This nonnumerical

definition was based on the facts that glycaemic thresholds for responses to hypoglycaemia vary among individuals and within the same individual.
Also, there is no specific glucose concentration that defines hypoglycaemia in diabetes.

Male Scientist

Implications of the recent CVOTs in type 2 diabetes: The right place for DPP-IV inhibitors today

Zachary Bloomgarden

The use of small molecule inhibitors of the enzyme dipeptidyl peptidase IV (DPP4i) was proposed in 1998 as an

approach to the management of diabetes, acting by reducing

glucagon-like peptide 1 (GLP-1) degradation and hence potentiating

its insulinotropic effect. By 2005, effects of the DPP4i vildagliptin and sitagliptin were reported in human trials, leading to the development of a class of drugs

whose use among US Medicare beneficiaries alone accounted

for expenditure of $1.5 billion in 2012, increasing to $3.9 billion in 2017.

Doctor and Patient

Safety of dapagliflozin in a broad population of patients with type 2 diabetes: Analyses from the DECLARE-TIMI 58 study


Cahn A, Raz I, Bonaca M, Mosenzon O, Murphy SA, Yanuv I, Rozenberg A, Wilding JPH, Bhatt DL, McGuire DK, Gause-Nilsson IAM, Fredriksson M, Johansson PA, Jermendy G, Hadjadj S, Langkilde AM, Sabatine MS, Wiviott SD, Leiter LA. Diabetes Obes Metab. 2020 Aug;22(8):1357-1368.

Aims: To evaluate comprehensively the safety of dapagliflozin in patients with type 2 diabetes (T2DM), with emphasis placed on potential safety concerns related to the sodium-glucose co-transporter-2 inhibitor class.

Methods: In the Dapagliflozin Effect on Cardiovascular Events - Thrombolysis in Myocardial Infarction 58 (DECLARE-TIMI 58) study, 17 160 patients with T2DM were randomized to dapagliflozin or placebo and followed for a median of 4.2 years. Safety was evaluated in 17 143 patients receiving at least one dose of study drug.


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

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