NEJM Evidence’s Post

📣 I'm excited to announce that our paper on "The association of chronic complications with time in tight range and time in range in people with type 1 diabetes: a retrospective cross-sectional real-world study" has been published in #Diabetologia. 💡 We found that both time in tight range #TITR and time in range #TIR were inversely associated with the presence of microvascular complications and cerebrovascular disease in people with #type1diabetes. These findings further substantiate the use of time in tight range and time in range in clinical practice as key measures in glycaemic management. 🔎 Full paper available on: https://lnkd.in/eRzh9UDi

Early signs of retinal hypertension are typically ignored, and reported as utterly normal. Retinal appearance is a helpful thing to double check in cases of chronic headaches, tinnitus, dizziness, dysopsia and other weird craniovascular symptoms. Here's a retinal photo from a mid twenties patients with fairly obvious arteriolar tortuosity and several sites of arteriovenous nicking. There is mild sclerosis of the arterioles. It is true that these images are not suggesting impending retinal damage. But that does not mean that it's normal, and it certainly does not exclude underlying pathology that can explain the patient's symptoms. A retinal appearance like this, at 25, is not expected. Craniohypertensive disease, as I have written about extensively, is often an occult problem that will be indicated through clinical signs and special tests, but even in this case, is hard to conclusively prove. This is why the red thread must be followed through various exams in order to reach a plausible diagnosis. Once a likely diagnosis has been postulated, the appropriate follow-up exams can be done in order to confirm or reject the theory.

Don't forget about atherogenic effect of sticky lipoprotein and endothelial dysfunction of hypertension in T2D. Diabetes care must always include the all ABC, and psychological disorders from diabetes distress to the others. EvidenceAlerts | Glycaemic control and macrovascular and microvascular outcomes: A systematic review and meta-analysis of trials investigating intensive glucose-lowering strategies in people with type 2 diabetes. https://lnkd.in/g-g7waVD

Do You suffer from Peripheral Neuropathy? There is Hope for a Successful Treatment! Twenty million Americans are estimated to have peripheral neuropathy (PN). This happens in one-third to one-half of people with diabetes. Other causes of PN include chemotherapy, excessive alcohol intake, Vitamin B deficiencies, and post-viral infections. Some are even idiopathic (meaning no underlying cause has been found). Potential symptoms of PN: 1. Persistent burning pain in the feet (especially at night) 2. Feeling like you are “walking on hot coals” 3. Losing your sense of balance 4. Persistent numbness Patricia Delzell, M.D. is featured in The Women's Journal and her article explores the latest advancements in musculoskeletal medicine, offering valuable insights for professionals and patients alike. For more information, contact Dr. Patricia Delzell at Advance Musculoskeletal Medicine Consultants: Ph. 440-557-5011. #wjmag #community #MusculoskeletalMedicine #HealthcareInnovation https://lnkd.in/gMmYpNBb

Excited to share our unique case in JCEM Case Reports (from the Endocrine Society) on a rare post-thymectomy autoimmune response triggering Type 1 Diabetes Mellitus in a 25-year-old. This observation challenges existing understandings and calls for further research into autoimmune endocrine dynamics post-Thymectomy. #AutoimmuneDiabetes #ClinicalResearch

A secondary analysis of the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study showed that fenofibrate, a weak PPAR-& activator, reduced the incidence of minor amputations. In an exploratory analysis of the recent large-scale PROMINENT trial, the selective peroxisome proliferator-activated receptor alpha modulator pemafibrate reduced incident diabetic lower extremity ulceration and gangrene by 37% (HR: 0.63; 95% CI. 0.41-0.96; P = 0.03). These provocative data support future trials in this high-risk setting in which no medical therapy in wide use has proven efficacy. #diabetes #diabeticfootulcers #diabetespemafibrate #diabetesamputations #highriskdiabetestreatment

Recent evidence highlights that lowering systolic blood pressure (SBP) to <130 mm Hg significantly reduces major cardiovascular events and all-cause mortality. A meta-analysis of 72,138 participants across seven trials found that targeting SBP below 130 mm Hg resulted in a 22% reduction in major CVD and an 11% reduction in all-cause mortality. Even more intensive control (<120 mm Hg) yielded further CVD reductions, though mortality benefits were less conclusive. These findings offer clear support for tighter BP control, yet the risk of adverse events underscores the importance of individualized treatment strategies. #Cardiology #Hypertension #BloodPressure #CVD #MedicalResearch #Healthcare #SBP

💊 𝐇𝐞𝐚𝐫𝐭 𝐅𝐚𝐢𝐥𝐮𝐫𝐞 𝐇𝐨𝐩𝐞𝐬 𝐑𝐞𝐯𝐢𝐯𝐞𝐝: 𝐍𝐨𝐯𝐨'𝐬 𝐒𝐞𝐦𝐚𝐠𝐥𝐮𝐭𝐢𝐝𝐞 𝐒𝐡𝐢𝐧𝐞𝐬 𝐢𝐧 𝐍𝐞𝐰 𝐒𝐭𝐮𝐝𝐲! 🌟 𝐈𝐧 𝐀𝐮𝐠𝐮𝐬𝐭 𝟐𝟎𝟐𝟒,Novo Nordisk’s heart failure #ambitions for its obesity star Wegovy (semaglutide) are starting to get back on track. Novo’s semaglutide cut the risk of combined #cardiovascular (CV) death or worsening heart failure (HF) events by 31%, based on an incident rate of 𝟓.𝟒% in semaglutide patients versus 𝟕.𝟓% in those on placebo.   In Novo's published post-hoc data drop, heart failure outcomes were examined in a total of 𝟑,𝟕𝟒𝟑 patients with a history of HFpEF at two different semaglutide doses: 2.4 mg in the FLOW study and 1 mg in the SELECT, STEP-HFpEF, and STEP-HFpEF DM trials. #Heartmuscle contracts normally in patients with heart failure with preserved ejection fraction, or HFpEF, but the ventricles do not relax, resulting in #reducedbloodflow. According to Novo's estimate in a press release, almost 80% of #individuals with heart failure are also overweight or obese, suggesting that obesity may be a major contributing factor to HFpEF. The illness is also linked to type 2 diabetes, which can worsen functioning, increase the load of symptoms, and result in a "more severely impaired quality of life" for patients. 𝐋𝐨𝐨𝐤 𝐚𝐭 𝐨𝐮𝐫 𝐂𝐨𝐫𝐫𝐞𝐥𝐚𝐭𝐞𝐝 𝐑𝐞𝐩𝐨𝐫𝐭 👉: https://bit.ly/3MvgPAt #Semaglutide #HeartFailure #MedicalResearch #PooledAnalysis #Cardiology #PharmaInnovation #HeartHealth #ClinicalStudies

••Here is an extremely obese patient (BMI:44) with a 15 weeks fetus. This is her first visit. She is also a type II diabetic and takes high doses of insulin. Unfortunately, her glucose levels are still not regulated. When I started the examination, I had difficulty seeing the baby because of the thick subcutaneous fat tissue. I knew I had to keep my eyes open because it was a baby of a diabetic mother. What do you think could be wrong with this poor baby? And the answer comes, Proximal femoral focal deficiency (PFFD) is a rare congenital anomaly characterized by dysgenesis and hypoplasia of variable segments of the proximal femur, with an incidence of 0.11 to 0.2 per 10,000 births. Several etiologic factors have been implicated, including diabetes mellitus, exposure to thalidomide, viral infections, exposure to radiation, chemical toxicity, and trauma to the fetus between the 4th and 8th weeks of gestation. The defect ranges in severity from femoral shortening associated with varus deformity to complete absence of both the acetabulum and proximal femur. The condition may be bilateral (rare) or unilateral (85–90% of cases), and may be associated with other congenital abnormalities, however, it is not associated with any chromosomal abnormalities. Associated abnormalities reported in the literature include: oligodactyly of the hand, fibular agenesis or hemimelia, absence of cruciate ligaments or patella, spinal deformities, and club foot. This case is important because femoral shortening is not unilateral. Only the 10% of PFFD cases are bilateral. Thank you for your comments. #fetalmedicine #obstetriccases #maternalfetalmedicine #fetalultrasound #fetalanomalyscan #prenatalcare #fetalextremities #lowerextremity #proximalfemoralfocaldeficiency #diabetesmellitus #diabeticmother

🌟 Exciting News in Diabetes Care! 🌟 Recent research suggests that Empagliflozin could revolutionize the treatment of Diabetic Peripheral Neuropathy (DPN) by offering both neuroprotection and therapeutic benefits. In a groundbreaking prospective clinical study, Empagliflozin demonstrated remarkable outcomes: significant improvements in electrophysiological studies, decreased Brief Pain Inventory short-form item (BPI-SF) scores, and lowered serum levels of neuron-specific enolase (NSE) and malondialdehyde (MDA). What's more, this drug achieved these results while minimizing side effects, offering hope for enhancing both neuropathy and systemic oxidative stress. This breakthrough not only improves patient outcomes but also enhances their Quality of Life (QOL). Stay tuned for more updates on this promising development in diabetes care! #DiabetesResearch #Neuroprotection #Empagliflozin #HealthcareInnovation #diabetes #diabeticneuropathy #sglt2 #pain https://lnkd.in/dm8WVqR7.