Diabetes and Cardiovascular Complications: The Epidemics Continue

Purpose of Review The cardiovascular complications of type 1 and 2 diabetes are major causes of morbidity and mortality. Extensive efforts have been made to maximize glycemic control; this strategy reduces certain manifestations of cardiovascular complications. There are drawbacks, however, as intensive glycemic control does not impart perennial protective benefits, and these efforts are not without potential adverse sequelae, such as hypoglycemic events. Recent Findings Here, the authors have focused on updates into key areas under study for mechanisms driving these cardiovascular disorders in diabetes, including roles for epigenetics and gene expression, interferon networks, and mitochondrial dysfunction. Updates on the cardioprotective roles of the new classes of hyperglycemia-targeting therapies, the sodium glucose transport protein 2 inhibitors and the agonists of the glucagon-like peptide 1 receptor system, are reviewed. Summary In summary, insights from ongoing research and the cardioprotective benefits of the newer type 2 diabetes therapies are providing novel areas for therapeutic opportunities in diabetes and CVD.

Immune checkpoint inhibitor-induced takotsubo syndrome and diabetic ketoacidosis: rare reactions

Immune checkpoint inhibitors (ICIs) are increasingly used to treat certain malignancies due to their higher efficacy compared with conventional chemotherapy. As familiarity with these agents increases, it is becoming apparent that a significant number of patients treated with ICIs experience adverse events. With time, more immune-related adverse events (IRAEs) are being recognised. It is important to be vigilant for IRAEs and recognise that a patient may have multiple IRAEs affecting multiple organ systems. Common cardiovascular adverse events associated with ICIs include myocarditis, arrhythmias and pericarditis. This case report identifies a patient presenting with takotsubo syndrome followed by ketoacidosis (associated with sodium-glucose transport protein 2 (SGLT2) inhibitor) in the setting of combination ipilimumab and nivolumab therapy for metastatic melanoma.

Effect of sodium-glucose transport protein 2 inhibitors on serum uric acid: an outpatient based prospective interventional study

Background: Hyperuricemia is considered to be associated with increased risk of cardiovascular diseases. It has been found to be related to features of metabolic syndromes like hyperglycemia and dyslipidemia. Sodium-glucose transport protein 2 (SGLT2) inhibitors are known to have a decremental effect on serum uric acid level. We evaluated the effect of SGLT2 inhibitors on serum uric acid of diabetic population.Methods: In this prospective study we recruited 50 type 2 diabetes mellitus (T2DM) patients who were on metformin monotherapy and were having inadequate glycemic control. Patients were prescribed SGLT2 inhibitors as an add-on therapy. Serum uric acid of the subjects was measured at the baseline and after 3 months. The primary outcome was to observe changes in serum uric acid (SUA) levels from the baseline to the end of the study. Glycemic changes were determined by observing the changes in glycated haemoglobin (HbA1c) levels (if any).Results: The study population was predominantly male (82%). BMI wise most of the subjects (44%) were overweight. Mean HbA1c of total population was 7.65±0.5, whereas mean serum uric acid was 6.31±0.72 at the baseline. After 3 months HbA1C and serum uric acid levels were 7.45±0.50 and 6.06±0.64 respectively. Both the changes were statistically significant (p<0.005).Conclusions: SGLT2 inhibitors could improve glycemic control and lower SUA levels in patients with uncontrolled T2DM. Randomized study with bigger sample size and longer study period are required to further demonstrate the effect of SGLT2 inhibitors on serum uric acid and explore the potential underlying mechanisms.

Reducing the risk of heart failure in diabetes mellitus: review of new therapeutics

Diabetes mellitus (DM) and heart failure (HF) are closely related: patients with diabetes have an increased risk of developing HF and those with HF are at higher risk of developing diabetes. When the two diseases are considered individually, HF has a much poorer prognosis than diabetes mellitus; therefore, treatment of HF is a priority in these group of patients. There are many drugs now available to achieve glycemic control in individuals with DM. However, as we enter an era of personalization in the management of DM, the next challenge will be the identification of therapeutic strategies that will not only achieve and maintain glycemic control, but that will also reverse existing complications. Given the high prevalence of HF in DM, there is a strong imperative to advance this field, with the view of identifying robust strategies that will not only improve long-term outcomes in subjects with DM and HF but also limit the likelihood of developing HF in the first place. Newer therapies like sodium- glucose transport protein- 2 inhibitors (SGLT-2 I) and sacubitril or valsartan have shown potential benefit for reducing the risk of heart failure in diabetic population. This review will summarize the new therapeutics to reduce the risk of HF in patients with DM.