Cardiometabolic Effects of Empagliflozin in Patients Undergoing Elective Percu-taneous Coronary Intervention for Type 2 Diabetes Mellitus

Aim      To evaluate cardiometabolic effects of empagliflozin in patients with ischemic heart disease and type 2 diabetes mellitus (DM) following elective percutaneous coronary intervention (PCI).Materials and methods Patients meeting the inclusion/non-inclusion criteria were randomized into two groups of equal number using simple randomization with successively assigned numbers. Group 1 included 37 patients (18 men and 19 women) who gave their consent for the treatment with empagliflozin 10 mg/day in addition to their previous hypoglycemic therapy. The drug administration started one month prior to the elective PCI and continued for the next 11 months (treatment duration, 12 months). Group 2 (comparison group) consisted of age- and DM duration-matched patients (37 patients; 18 men and 19 women) who continued on their hypoglycemic therapy previously prescribed by endocrinologists during the entire study period. Before the study, 36.11 % patients of the empagliflozin group and 27.03 % of the comparison group had unsatisfactory glycemic control as shown by the level of glycated hemoglobin (HbA1c).Results At 6 and 12 months of the study, fasting glycemia and HbA1c were significantly lower in the empagliflozin treatment group. The groups were comparable by the incidence of adverse outcomes: 8 (22.24 %) patients in the empagliflozin group and 10 (27.04 %) patients in the comparison group (р=0.787). The 12-month empagliflozin treatment reduced total cholesterol (C) by 5.56 % (p<0.05), low density lipoprotein (LDL) C by 3.67 % (p<0.05), visceral adipose tissue area (VATA) by 5.83 % (p<0.05), and subcutaneous adipose tissue area (SATA) by 3.54 % (p<0.05).Conclusion      The empagliflozin treatment for 30 days prior to and after elective PCI can enhance the effectiveness of myocardial revascularization due to the demonstrated beneficial cardiometabolic effects.

Analysis of the association of polymorphisms of genes markers functions of endothelium and vascular-plate hemostasis with development of diabetic foot syndrome

The aim. To study the prevalence of various combinations of polymorphic variants of genes markers of endothelial function and vascular-platelet hemostasis in the development of diabetic foot syndrome.Materials and methods. In 198 patients with uncomplicated diabetes mellitus and 199 patients with diabetic foot syndrome, the frequency of polymorphic variants of the NOS 786C>T, END1 Lys198Asn, ITGB3 1565T>C (Leu33Pro), F5 1691G>A, F2 20210G>A, MMP9 8202A>G, MTHFR 1298A>C, VEGFA-634C>G genes was studied. Using binary logistic regression analysis, the relationship of various combinations of polymorphisms of the studied genes with the development of diabetic foot was assessed.Results. In diabetic foot syndrome, the most significant contribution is made by the combination of polymorphic variants of the ITGB3 1565T>C (Leu33Pro) and MTHFR 1298A>C genes. With the development of this complication of diabetes mellitus, a combination of the 1565 TC polymorphism of gene ITGB3 and the 1298AA polymorphism of gene MTHFR is 2.1 times more common. The association of the 1565TT polymorphism of gene ITGB3 and the 1298AC polymorphism of gene MTHFR is 2 times more common in diabetes mellitus without complications.Conclusion. The combination of the 1565TС polymorphism of gene ITGB3 and the 1298АА polymorphism of gene MTHFR is associated with the risk of developing a diabetic foot and increases the risk of developing this complication by 2.4 times. The presence of a combination of the 1565TT polymorphisms of gene ITGB3 and the 1298AC polymorphism of gene MTHFR is more common in uncomplicated diabetes mellitus, which suggests its protective effect against the development of diabetic foot syndrome.

Lifestyle modification program, LIFE is LIGHT, in patients with type 2 diabetes mellitus and obesity: Results from a 48-week, multicenter, non-randomized, parallel-group, open-label study

BACKGROUND

Obesity is a potential risk factor for development of type 2 diabetes mellitus (T2DM). To achieve long-term weight reduction in patients with T2DM and obesity using comprehensive lifestyle management program (LMP).

MATERIALS AND METHODS

This 48-week interventional, multicenter, parallel-group, open-label study included patients aged ≥18 years with T2DM and a body mass index (BMI) of 27-40 kg/m2. The primary objective was to demonstrate a clinically significant weight reduction (≥5%) from baseline in intensive lifestyle modification (ILM) and standard treatment (ST) groups.

RESULTS

The ILM group (N = 100) received recommendations for dietary and physical activity, and behavioral counseling. The ST group (N = 30) was managed in accordance with routine T2DM clinical practice. The patients in ST group were older (60.6 ± 8.9 vs. 54.6 ± 10.2 years in ILM group); overall more than 60% were women. At Week 48, the mean reduction in body weight was 5.8% (95% confidence interval [CI]: -6.9, -4.6) and 1.2% (95% CI: -2.6, 0.2) (p < 0.001) in the ILM and ST group, respectively. At Week 48, a weight loss of ≥5% was achieved by 50% of patients in the ILM group versus 13.3% in the ST group (p = 0.002). The decreases in BMI, waist-to-hip ratio and glycated hemoglobin (HbA1c) was significantly greater in the ILM versus ST group with between-group differences of -1.63 (p ≤ 0.001), -0.03 (р ≤ 0.001) and -0.69% (p = 0.002), respectively.

CONCLUSION

A clinically significant weight reduction (≥5%) was demonstrated in patients with obesity and T2DM with use of a comprehensive LMP, along with improvements in BMI, waist-to-hip ratio, and HbA1c.

[Anemia as a risk factor of contrast-associated acute kidney injury]

AIM

The aim of our study was to assess the role of anemia as a risk factor of contrast-associated acute kidney injury (CA-AKI) in patients with stable coronary artery disease.

MATERIALS AND METHODS

1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). 83 patients had anemia. CA-AKI was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The primary endpoint of the study was the development of CA-AKI according to KDIGO criteria.

RESULTS

CA-AKI developed in 12 (14.5%) patients with anemia according to the relative increase of the level of serum creatinine (25% and more from the baseline). With using the absolute increase of the level of serum creatinine the prevalence of CA-AKI was 2 (2.4%) patients. Patients with anemia had higher rate of CA-AKI than the overall population of the study (14.4% versus 12.7%). Although our results were not statistically significant (р=0.61, odds ratio 1.19, 95% confidence interval 0.632.24).

CONCLUSION

The prevalence of CA-AKI was higher in the group of patients with anemia, but didnt meet statistical significance and needs further evaluation in larger studies.

[The attitude of patients with types 1 and 2 diabetes mellitus towards having the disease]

AIM

To analyze the types of attitude towards disease, their relationships to its course in patients with diabetes mellitus (DM).

SUBJECTS AND METHODS

418 patients with DM, including 318 with type 2 DM (T2DM) and 100 with Type 1 (T1DM), were examined. Clinical and laboratory examinations were performed; the types of attitude towards the disease were studied.

RESULTS

The patients with T2DM were more frequently found to have anxious (12.9%) and hypochondriacal (10.7%) types of attitude towards the disease; those with T1DM had euphoric types. The paranoiac type of disease attitude, which was characterized by the presence of peculiar notions about the disease, was detected in 15.1% of the patients with T2DM and in 13% of those with T1DM. Hypernosognosia (overreaction to disease) was more often identified in T2DM (62.3% versus 39% in T1DM (χ2; p < 0.001). In the T2DM group, hypernosognosia was more frequently seen in women, unemployed persons, and obese patients. With the comparable awareness about the disease and degree of self-control, the patients with T2DM with no signs of hypernosognosia had a lower glycated hemoglobin level [7.35 (6.6; 8.6)%] than those with hypernosognosia [7.9 (7; 9.4)%] (p = 0.024).

CONCLUSION

The revealed peculiarities of attitude towards the disease in patients with DM justify the need for increased attention to their psychological characteristics. The situation could be improved if the physicians are be informed, the time of outpatient care is prolonged, and psychotherapists and/or clinical psychologists are widely involved in the management of diabetic patients.

[Effectiveness of diffuse diabetic macular edema treatment in relation to structural changes in macular region]

AIM

to describe baseline functional and anatomical parameters of the macular region and how they change under ranibizumab therapy depending on the type of diabetic macular edema (DME) determined with optical coherence tomography (OCT).

MATERIAL AND METHODS

The study included 100 patients (100 eyes) with diabetes mellitus and DME (38 men and 62 women) aged 61.9±5.6 years with the mean disease duration of 8.48 years. Basing on OCT findings, 4 groups (25 patients each) were formed: sponge-like DME, cystoid DME, DME with serous neuroepithelium detachment (NED), and mixed DME (cystoid DME and serous NED). All patients received 3 consecutive monthly injections of 0.5 mg ranibizumab. The relationship between anatomical, functional, and clinical parameters was analyzed.

RESULTS

The lowest visual acuity (VA) at baseline was found in patients with mixed DME (р<0.05). The greatest increase in VA after the 3 injections was noted in patients with sponge-like DME - 0.34±0.18. Retinal thickness was significantly lower (р<0.05) in sponge-like DME as compared to other groups both at baseline and after the treatment. Foveolar thickness decreased after the treatment in all groups, the effect being the most pronounced (the edema got reduced by 42.4%, р<0.05) in cystoid DME. The most significant reduction in macular volume (by 2.7 mm3) as well as its lowest absolute post-treatment values were reported for patients with cystoid edema (9.01 mm3, р<0.05 as compared to sponge-like and mixed DME). Correlation analysis revealed an evident relationship between the improvement in VA (ΔVA) and the decrease in macular volume (р<0.05). Of clinical parameters, only diabetes duration correlated with the extent of VA improvement (r=-0.3; p<0.05).

CONCLUSION

The effectiveness of intravitreal ranibizumab therapy for diffuse DME depends on the morphological type of macular edema by OCT. Moreover, it correlates with diabetes duration.