Study finds no link between SGLT-2 inhibitors and fracture risk in patients with type 2 diabetes
Recent research analysis
published in the ADA’s Diabetes Care
journal examined the association between sodium-glucose cotransporter 2 (SGLT2) inhibitors and the risk of fractures. To address the limitations in previous similar studies, the researchers conducted a population-based cohort study using the U.K. Clinical Practice Research Datalink (CPRD) to assemble a base cohort of all individuals, at least 40 years old, newly treated with antidiabetic drugs between January 1, 1988 and December 31, 2017. The study, which included 73.178 patients with 9,454 SGLT2 inhibitor users and 18,410 DPP-4 inhibitor users found a fracture incidence rate of 12.88 per 1,000 users. In the paper’s conclusion, the researcher wrote: “Overall, our real-world study provides further reassurance on the safety of this new class of drugs on bone health among patients with type 2 diabetes.”
FDA Approves New Intranasal Glucagon Spray for Hypoglycemia Treatment
The FDA recently announced
the approval of the first glucagon-based treatment for severe hypoglycemia that doesn’t require an injection. The product, to be sold as Baqsimi, is an intranasal powder delivered through a single use dispenser. The approval was based upon two trials in adults and one trial in adolescents wherein the product demonstrated an ability to “adequately increased blood sugar levels" in response to insulin-induced hypoglycemia. In the FDA’s publicly released statement, Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research noted: “There are many products on the market for those who need insulin, but until now, people suffering from a severe hypoglycemic episode had to be treated with a glucagon injection that first had to be mixed in a several-step process. This new way to administer glucagon may simplify the process, which can be critical during an episode, especially since the patient may have lost consciousness or may be having a seizure.”
ACA and AHA Release Updated Guidelines for Prevention of Sudden Cardiac Death
The American Heart Association and the American College of Cardiology have recently released guidelines on the effective prevention of sudden cardiac death
in patients with ventricular arrhythmia. The updated guidelines includes a range of changes, the biggest of which is the addition of angiotensin receptor-neprilysin inhibitors, which the synopsis authors note remain controversial. Additional changes include the recommendation of guideline-directed medical therapy for those with reduced EF (<40%) to include beta-blockers, mineralocorticoid recepter antagonists, and angiotensin-converting enzyme inhibitors. Sudden cardiac death currently stands as a major public health concern, accounting for 50% of all cardiovascular death.
Coronary Artery Calcium Testing Predicts Death in Patients Under 50
A recent study
published in JAMA Network Open
found that for adults aged 30-49 years older with risk factors of cardiovascular disease (CVD), high coronary artery calcium (CAC) scores were associated with increased risk for actual CVD and mortality. The cohort study included 22,346 individuals from the CAC Consortium with clinical indications for CAC, 34% of which had prevalent CAC. In the study synopsis, the author’s concluded: “The risk of death from coronary heart disease, cardiovascular disease, or all-cause mortality was significantly higher for those with elevated CAC scores, even after multivariable adjustment.” The researchers suggested that while previously considered to be a superfluous process for younger patients, coronary artery calcium testing may be worthwhile: “"This paper gives credence to the idea that in certain individuals this might be something you want to think about. The radiation dose is pretty similar to a mammogram, so it's a pretty low dose, and the cost now is around a $100, so it's not a super expensive test, and it can provide some meaningful information clinically."