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- Dror Dicker
- Internal Medicine D & Obesity Clinic
- Hasharon hospital
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- Primary Outcomes
- Major CV Events
- Amputation
- Interventions for CAD, PVD
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- Non-Glycemic Risk Factor Control
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- If other CV risk factor control is good, there is no additional CV benefit of lowering
HbA1c from 8.4% to 6.9% in older people with advanced DM (VADT).
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- A ten member data and safety monitoring board had been reviewing
mortality trends.
- On January 8, 2008, it concluded that increased rate of all-cause
mortality in the intensive therapy group outweighed any potential
benefits.
- Patients were informed February 5, 2008.
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it blood pressure?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it blood pressure?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it LDL-C?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it LDL-C?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it rosiglitazone use?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it rosiglitazone use?
- NO
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37
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it weight gain?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it weight gain?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it hypoglycemia?
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- Why was there higher all-cause mortality in the intensive glycemic
therapy arm?
- Was it hypoglycemia?
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- If other CV risk factor control is good, there is no additional CV benefit of lowering
HbA1c from 8.4% to 6.9% in older people with advanced DM (VADT).
- If other CV risk factor control is good, there may be CV harm in lowering
HbA1c from 7.5% to 6.4% in older people with advanced DM, perhaps due
to hypoglycemia (ACCORD).
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- If other CV risk factor control is good, there is no additional CV benefit of lowering
HbA1c from 8.4% to 6.9% in older people with advanced DM (VADT).
- If other CV risk factor control is good, there may be CV harm in lowering
HbA1c from 7.5% to 6.4% in older people with advanced DM, perhaps due
to hypoglycemia (ACCORD).
- Reducing blood glucose early in the course of the disease may not be
harmful (ADVANCE) and may even
confer CV benefit (UKPDS Follow-Up).
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- Investigating the potential role that medications may have played in the
mortality imbalance continues to be an important consideration for
ACCORD Investigators.
- This is a difficult task because:
- Participants were not randomized to different medications
- Choice of medication in any participant was based on clinical judgment
and characteristics of participants
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- We have not been able to identify a single agent, or combination, that
accounts for the imbalance in mortality.
- Exenatide è less
mortality, but used rarely and more often in Intensive Glycemia group
- Premixed Insulin è greater
mortality, but used more often in Standard Glycemia group
- Bolus Insulin è greater
mortality, but no difference in mortality hazard ratios by randomized
group and we don’t know if the relationship with mortality is a
reflection of use or the participants to whom it was given
- Approximately a 20% increase in mortality associated with Intensive
Glycemia even after controlling for participant characteristics and
post-randomization use of glycemia medications.
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- Patients with type 2 diabetes (on any monotherapy or dual combination
with metformin)
- Noninferiority design, with per-protocol as primary analysis
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- Our results propose a novel 2-pathway schema for cardiovascular actions
of GLP-1,
- one that depends on the GLP-1R
for inotropic action, glucose uptake, ischemic preconditioning, and mild
vasodilatory actions.
- Second that depends on rapid metabolism of GLP-1 to GLP-1(9-36),the
latter having GLP-1R–independent effects on postischemic recovery of
cardiac function and vasodilation.
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- בחולים עם
סוכרת סוג 2
ממושכת ומחלת
לב וכלי דם איזון
המוגלובין
מסוכר (HA1C)
צריך להיות
מתון (7-7.5).
- בחולים
אלו יש לאזן
קפדנית את
כלל גורמי
הסיכון
במיוחד לחץ
הדם.
- תת סוכר
ועליה במשקל
הינם
הגורמים
החשודים כמעלים
התמותה
כתוצאה של
איזון קפדני
מדי.
- Sitagliptin
ואנלוגים של GLP-1 ׁ(אינקרטינים)
עשויים לתת
מענה כולל
לטיפול בחולה
הסוכרתי בשל
השפעתם
המיטיבה על
ערכי הסוכר,
המשקל
ופרופיל
השומנים ללא
ארועיי היפוגליקמיה
משמעותיים.
- עדויות
מחקריות
ראשונות
מצביעות על
השפעה מיטיבה
של
האינקרטינים
על:
-
התפקוד
הלבבי
-
והפחתת לחץ
הדם בבני אדם
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Notes
