AjaDuo Update Podcast- Diabetes News & Clinical Updates

ImagicaHealth

Want to stay updated with the latest in diabetes research, reviews, and perspectives? Our content is curated, written, and edited by practicing healthcare professionals with clinical and scientific expertise in diabetes care. Our editorial team is comprised of highly-trained physicians. Our summaries are designed to deliver concise, relevant insights to support effective diabetes management in clinical practice. New summaries are available monthly.

  1. 3d ago

    Integrated Cardiovascular Risk Assessment in Young Adults with Type 2 Diabetes: The “YOUNG DIABETES” Program

    Abstarct: Introduction and Objective: Early-onset type 2 diabetes (T2D) is associated with a more adverse cardiometabolic profile and increased cardiovascular (CV) risk. We aimed to characterize cardiovascular risk and subclinical atherosclerosis in young adults with type 2 diabetes (T2D) participating in the YOUNG DIABETES program. Methods: Observational study including individuals with type 2 diabetes (T2D) diagnosed at ≤50 years and current age ≤55 years enrolled in the YOUNG DIABETES clinical program. Participants underwent clinical and biochemical assessment, cardiovascular (CV) risk estimation (SCORE2-Diabetes), and carotid ultrasound to detect subclinical atherosclerosis.  Results: A total of 179 participants were included; 37% were women. Median age was 45 years [37-50] and diabetes duration 4 years [1-10]. Active smoking was present in 18% and 25% were former smokers. Median Body Mass Index (BMI) was 30.1 kg/m² [26.5-34.3], Median Glycated Hemoglobin (HbA1c) 7.2% [6.4-8.6], Median Low-Density Lipoprotein Cholesterol (LDL-C) 101 mg/dL [86-125.3], and calculated cardiovascular (CV) risk by SCORE2-Diabetes 5.2% [3.9-7].Carotid ultrasound was performed in 115 participants and identified subclinical atherosclerosis in 31% (20% had 1-2 plaques and 11% ≥3 plaques). Individuals with atherosclerosis were older (49 vs 42.5 years-old, p=0.0001), had longer diabetes duration (8 vs 2.5 years, p=0.0007), and higher HbA1c levels (7.9 vs 7%, p=0.03), No differences were observed by sex, smoking status, Body Mass Index (BMI), lipid profile, or calculated cardiovascular (CV) risk. In multivariate analysis, diabetes duration (OR 1.09 [1.01-1.17] and smoking exposure (OR 1.04 [1.00-1.07]) were independently associated with greater plaque burden.  Conclusion: In young adults with type 2 diabetes (T2D), in which SCORE2-Diabetes may underestimate cardiovascular risk, the YOUNG DIABETES program enables comprehensivecardiovascular risk stratification including detection of subclinical atherosclerosis. Carotid plaques were independently associated with longer diabetes duration and smoking exposure, highlighting the importance of early and strict glycemic control and smoking avoidance to reduce cardiovascular risk in young-onset type 2 diabetes (T2D).

    3 min

  2. 3d ago

    Adoption of GLP-1RA and SGLT2i Drug Classes among Patients with Cardiovascular or Renal Indications: Evolution of Prescribing Patterns over Time

    Abstarct: Introduction and Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and Sodium-glucose transporter 2 inhibitors (SGLT2i) are crucial components of type 2 diabetes care, especially for adults with Cardio-vascular disease (CVD) or Diabetic kidney disease (DKD). However, early adoption of Glucagon-like peptide-1 receptor agonists GLP-1RA and SGLT2i remains low. Our aim was to evaluate the association between prescription of of Glucagon-like peptide-1 receptor agonists and Sodium–Glucose Cotransporter 2 Inhibitors medications and presence of indications for the drugs among patients with type 2 diabetes and how prescribing patters have evolved between 2016 and 2023.  Methods: We analyzed Electronic Health Record (EHR) data from adults with type 2 diabetes with one or more indications for Glucagon-like peptide-1 receptor agonists or Sodium–Glucose Cotransporter 2 Inhibitors - 1) Cardio-vasculardisease (CVD) or Diabetic kidney disease (DKD), 2) obesity, or 3) high Glycated Hemoglobin (HbA1c) level above 8% within a large regional health system. We used cluster-robust linear probability modeling with a primary outcome of receiving a Glucagon-like peptide-1 receptor agonists or Sodium–Glucose Cotransporter 2 Inhibitors prescription and predictor of indication for Glucagon-like peptide-1 receptor agonists or Sodium–Glucose Cotransporter 2 Inhibitors therapy. To examine changes over time, we introduced an interaction term of time period, 2016-2018, 2019-2021, and 2022-2023. Results: We analyzed data from 7,917 adults and 12,667 patient-time-periods. Cardiovascular disease or Diabetic kidney disease increased probability of prescription of either drug by 6.4%, obesity by 12.6%, and high A1c by 16.3% (p0.001 for all). Cardiovascular disease or Diabetic kidney disease was not associated with acceleration in prescribing rate over time, while obesity significantly accelerated prescribing in the third time period by 7% (p=0.01 for interaction). For the 2022-2023 period, estimated prescription rates were similar for obesity (50.9%) and high A1c (50.7%) but lower for Cardio-vascular disease or Diabetic kidney disease (46.7%). Conclusion: Adults with type 2 diabetes and Cardiovasculardisease or Diabetic kidney disease had increased prescribing of Glucagon-like peptide-1 receptor agonists and Sodium–Glucose Cotransporter 2 Inhibitors, continue to receive the Glucagon-like peptide-1 receptor agonists and Sodium–Glucose Cotransporter 2 Inhibitors at lower rates than adults with obesity or high A1c. Targeted clinical interventions, such as clinical decision support tools, are needed to ensure that guideline-based prescribing increases to maximize population benefit in high-risk patients with type 2 diabetes.

    4 min

  3. 3d ago

    Effect of Different Treatment Durations of Sodium–Glucose Cotransporter 2 Inhibitor on Cardiovascular Outcomes in Patients with Type 2 Diabetes: A Target Trial Emulation Study Free

    Abstarct: Introduction and Objective: Despite cardiovascular benefits of Sodium-glucose cotransporter 2 inhibitors (SGLT2i), treatment persistence is suboptimal in routine clinical practice. We investigated whether longer treatment durations offer greater cardiovascular benefits. Methods: We used nationwide healthcare data of South Korea (2012-2023) to emulate a target trial comparing following treatment strategies: treated with Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i) for 1 year, 1-2 years, 2-3 years, and ≥3 years among patients with type 2 diabetes. Primary outcomes were Major adverse cardiovascular events (MACE) and hospitalization for heart failure (HHF). Cloning, censoring, and weighting methods were applied, and 5-year absolute risks, risk differences, and risk ratios were estimated using weighted Kaplan-Meier methods. Results: 1,174,088 eligible patients initiating Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i) were identified (mean age 57.3 years; 40.5% female). Compared to patients treated with Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i) for 1 year, those treated for 1-2 years, 2-3 years,and ≥3 years had progressively lower risks of Major adverse cardiovascular events (MACE) (RRs: 0.93 [95% CI, 0.90-0.96],0.82 [0.78-0.85], and 0.69 [0.67-0.72], respectively) and Hospitalization for heart failure (HHF) (RRs: 0.93 [0.90-0.97], 0.91 [0.80-0.99], and 0.74 [0.67-0.79], respectively) over a 5-year follow-up. Conclusion: Longer Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i) use was associated with progressively lower cardiovascular risk, highlighting cardioprotective benefits of sustained treatment.

    2 min

  4. 3d ago

    Effects of Empagliflozin on Hepatic Glucose Production, Gluconeogenesis, and Lipolysis in Type 2 Diabetes

    Abstarct: Introduction and Objective: We previously showed that Sodium–Glucose Cotransporter 2 Inhibitors  (SGLT2 inhibitors) stimulate endogenous glucose production, offsetting their glucosuria-induced glucose lowering action, and that this effect is not explained by changes in plasma glucose, insulin, or glucagon concentration using a pancreatic clamp. To investigate the impact of Empagliflozin, a Sodium–Glucose Cotransporter 2 Inhibitor on fasting Hepatic glucose production (HGP), gluconeogenic flux, and lipolytic activity in type 2 diabetes individuals. Methods: 15individuals with type 2 diabetes (Age 57 ± 2 yrs, HbA1c = 9.0 ± 1.0%; BMI 31 ± 1.5 kg/m²) underwent a tracer-based metabolic study with 6, 6-²H2-Glucose, a stable isotope tracer used to measure hepatic glucose production (HGP) and ²H5-Glycerol, a stable isotope tracer used to measure lipolysis, or fat breakdown. Tracers were infused continuously from -180 min to 300 min (total 480 min). Heavy Water (D₂O), used to measure gluconeogenesis, the production of new glucose by the liver, was ingested on the night prior to study. Empagliflozin 25 mg was ingested at time 0 min. This design allowed quantitation of baseline (following overnight fast)and hepatic and adipocyte responses to Sodium–Glucose Cotransporter 2 (SGLT2) inhibition over a 5-hour treatment period. Results: Baseline (following overnight fast) Hepatic glucose production (HGP) and gluconeogenesis were 2.33 and 1.57 mg/kg/min, respectively. Following Empagliflozin gluconeogenesis (GNG) increased to 1.77 mg/kg/min (p0.01),while Hepatic glucose production (HGP) remained unchanged (2.43 mg/kg/min). Baseline glycerol Rate of Appearance (Ra) was 3.57 µmol/kg/min and following empagliflozin increased to 4.02 µmol/kg/min (p0.01), in association with increases inplasma glycerol (134 to 157 µmol/L, p0.01) and Free Fatty Acids (FFA) (0.51 to 0.71 µmol/L, p0.01) concentrations.  Conclusion: Sodium–Glucose Cotransporter 2 (SGLT2) Inhibition with empagliflozin: (i) stimulates gluconeogenesis, preventing the normal fasting - induced decline in Hepatic glucose production (HGP) and (ii) augments lipolysis, providing glycerol as a substrate to drive gluconeogenesis. This explains why Sodium–Glucose Cotransporter 2 inhibitors (SGLT2i) do not cause hypoglycemia.

    3 min

  5. Jun 1

    Effectiveness and safety of empagliflozin in routine care patients: results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study

    Objective: Over 99% of the EMPA-REG OUTCOME trial participants had established cardiovascular disease (CVD). We aimed to investigate effectiveness and safety outcomes among patients with type 2 diabetes (T2D) initiating empagliflozin vs dipeptidyl peptidase-4 inhibitor (DPP-4i) across the broad spectrum of cardiovascular risk. Methods: In a population-based cohort study we identified 39,072 pairs of 1:1 propensityscore-matched adult patients with type 2 diabetes (T2D) initiating empagliflozin or dipeptidyl peptidase-4 inhibitor (DPP-4i), using data from 2 U.S. commercial insurance databases and Medicare between 08/2014–09/2017. Primary outcomes were a composite of myocardial infarction (MI)/stroke, and hospitalization for heart failure (HHF). Safety outcomes were bone fractures, lower-limb amputations (LLA), diabetic ketoacidosis (DKA),and acute kidney injury (AKI). We estimated pooled hazard ratios (HR) and 95% CI adjusting for >140 baseline covariates. Results: Study participants had mean age of 60 years and only 28% had established cardiovascular disease (CVD). Compared to dipeptidyl peptidase-4 inhibitor (DPP-4i), empagliflozin was associated with similar risk of myocardial infarction (MI)/stroke [HR (95% CI), 0.99 (0.81–1.21)], and lower risk of hospitalization for heart failure (HHF) [0.48 (0.35–0.67) and 0.63 (0.54–0.74), based on a primary and any heart failure HF discharge diagnosis, respectively]. The heart failure HF was 0.52 (0.38–0.72) for all-cause mortality (ACM) and 0.83 (0.70–0.98) for a composite of myocardial infarction MI/stroke/ all-cause mortality ACM. Empagliflozin was associated with a similar risk of lower-limb amputations LLA and fractures, an increased risk of diabetic ketoacidosis DKA [1.71 (1.08–2.71)], and a decreased risk of acute kidney injury  AKI [0.60 (0.43–0.85)].Conclusions: In clinical practice, the initiation of empagliflozin vs dipeptidyl peptidase-4 inhibitor DPP-4i was associated with a lower risk of hospitalization for heart failure (HHF), all-cause mortality (ACM), and myocardial infarction (MI)/stroke/ all-cause mortality (ACM),a similar risk of myocardial infarction (MI)/stroke, and a safety profile consistent with documented information.

    3 min

  6. Jun 1

    Real-World CGM Comparison of Teneligliptin+Dapagliflozin, Sitagliptin+Dapagliflozin, and Linagliptin+Empagliflozin in Indian T2DM: Amplify-TIR Study

    Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder marked by persistent hyperglycemia. While HbA1c has traditionally been used to assess glycemic control, growing evidence highlights glycemic variability (GV) and Time in Range (TIR) as more precise indicators of glucose fluctuations, which are linked to diabetic complications, especially chronic kidney disease (CKD). Emerging combination therapies targeting different pathophysiologic mechanisms of type 2 diabetes mellitus (T2DM), such as Sodium-glucose cotransporter (SGLT) 2 inhibitors and dipeptidylpeptidase (DPP)-4 inhibitors, offer promise in reducing glycemic variability. Objective: To compare the efficacy of three commonly prescribed fixed-dose combination (FDC) therapies— Teneligliptin + Dapagliflozin (Arm-A), Sitagliptin + Dapagliflozin (Arm-B), and Linagliptin + Empagliflozin (Arm-C)—in improving glycemic control and renal parameters in Indian type 2 diabetes mellitus (T2DM) patients using continuous glucose monitoring (CGM). Method: This prospective, comparative study enrolled 90 patients (30 in each arm). continuous glucose monitoring (CGM)  was used to evaluate glycemic parameters including time-in-range [TIR], Time Above Range [TAR]), Time Below Range [TBR], Mean Amplitude of Glycemic Excursions (MAGE), Largest Amplitude of Glycemic Excursions (LAGE), Meanpost-prandial glycemic excursions (MPPGE), HbA1c, FPG, PPG, and renal function indicators (eGFR, serum creatinine, BUN) at baseline and study conclusion. Results: All arms demonstrated significant improvements in time-in-range [TIR], MeanAmplitude of Glycemic Excursions (MAGE), Largest Amplitude of Glycemic Excursions (LAGE), HbA1c, FPG, and PPG (p0.001). Arm-A showed a significantly superior reduction in Time Above Range [TAR]) and Mean post-prandial glycemic excursions (MPPGE) compared to Arm-B (p=0.029 and p=0.040, respectively)

    3 min

  7. Jun 1

    Fasting and postprandial kidney haemodynamic effects of empagliflozin and linagliptin in mono- and combination therapy compared to gliclazide in overweight people with type 2 diabetes

    Background: Sodium-glucose cotransporter (SGLT) 2 inhibitors attenuate fasting glomerular hyperfiltration in people with type 2 diabetes (T2D). However, Sodium-glucosecotransporter 2-inhibition increases glucagon levels, which facilitate postprandial hyperfiltration. The impact of Sodium-glucose cotransporter 2 inhibition on protein-related hyperfiltration and postprandial (intra) kidney haemodynamic function is unclear. Moreover, the interaction with dipeptidylpeptidase (DPP)-4 inhibitors, known to reduce glucagon levels and to affect meal related factors modulating glomerular filtration rate GFR, is unknown. Aims: We aimed to assess the effects of empagliflozin and linagliptin in mono- and combination therapy compared to the initiation and intensification of SU-derivative gliclazide treatment on fasting and postprandial kidney haemodynamic function. Materials and Methods: We compared three 16-week glucose-loweringstrategies added to ongoing metformin monotherapy: (1) EMPA-LINA: 8-week empagliflozin 10 mg QD (EMPA0-8w) followed by the addition of 8-week linagliptin 5 mg QD (LINA8-16w); (2) LINA-EMPA: 8-week linagliptin (LINA0-8w) followed by the addition of 8-week empagliflozin (EMPA8-16w) versus; (3) GLIC-GLIC: 8-week gliclazide 30 mg QD (GLIC0-8w) followed by the addition of 8-week gliclazide 30 mg (GLIC8- 16w). We studied (intra) kidney haemodynamic interactions of this combination using iohexol and PAHclearance techniques to assess measured glomerular filtration rate (mGFR) and effectiverenal plasma flow (ERPF). Results: We studied n = 61 overweight people with type 2 diabetes T2D (HbA1c 62 + 11 mmol/mol, eGFR 89 [78_100] mL/min/1.73 m2 and urinary albumin-creatinine-ratio 1.0 [0.4_1.9] mg/mmol). In the fasting state, 0-8 week empagliflozin EMPA0-8w (−13.2; −21.3 to −5.1 mL/min) but not 0-8 week linagliptin LINA0-8w reduced within-group measured glomerular filtration rate (mGFR). 8-16 week empagliflozin EMPA8-16w (−10.2; −16.5 to −4.0 mL/min) but not 8-16 week linagliptin LINA8-16w reduced within-group measuredglomerular filtration rate (mGFR). Following a proteinload, 0-8 week empagliflozin EMPA0 8w (−11.4; −20.2 to −2.6 mL/min) and 8-16 week empagliflozin EMPA8-16w (−16.2; −22.9 to −9.4 mL/min) but not 0-8 week linagliptin LINA0-8wor 8-16 week linagliptin LINA8-16w reduced within-group measured glomerular filtrationrate (mGFR). Versus the comparatorarm, fasting measured glomerular filtration rate (mGFR) 0-8 week empagliflozin EMPA0-8w, 8-16 week empagliflozin EMPA8-16w and EMPA-LINA and postprandial mGFR EMPA8-16w and LINA-EMPA, were significantly reduced. measured glomerular filtration rate (mGFR)  reductions resulted from intra kidney efferentvasodilation rather than afferent vasoconstriction. Conclusion: In type 2 diabetes people without chronic kidney disease (CKD), the favourablekidney haemodynamic effects of empagliflozin persist in the postprandial state and are irrespective of concurrent use of linagliptin.

    4 min

  8. Jun 1

    Self-care practices in diabetes among populations in India: a systematic review and meta-analysis

    Introduction: Diabetes mellitus is a chronic condition that requires consistent self management to prevent complications and maintain quality of life. This meta-analysis estimated the pooled prevalence of various self-care components in Indian populations with diabetes and their regional distribution. Methods: A literature search was conducted for studies published between January 2014 and November 2024 in PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. Studies reporting prevalence of various self-care practices among diabetic populations in India were included. Data was extracted based on study details, demographics, setting, and self-care practices. Study quality and bias risk were assessed using the Newcastle-OttawaScale. Statistical analysis was done in Stata version 18. A mixed method model was used to estimate the pooled prevalence. Heterogeneity was explored through sub-group analysis, sensitivity analysis and meta-regression. Results: A total of 29 articles were included in this review with 7863 populations. Most studies belonged to southern India (n = 19, 65.5%), and community settings (n= 15, 51.7%). The pooled prevalence of drug adherence was highest (71%, 95% CI: 63–79).This was followed by glucose monitoring (60, 50–70), dietary compliance (51, 42–59), healthy coping (43, 22–63), physical activity (41, 34–47), risk reduction (28, 20–36), and problem solving (22, 12–33). Meta-regression showed that the prevalence of physical activity is notably higher in the West (1.02, 95% CI: 0.57–1.48), East (0.77, 0.36–1.18), North (0.78, 0.36–1.18), and South (0.65, 0.31–1.0) regions compared to Central region. Glucose monitoring was significantly higher in East (0.7, 0.2–1.2) and South (0.57, 0.15–1.0) regions compared to Central region. Conclusion: Self-care practices among diabetic populations in India remain suboptimal, with considerable variation across regions. These findings underscore the urgent need for context-specific, scalable interventions and strengthened health system support to promote comprehensive diabetes self-management across the country.

    3 min
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Want to stay updated with the latest in diabetes research, reviews, and perspectives? Our content is curated, written, and edited by practicing healthcare professionals with clinical and scientific expertise in diabetes care. Our editorial team is comprised of highly-trained physicians. Our summaries are designed to deliver concise, relevant insights to support effective diabetes management in clinical practice. New summaries are available monthly.

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