Clinical Edge Journal Scan

Heart failure with preserved ejection fraction (HFpEF) is common in elderly adults with type 2 diabetes (T2D), and these individuals are at high risk for frailty and cognitive impairment. Empagliflozin has been shown to reduce cardiovascular death or hospitalization for heart failure in individuals with HFpEF with or without diabetes, but little is known about the impact of empagliflozin on cognition in patients with diabetes and HFpEF. In a prospective observation study of 162 frail older adults with T2D and HFpEF, Mone and colleagues reported that after receiving empagliflozin for 1 month, there was a significant improvement in the Montreal Cognitive Assessment score, but no improvement was seen with metformin or insulin. Although the study was limited by its observational design, small sample size, and short follow-up, it indicates that improved cognition may be another unexpected benefit of empagliflozin in patients with HFpEF.

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study continues to provide valuable information for the management of T2D. ACCORD Lipid had previously shown that fenofibrate vs. placebo added to simvastatin did not reduce major atherosclerotic cardiovascular events in about 5500 patients with T2D who were at high risk for cardiovascular disease. Ferreira and colleagues have now reported that fenofibrate in ACCORD Lipid reduced hospitalization for heart failure or cardiovascular death by 18%, with the benefit predominantly in those treated with standard glucose-lowering therapy. This analysis was done post hoc and is hypothesis-generating for fenofibrate reducing HF-related events. The soon to be completed PROMINENT study of pemafibrate includes a secondary composite cardiovascular outcome with hospitalization for heart failure as a component, so more information regarding the impact of fibrates on heart failure will be available soon.

Diabetes is associated with a threefold greater risk for stroke and microvascular disease. In another analysis of ACCORD, Kaze and colleagues reported that a higher urine albumin‐to‐creatinine ratio and a lower estimated glomerular filtration rate were each independently associated with an increased risk for stroke. Although further adequately powered studies are required, this analysis suggests that prevention of kidney disease and its progression may help mitigate the risk for stroke in people with T2D.

People with severe mental illness (SMI), such as schizophrenia, bipolar disorder, or depression, are at increased risk for T2D, but it is unknown whether they are more likely to develop the complications of diabetes. Scheuer and colleagues published data from a large nationwide registry in Denmark. They found that, compared with people without SMI, people with SMI were more likely to develop nephropathy or cardiovascular disease, have an amputation, and that the nephropathy and cardiovascular disease occurred at younger ages in those with SMI. Although there are limitations with registry data, this study supports diabetes guidelines that recommend cardiorenal protection with sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists in patients with T2D who are at high risk for nephropathy progression and cardiovascular disease. Because this study suggests that SMI along with T2D confers greater risk for nephropathy and cardiovascular disease at younger ages, perhaps we should consider these cardiorenal protective agents early on in persons with T2D and SMI.

Heart failure with preserved ejection fraction (HFpEF) is common in elderly adults with type 2 diabetes (T2D), and these individuals are at high risk for frailty and cognitive impairment. Empagliflozin has been shown to reduce cardiovascular death or hospitalization for heart failure in individuals with HFpEF with or without diabetes, but little is known about the impact of empagliflozin on cognition in patients with diabetes and HFpEF. In a prospective observation study of 162 frail older adults with T2D and HFpEF, Mone and colleagues reported that after receiving empagliflozin for 1 month, there was a significant improvement in the Montreal Cognitive Assessment score, but no improvement was seen with metformin or insulin. Although the study was limited by its observational design, small sample size, and short follow-up, it indicates that improved cognition may be another unexpected benefit of empagliflozin in patients with HFpEF.

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study continues to provide valuable information for the management of T2D. ACCORD Lipid had previously shown that fenofibrate vs. placebo added to simvastatin did not reduce major atherosclerotic cardiovascular events in about 5500 patients with T2D who were at high risk for cardiovascular disease. Ferreira and colleagues have now reported that fenofibrate in ACCORD Lipid reduced hospitalization for heart failure or cardiovascular death by 18%, with the benefit predominantly in those treated with standard glucose-lowering therapy. This analysis was done post hoc and is hypothesis-generating for fenofibrate reducing HF-related events. The soon to be completed PROMINENT study of pemafibrate includes a secondary composite cardiovascular outcome with hospitalization for heart failure as a component, so more information regarding the impact of fibrates on heart failure will be available soon.

Diabetes is associated with a threefold greater risk for stroke and microvascular disease. In another analysis of ACCORD, Kaze and colleagues reported that a higher urine albumin‐to‐creatinine ratio and a lower estimated glomerular filtration rate were each independently associated with an increased risk for stroke. Although further adequately powered studies are required, this analysis suggests that prevention of kidney disease and its progression may help mitigate the risk for stroke in people with T2D.

People with severe mental illness (SMI), such as schizophrenia, bipolar disorder, or depression, are at increased risk for T2D, but it is unknown whether they are more likely to develop the complications of diabetes. Scheuer and colleagues published data from a large nationwide registry in Denmark. They found that, compared with people without SMI, people with SMI were more likely to develop nephropathy or cardiovascular disease, have an amputation, and that the nephropathy and cardiovascular disease occurred at younger ages in those with SMI. Although there are limitations with registry data, this study supports diabetes guidelines that recommend cardiorenal protection with sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists in patients with T2D who are at high risk for nephropathy progression and cardiovascular disease. Because this study suggests that SMI along with T2D confers greater risk for nephropathy and cardiovascular disease at younger ages, perhaps we should consider these cardiorenal protective agents early on in persons with T2D and SMI.

Heart failure with preserved ejection fraction (HFpEF) is common in elderly adults with type 2 diabetes (T2D), and these individuals are at high risk for frailty and cognitive impairment. Empagliflozin has been shown to reduce cardiovascular death or hospitalization for heart failure in individuals with HFpEF with or without diabetes, but little is known about the impact of empagliflozin on cognition in patients with diabetes and HFpEF. In a prospective observation study of 162 frail older adults with T2D and HFpEF, Mone and colleagues reported that after receiving empagliflozin for 1 month, there was a significant improvement in the Montreal Cognitive Assessment score, but no improvement was seen with metformin or insulin. Although the study was limited by its observational design, small sample size, and short follow-up, it indicates that improved cognition may be another unexpected benefit of empagliflozin in patients with HFpEF.

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study continues to provide valuable information for the management of T2D. ACCORD Lipid had previously shown that fenofibrate vs. placebo added to simvastatin did not reduce major atherosclerotic cardiovascular events in about 5500 patients with T2D who were at high risk for cardiovascular disease. Ferreira and colleagues have now reported that fenofibrate in ACCORD Lipid reduced hospitalization for heart failure or cardiovascular death by 18%, with the benefit predominantly in those treated with standard glucose-lowering therapy. This analysis was done post hoc and is hypothesis-generating for fenofibrate reducing HF-related events. The soon to be completed PROMINENT study of pemafibrate includes a secondary composite cardiovascular outcome with hospitalization for heart failure as a component, so more information regarding the impact of fibrates on heart failure will be available soon.

Diabetes is associated with a threefold greater risk for stroke and microvascular disease. In another analysis of ACCORD, Kaze and colleagues reported that a higher urine albumin‐to‐creatinine ratio and a lower estimated glomerular filtration rate were each independently associated with an increased risk for stroke. Although further adequately powered studies are required, this analysis suggests that prevention of kidney disease and its progression may help mitigate the risk for stroke in people with T2D.

People with severe mental illness (SMI), such as schizophrenia, bipolar disorder, or depression, are at increased risk for T2D, but it is unknown whether they are more likely to develop the complications of diabetes. Scheuer and colleagues published data from a large nationwide registry in Denmark. They found that, compared with people without SMI, people with SMI were more likely to develop nephropathy or cardiovascular disease, have an amputation, and that the nephropathy and cardiovascular disease occurred at younger ages in those with SMI. Although there are limitations with registry data, this study supports diabetes guidelines that recommend cardiorenal protection with sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists in patients with T2D who are at high risk for nephropathy progression and cardiovascular disease. Because this study suggests that SMI along with T2D confers greater risk for nephropathy and cardiovascular disease at younger ages, perhaps we should consider these cardiorenal protective agents early on in persons with T2D and SMI.

Key clinical point: Colchicine use in patients with gout is associated with a lower risk for type 2 diabetes mellitus (T2D).

Major finding: Colchicine users vs. nonusers had a lower cumulative incidence of T2D (18.8% vs. 25.0%) and a significantly lower risk for T2D (adjusted hazard ratio 0.74; 95% CI 0.36-0.87), with the inverse association remaining significant across both sexes and different age groups.

Study details: The data come from a retrospective cohort study including patients newly diagnosed with gout who used (n = 3841) and did not use (n = 7682) colchicine.

Disclosures: The study received no external funding. The authors declared no conflict of interests.

Source: Chu C-C et al. Association between clinical use of colchicine and risk of type 2 diabetes mellitus among gouty patients: A nationwide cohort study. Int J Environ Res Public Health. 2022;19(6):3395 (Mar 14). Doi: 10.3390/ijerph19063395

Key clinical point: Colchicine use in patients with gout is associated with a lower risk for type 2 diabetes mellitus (T2D).

Major finding: Colchicine users vs. nonusers had a lower cumulative incidence of T2D (18.8% vs. 25.0%) and a significantly lower risk for T2D (adjusted hazard ratio 0.74; 95% CI 0.36-0.87), with the inverse association remaining significant across both sexes and different age groups.

Study details: The data come from a retrospective cohort study including patients newly diagnosed with gout who used (n = 3841) and did not use (n = 7682) colchicine.

Disclosures: The study received no external funding. The authors declared no conflict of interests.

Source: Chu C-C et al. Association between clinical use of colchicine and risk of type 2 diabetes mellitus among gouty patients: A nationwide cohort study. Int J Environ Res Public Health. 2022;19(6):3395 (Mar 14). Doi: 10.3390/ijerph19063395

Key clinical point: Colchicine use in patients with gout is associated with a lower risk for type 2 diabetes mellitus (T2D).

Major finding: Colchicine users vs. nonusers had a lower cumulative incidence of T2D (18.8% vs. 25.0%) and a significantly lower risk for T2D (adjusted hazard ratio 0.74; 95% CI 0.36-0.87), with the inverse association remaining significant across both sexes and different age groups.

Study details: The data come from a retrospective cohort study including patients newly diagnosed with gout who used (n = 3841) and did not use (n = 7682) colchicine.

Disclosures: The study received no external funding. The authors declared no conflict of interests.

Source: Chu C-C et al. Association between clinical use of colchicine and risk of type 2 diabetes mellitus among gouty patients: A nationwide cohort study. Int J Environ Res Public Health. 2022;19(6):3395 (Mar 14). Doi: 10.3390/ijerph19063395

Key clinical point: In adults with type 2 diabetes (T2D), higher albuminuria and worsening chronic kidney disease (CKD) were independently associated with a higher risk for incident stroke.

Major finding: Compared with a urine albumin-to-creatinine ratio of <30 mg/g and no CKD, moderate (adjusted hazard ratio [aHR] 1.61; P = .010) and severe (aHR 2.29; P = .001) albuminuria and worsening CKD stages (stage 1: aHR 1.76; P = .020; stage 2: aHR 1.77; P = .012; and stage 3: aHR 2.03; P = .003) were significantly associated with a higher risk for stroke, respectively.

Study details: This study included 9170 adults with T2D from the ACCORD study, of which 156 experienced stroke events over a median follow-up of 4.9 years.

Disclosures: The study did not declare any source of funding. Dr. G Fonarow reported consulting for various sources.

Source: Kaze AD et al. Diabetic kidney disease and risk of incident stroke among adults with type 2 diabetes. BMC Med. 2022;20:127 (Mar 29). Doi: 10.1186/s12916-022-02317-0

Key clinical point: In adults with type 2 diabetes (T2D), higher albuminuria and worsening chronic kidney disease (CKD) were independently associated with a higher risk for incident stroke.

Major finding: Compared with a urine albumin-to-creatinine ratio of <30 mg/g and no CKD, moderate (adjusted hazard ratio [aHR] 1.61; P = .010) and severe (aHR 2.29; P = .001) albuminuria and worsening CKD stages (stage 1: aHR 1.76; P = .020; stage 2: aHR 1.77; P = .012; and stage 3: aHR 2.03; P = .003) were significantly associated with a higher risk for stroke, respectively.

Study details: This study included 9170 adults with T2D from the ACCORD study, of which 156 experienced stroke events over a median follow-up of 4.9 years.

Disclosures: The study did not declare any source of funding. Dr. G Fonarow reported consulting for various sources.

Source: Kaze AD et al. Diabetic kidney disease and risk of incident stroke among adults with type 2 diabetes. BMC Med. 2022;20:127 (Mar 29). Doi: 10.1186/s12916-022-02317-0

Key clinical point: In adults with type 2 diabetes (T2D), higher albuminuria and worsening chronic kidney disease (CKD) were independently associated with a higher risk for incident stroke.

Major finding: Compared with a urine albumin-to-creatinine ratio of <30 mg/g and no CKD, moderate (adjusted hazard ratio [aHR] 1.61; P = .010) and severe (aHR 2.29; P = .001) albuminuria and worsening CKD stages (stage 1: aHR 1.76; P = .020; stage 2: aHR 1.77; P = .012; and stage 3: aHR 2.03; P = .003) were significantly associated with a higher risk for stroke, respectively.

Study details: This study included 9170 adults with T2D from the ACCORD study, of which 156 experienced stroke events over a median follow-up of 4.9 years.

Disclosures: The study did not declare any source of funding. Dr. G Fonarow reported consulting for various sources.

Source: Kaze AD et al. Diabetic kidney disease and risk of incident stroke among adults with type 2 diabetes. BMC Med. 2022;20:127 (Mar 29). Doi: 10.1186/s12916-022-02317-0

Key clinical point: Patients with type 2 diabetes (T2D) who maintain glycosylated hemoglobin (HbA1c) levels of <7% vs. ≥7% during a 5-year post-period have a lower risk for diabetes-related complications.

Major finding: Maintaining an HbA1c level of <7% vs. ≥7% during the 5-year post-period was associated with a lower risk of developing cardiovascular disease (odds ratio [OR] 0.76; 95% CI 0.61-0.94), metabolic disease (OR 0.37; 95% CI 0.22-0.60), neuropathy (OR 0.62; 95% CI 0.45-0.84), nephropathy (OR 0.81; 95% CI 0.69-0.94), and peripheral vascular disease (OR 0.52; 95% CI 0.33-0.83).

Study details: Findings are from a retrospective study including 3067 adult patients with T2D and sustained glycemic control (HbA1c <7%; n = 2,119) or sustained suboptimal glycemic control (HbA1c ≥7%; n = 1,488).

Disclosures: This study was funded by Eli Lilly and Company. KS Boye, R Paczkowski, and VT Thieu reported being employees and shareholders of Eli Lilly and MJ Lage received personal compensation from Eli Lilly.

Source: Boye KS et al. The association between sustained HbA1c control and long-term complications among individuals with type 2 diabetes: A retrospective study. Adv Ther. 2022 (Mar 22). Doi: 10.1007/s12325-022-02106-4

Key clinical point: Patients with type 2 diabetes (T2D) who maintain glycosylated hemoglobin (HbA1c) levels of <7% vs. ≥7% during a 5-year post-period have a lower risk for diabetes-related complications.

Major finding: Maintaining an HbA1c level of <7% vs. ≥7% during the 5-year post-period was associated with a lower risk of developing cardiovascular disease (odds ratio [OR] 0.76; 95% CI 0.61-0.94), metabolic disease (OR 0.37; 95% CI 0.22-0.60), neuropathy (OR 0.62; 95% CI 0.45-0.84), nephropathy (OR 0.81; 95% CI 0.69-0.94), and peripheral vascular disease (OR 0.52; 95% CI 0.33-0.83).

Study details: Findings are from a retrospective study including 3067 adult patients with T2D and sustained glycemic control (HbA1c <7%; n = 2,119) or sustained suboptimal glycemic control (HbA1c ≥7%; n = 1,488).

Disclosures: This study was funded by Eli Lilly and Company. KS Boye, R Paczkowski, and VT Thieu reported being employees and shareholders of Eli Lilly and MJ Lage received personal compensation from Eli Lilly.

Source: Boye KS et al. The association between sustained HbA1c control and long-term complications among individuals with type 2 diabetes: A retrospective study. Adv Ther. 2022 (Mar 22). Doi: 10.1007/s12325-022-02106-4

Key clinical point: Patients with type 2 diabetes (T2D) who maintain glycosylated hemoglobin (HbA1c) levels of <7% vs. ≥7% during a 5-year post-period have a lower risk for diabetes-related complications.

Major finding: Maintaining an HbA1c level of <7% vs. ≥7% during the 5-year post-period was associated with a lower risk of developing cardiovascular disease (odds ratio [OR] 0.76; 95% CI 0.61-0.94), metabolic disease (OR 0.37; 95% CI 0.22-0.60), neuropathy (OR 0.62; 95% CI 0.45-0.84), nephropathy (OR 0.81; 95% CI 0.69-0.94), and peripheral vascular disease (OR 0.52; 95% CI 0.33-0.83).

Study details: Findings are from a retrospective study including 3067 adult patients with T2D and sustained glycemic control (HbA1c <7%; n = 2,119) or sustained suboptimal glycemic control (HbA1c ≥7%; n = 1,488).

Disclosures: This study was funded by Eli Lilly and Company. KS Boye, R Paczkowski, and VT Thieu reported being employees and shareholders of Eli Lilly and MJ Lage received personal compensation from Eli Lilly.

Source: Boye KS et al. The association between sustained HbA1c control and long-term complications among individuals with type 2 diabetes: A retrospective study. Adv Ther. 2022 (Mar 22). Doi: 10.1007/s12325-022-02106-4

Key clinical point: Patients with type 2 diabetes (T2D) and severe mental illness (SMI) are at a higher risk of developing nephropathy, lower limp amputations, and cardiovascular diseases (CVD), but not retinopathy, compared with those with T2D and without SMI.

Major finding: Compared with patients with T2D and without SMI, those with T2D and SMI had a higher incidence rate (IR) of nephropathy (IR ratio [IRR] 1.15; 95% CI 1.12-1.18), amputations (IRR 1.15; 95% CI 1.04-1.28), and CVD (men IRR 1.10; 95% CI 1.06-1.15, and women IRR 1.18; 95% CI 1.13-1.22), but a lower IR of retinopathy (IRR 0.75; 95% CI 0.70-0.81).

Study details: Findings are from a population-based dynamic cohort study including 371,625 patients with T2D, of which 30,102 had a coexisting SMI.

Disclosures: This study did not receive any funding. Some authors declared owning shares or receiving research grants from various sources.

Source: Scheuer SH et al. Severe mental illness and the risk of diabetes complications. A nationwide register-based cohort study. J Clin Endocrinol Metab. 2022 (Mar 31). Doi: 10.1210/clinem/dgac204

Key clinical point: Patients with type 2 diabetes (T2D) and severe mental illness (SMI) are at a higher risk of developing nephropathy, lower limp amputations, and cardiovascular diseases (CVD), but not retinopathy, compared with those with T2D and without SMI.

Major finding: Compared with patients with T2D and without SMI, those with T2D and SMI had a higher incidence rate (IR) of nephropathy (IR ratio [IRR] 1.15; 95% CI 1.12-1.18), amputations (IRR 1.15; 95% CI 1.04-1.28), and CVD (men IRR 1.10; 95% CI 1.06-1.15, and women IRR 1.18; 95% CI 1.13-1.22), but a lower IR of retinopathy (IRR 0.75; 95% CI 0.70-0.81).

Study details: Findings are from a population-based dynamic cohort study including 371,625 patients with T2D, of which 30,102 had a coexisting SMI.

Disclosures: This study did not receive any funding. Some authors declared owning shares or receiving research grants from various sources.

Source: Scheuer SH et al. Severe mental illness and the risk of diabetes complications. A nationwide register-based cohort study. J Clin Endocrinol Metab. 2022 (Mar 31). Doi: 10.1210/clinem/dgac204

Key clinical point: Patients with type 2 diabetes (T2D) and severe mental illness (SMI) are at a higher risk of developing nephropathy, lower limp amputations, and cardiovascular diseases (CVD), but not retinopathy, compared with those with T2D and without SMI.

Major finding: Compared with patients with T2D and without SMI, those with T2D and SMI had a higher incidence rate (IR) of nephropathy (IR ratio [IRR] 1.15; 95% CI 1.12-1.18), amputations (IRR 1.15; 95% CI 1.04-1.28), and CVD (men IRR 1.10; 95% CI 1.06-1.15, and women IRR 1.18; 95% CI 1.13-1.22), but a lower IR of retinopathy (IRR 0.75; 95% CI 0.70-0.81).

Study details: Findings are from a population-based dynamic cohort study including 371,625 patients with T2D, of which 30,102 had a coexisting SMI.

Disclosures: This study did not receive any funding. Some authors declared owning shares or receiving research grants from various sources.

Source: Scheuer SH et al. Severe mental illness and the risk of diabetes complications. A nationwide register-based cohort study. J Clin Endocrinol Metab. 2022 (Mar 31). Doi: 10.1210/clinem/dgac204

Key clinical point: The preadmission antidiabetic medications may influence mortality outcomes in patients with COVID-19 and type 2 diabetes (T2D).

Major finding: The risk for in-hospital mortality was significantly lower among patients taking metformin (odd ratio [OR] 0.54; 95% CI 0.47-0.62), glucagon-like peptide-1 receptor agonist (OR 0.51; 95% CI 0.37-0.69), and sodium-glucose transporter-2 inhibitor (OR 0.60; 95% CI 0.40-0.88), but higher among those taking dipeptidyl peptidase-4 inhibitor (OR 1.23; 95% CI 1.07-1.42) and insulin (OR 1.70; 95% CI 1.33-2.19), compared with patients taking none of these medications. Sulfonylurea, thiazolidinedione, and alpha-glucosidase inhibitors showed neutral effects on mortality.

Study details: The data come from a meta-analysis of 61 studies including 3,061,584 patients with COVID-19 and T2D.

Disclosures: This study received no specific grant from any funding agency.

Source: Nguyen NN et al. Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: A meta-analysis. Metabolism. 2022;131:155196 (Mar 31). Doi: 10.1016/j.metabol.2022.155196

Key clinical point: The preadmission antidiabetic medications may influence mortality outcomes in patients with COVID-19 and type 2 diabetes (T2D).

Major finding: The risk for in-hospital mortality was significantly lower among patients taking metformin (odd ratio [OR] 0.54; 95% CI 0.47-0.62), glucagon-like peptide-1 receptor agonist (OR 0.51; 95% CI 0.37-0.69), and sodium-glucose transporter-2 inhibitor (OR 0.60; 95% CI 0.40-0.88), but higher among those taking dipeptidyl peptidase-4 inhibitor (OR 1.23; 95% CI 1.07-1.42) and insulin (OR 1.70; 95% CI 1.33-2.19), compared with patients taking none of these medications. Sulfonylurea, thiazolidinedione, and alpha-glucosidase inhibitors showed neutral effects on mortality.

Study details: The data come from a meta-analysis of 61 studies including 3,061,584 patients with COVID-19 and T2D.

Disclosures: This study received no specific grant from any funding agency.

Source: Nguyen NN et al. Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: A meta-analysis. Metabolism. 2022;131:155196 (Mar 31). Doi: 10.1016/j.metabol.2022.155196

Key clinical point: The preadmission antidiabetic medications may influence mortality outcomes in patients with COVID-19 and type 2 diabetes (T2D).

Major finding: The risk for in-hospital mortality was significantly lower among patients taking metformin (odd ratio [OR] 0.54; 95% CI 0.47-0.62), glucagon-like peptide-1 receptor agonist (OR 0.51; 95% CI 0.37-0.69), and sodium-glucose transporter-2 inhibitor (OR 0.60; 95% CI 0.40-0.88), but higher among those taking dipeptidyl peptidase-4 inhibitor (OR 1.23; 95% CI 1.07-1.42) and insulin (OR 1.70; 95% CI 1.33-2.19), compared with patients taking none of these medications. Sulfonylurea, thiazolidinedione, and alpha-glucosidase inhibitors showed neutral effects on mortality.

Study details: The data come from a meta-analysis of 61 studies including 3,061,584 patients with COVID-19 and T2D.

Disclosures: This study received no specific grant from any funding agency.

Source: Nguyen NN et al. Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: A meta-analysis. Metabolism. 2022;131:155196 (Mar 31). Doi: 10.1016/j.metabol.2022.155196

Key clinical point: In patients with type 2 diabetes (T2D), the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) vs. dipeptidyl peptidase-4 inhibitors (DPP4i) was associated with a lower risk for end-stage renal disease (ESRD) and acute renal failure (ARF) and a slower decline in the estimated glomerular filtration rate (eGFR).

Major finding: Over a median follow-up of 3.8 years, the use of SGLT2i vs. DPP4i was associated with a significantly lower risk for ESRD (hazard ratio [HR] 0.51; P < .001) and ARF (HR 0.59; P < .001) and a significantly slower decline in eGFR (−0.060 vs. −0.625 mL/min/1.73m²  per year; P_interaction < .001).

Study details: This retrospective cohort study propensity score matched 6333 patients with T2D receiving an SGLT2i with 25,332 of those receiving a DPP4i.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Au PCM et al. Association between SGLT20iInhibitors vs DPP4 inhibitors and renal outcomes among patients with type 2 diabetes. J Clin Endocrinol Metab. 2022 (Mar 18). Doi:  10.1210/clinem/dgac164

Key clinical point: In patients with type 2 diabetes (T2D), the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) vs. dipeptidyl peptidase-4 inhibitors (DPP4i) was associated with a lower risk for end-stage renal disease (ESRD) and acute renal failure (ARF) and a slower decline in the estimated glomerular filtration rate (eGFR).

Major finding: Over a median follow-up of 3.8 years, the use of SGLT2i vs. DPP4i was associated with a significantly lower risk for ESRD (hazard ratio [HR] 0.51; P < .001) and ARF (HR 0.59; P < .001) and a significantly slower decline in eGFR (−0.060 vs. −0.625 mL/min/1.73m²  per year; P_interaction < .001).

Study details: This retrospective cohort study propensity score matched 6333 patients with T2D receiving an SGLT2i with 25,332 of those receiving a DPP4i.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Au PCM et al. Association between SGLT20iInhibitors vs DPP4 inhibitors and renal outcomes among patients with type 2 diabetes. J Clin Endocrinol Metab. 2022 (Mar 18). Doi:  10.1210/clinem/dgac164

Key clinical point: In patients with type 2 diabetes (T2D), the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) vs. dipeptidyl peptidase-4 inhibitors (DPP4i) was associated with a lower risk for end-stage renal disease (ESRD) and acute renal failure (ARF) and a slower decline in the estimated glomerular filtration rate (eGFR).

Major finding: Over a median follow-up of 3.8 years, the use of SGLT2i vs. DPP4i was associated with a significantly lower risk for ESRD (hazard ratio [HR] 0.51; P < .001) and ARF (HR 0.59; P < .001) and a significantly slower decline in eGFR (−0.060 vs. −0.625 mL/min/1.73m²  per year; P_interaction < .001).

Study details: This retrospective cohort study propensity score matched 6333 patients with T2D receiving an SGLT2i with 25,332 of those receiving a DPP4i.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Au PCM et al. Association between SGLT20iInhibitors vs DPP4 inhibitors and renal outcomes among patients with type 2 diabetes. J Clin Endocrinol Metab. 2022 (Mar 18). Doi:  10.1210/clinem/dgac164

Key clinical point: Resistance training (RT) effectively reduces glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2D), with RT interventions triggering a larger vs. medium or smaller improvement in muscular strength leading to a greater reduction in HbA1c.

Major finding: RT intervention vs. control treatment significantly decreased HbA1c (weighted mean difference −0.39; P < .001), with a larger vs. medium or small effect on muscular strength leading to a greater reduction in HbA1c (β −0.99; P = .0470).

Study details: Findings are from a meta-analysis of 20 trials including 1172 patients with T2DM.

Disclosures: The study received no specific funding. The authors declared no competing interests.

Source: Jansson AK et al. Effect of resistance training on HbA1c in adults with type 2 diabetes mellitus and the moderating effect of changes in muscular strength: a systematic review and meta-analysis. BMJ Open Diabetes Res Care. 2022;10:e002595 (Mar 10). Doi: 10.1136/bmjdrc-2021-002595

Key clinical point: Resistance training (RT) effectively reduces glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2D), with RT interventions triggering a larger vs. medium or smaller improvement in muscular strength leading to a greater reduction in HbA1c.

Major finding: RT intervention vs. control treatment significantly decreased HbA1c (weighted mean difference −0.39; P < .001), with a larger vs. medium or small effect on muscular strength leading to a greater reduction in HbA1c (β −0.99; P = .0470).

Study details: Findings are from a meta-analysis of 20 trials including 1172 patients with T2DM.

Disclosures: The study received no specific funding. The authors declared no competing interests.

Source: Jansson AK et al. Effect of resistance training on HbA1c in adults with type 2 diabetes mellitus and the moderating effect of changes in muscular strength: a systematic review and meta-analysis. BMJ Open Diabetes Res Care. 2022;10:e002595 (Mar 10). Doi: 10.1136/bmjdrc-2021-002595

Key clinical point: Resistance training (RT) effectively reduces glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2D), with RT interventions triggering a larger vs. medium or smaller improvement in muscular strength leading to a greater reduction in HbA1c.

Major finding: RT intervention vs. control treatment significantly decreased HbA1c (weighted mean difference −0.39; P < .001), with a larger vs. medium or small effect on muscular strength leading to a greater reduction in HbA1c (β −0.99; P = .0470).

Study details: Findings are from a meta-analysis of 20 trials including 1172 patients with T2DM.

Disclosures: The study received no specific funding. The authors declared no competing interests.

Source: Jansson AK et al. Effect of resistance training on HbA1c in adults with type 2 diabetes mellitus and the moderating effect of changes in muscular strength: a systematic review and meta-analysis. BMJ Open Diabetes Res Care. 2022;10:e002595 (Mar 10). Doi: 10.1136/bmjdrc-2021-002595

Key clinical point: Fenofibrate reduced the composite outcome of heart failure (HF) hospitalizations or cardiovascular death in patients with type 2 diabetes (T2D) treated with simvastatin, predominantly in those who received the standard background glucose-lowering therapy.

Major finding: The composite outcome of HF hospitalization or cardiovascular death was significantly lower with fenofibrate vs. placebo (hazard ratio [HR] 0.82; P = .048), with reduction primarily observed with the standard glucose-lowering strategy (HR 0.64; 95% CI 0.48-0.85), but not with the intensive glucose-lowering strategy (HR 1.02; 95% CI 0.79-1.33; P_interaction = .017).

Study details: Findings are from the ACCORD Lipid trial including 5518 patients with T2D who were randomly assigned to receive simvastatin plus fenofibrate (n = 2765) or simvastatin plus placebo (n = 2753).

Disclosures: The study was funded by national funds through FCT-Portuguese Foundation for

Science and Technology, under the scope of the Cardiovascular R&D Center-UnIC. Some authors declared being consultants and receiving research support or personal fees from various sources.

Source: Ferreira JP et al. Fenofibrate and heart failure outcomes in patients with type 2 diabetes: analysis from ACCORD. Diabetes Care. 2022 (Mar 23). Doi: 10.2337/dc21-1977

Key clinical point: Fenofibrate reduced the composite outcome of heart failure (HF) hospitalizations or cardiovascular death in patients with type 2 diabetes (T2D) treated with simvastatin, predominantly in those who received the standard background glucose-lowering therapy.

Major finding: The composite outcome of HF hospitalization or cardiovascular death was significantly lower with fenofibrate vs. placebo (hazard ratio [HR] 0.82; P = .048), with reduction primarily observed with the standard glucose-lowering strategy (HR 0.64; 95% CI 0.48-0.85), but not with the intensive glucose-lowering strategy (HR 1.02; 95% CI 0.79-1.33; P_interaction = .017).

Study details: Findings are from the ACCORD Lipid trial including 5518 patients with T2D who were randomly assigned to receive simvastatin plus fenofibrate (n = 2765) or simvastatin plus placebo (n = 2753).

Disclosures: The study was funded by national funds through FCT-Portuguese Foundation for

Science and Technology, under the scope of the Cardiovascular R&D Center-UnIC. Some authors declared being consultants and receiving research support or personal fees from various sources.

Source: Ferreira JP et al. Fenofibrate and heart failure outcomes in patients with type 2 diabetes: analysis from ACCORD. Diabetes Care. 2022 (Mar 23). Doi: 10.2337/dc21-1977

Key clinical point: Fenofibrate reduced the composite outcome of heart failure (HF) hospitalizations or cardiovascular death in patients with type 2 diabetes (T2D) treated with simvastatin, predominantly in those who received the standard background glucose-lowering therapy.

Major finding: The composite outcome of HF hospitalization or cardiovascular death was significantly lower with fenofibrate vs. placebo (hazard ratio [HR] 0.82; P = .048), with reduction primarily observed with the standard glucose-lowering strategy (HR 0.64; 95% CI 0.48-0.85), but not with the intensive glucose-lowering strategy (HR 1.02; 95% CI 0.79-1.33; P_interaction = .017).

Study details: Findings are from the ACCORD Lipid trial including 5518 patients with T2D who were randomly assigned to receive simvastatin plus fenofibrate (n = 2765) or simvastatin plus placebo (n = 2753).

Disclosures: The study was funded by national funds through FCT-Portuguese Foundation for

Science and Technology, under the scope of the Cardiovascular R&D Center-UnIC. Some authors declared being consultants and receiving research support or personal fees from various sources.

Source: Ferreira JP et al. Fenofibrate and heart failure outcomes in patients with type 2 diabetes: analysis from ACCORD. Diabetes Care. 2022 (Mar 23). Doi: 10.2337/dc21-1977

Key clinical point: Empagliflozin showed a beneficial effect on cognitive and physical impairment in frail older patients with type 2 diabetes (T2D) and heart failure with preserved ejection fraction (HFpEF).

Major finding: The mean Montreal Cognitive Assessment score significantly improved from baseline to 1 month in the empagliflozin group (19.80 vs. 22.25; P < .001) but not in the metformin (P = .26) and insulin (P = .81) groups, with empagliflozin showing a significant effect on amelioration of cognitive impairment (odds ratio 3.609; P = .03). The 5-meter gait speed improved significantly in the empagliflozin and metformin groups (both P < .05), but not in the insulin group.

Study details: This prospective observational study included 162 frail older patients aged >65 years who had T2D and HFpEF and were treated with empagliflozin (n = 52), metformin (n = 56), or insulin (n = 54).

Disclosures: The study was partly supported by the US National Institute of Diabetes and Digestive and Kidney Diseases, US National Heart, Lung, and Blood Institute, and US National Institute on Aging, among others. The authors declared no conflicts of interest.

Source: Mone P et al. Empagliflozin improves cognitive impairment in frail older adults with type 2 diabetes and heart failure with preserved ejection fraction. Diabetes Care. 2022 (Mar 21). Doi: 10.2337/dc21-2434

Key clinical point: Empagliflozin showed a beneficial effect on cognitive and physical impairment in frail older patients with type 2 diabetes (T2D) and heart failure with preserved ejection fraction (HFpEF).

Major finding: The mean Montreal Cognitive Assessment score significantly improved from baseline to 1 month in the empagliflozin group (19.80 vs. 22.25; P < .001) but not in the metformin (P = .26) and insulin (P = .81) groups, with empagliflozin showing a significant effect on amelioration of cognitive impairment (odds ratio 3.609; P = .03). The 5-meter gait speed improved significantly in the empagliflozin and metformin groups (both P < .05), but not in the insulin group.

Study details: This prospective observational study included 162 frail older patients aged >65 years who had T2D and HFpEF and were treated with empagliflozin (n = 52), metformin (n = 56), or insulin (n = 54).

Disclosures: The study was partly supported by the US National Institute of Diabetes and Digestive and Kidney Diseases, US National Heart, Lung, and Blood Institute, and US National Institute on Aging, among others. The authors declared no conflicts of interest.

Source: Mone P et al. Empagliflozin improves cognitive impairment in frail older adults with type 2 diabetes and heart failure with preserved ejection fraction. Diabetes Care. 2022 (Mar 21). Doi: 10.2337/dc21-2434

Key clinical point: Empagliflozin showed a beneficial effect on cognitive and physical impairment in frail older patients with type 2 diabetes (T2D) and heart failure with preserved ejection fraction (HFpEF).

Major finding: The mean Montreal Cognitive Assessment score significantly improved from baseline to 1 month in the empagliflozin group (19.80 vs. 22.25; P < .001) but not in the metformin (P = .26) and insulin (P = .81) groups, with empagliflozin showing a significant effect on amelioration of cognitive impairment (odds ratio 3.609; P = .03). The 5-meter gait speed improved significantly in the empagliflozin and metformin groups (both P < .05), but not in the insulin group.

Study details: This prospective observational study included 162 frail older patients aged >65 years who had T2D and HFpEF and were treated with empagliflozin (n = 52), metformin (n = 56), or insulin (n = 54).

Disclosures: The study was partly supported by the US National Institute of Diabetes and Digestive and Kidney Diseases, US National Heart, Lung, and Blood Institute, and US National Institute on Aging, among others. The authors declared no conflicts of interest.

Source: Mone P et al. Empagliflozin improves cognitive impairment in frail older adults with type 2 diabetes and heart failure with preserved ejection fraction. Diabetes Care. 2022 (Mar 21). Doi: 10.2337/dc21-2434