BP-lowering drugs reduced major CV events by similar amounts in patients with and without type 2 diabetes

Source Citation Nazarzadeh M, Bidel Z, Canoy D, et al. Blood pressure–lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis. Lancet Diabetes Endocrinol. 2022;10:645-54. 35878651

In HFpEF, the benefit of empagliflozin on a composite of CV death or HF hospitalization at 26 mo did not vary by diabetes status

Source Citation Filippatos G, Butler J, Farmakis D, et al. Empagliflozin for heart failure with preserved left ventricular ejection fraction with and without diabetes. Circulation. 2022;146:676-86. 35762322

In adults with obesity without diabetes, adding tirzepatide to a lifestyle intervention increased weight loss at 72 wk

Source Citation Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387:205-16. 35658024

In type 2 diabetes, SGLT2 inhibitors reduced risk for serious hyperkalemia without increasing hypokalemia

Source Citation Neuen BL, Oshima M, Agarwal R, et al. Sodium–glucose cotransporter 2 inhibitors and risk of hyperkalemia in people with type 2 diabetes: a meta-analysis of individual participant data from randomized, controlled trials. Circulation. 2022;145:1460-70. 35394821

In patients with type 2 diabetes and CKD, finerenone improved CV and kidney outcomes

Source Citation Agarwal R, Filippatos G, Pitt B, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022;43:474-84. 35023547

In overweight or obesity without diabetes, weekly semaglutide vs. daily liraglutide increased weight loss at 68 wk

Source Citation Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: the STEP 8 randomized clinical trial. JAMA. 2022;327:138-50. 35015037

Antihypertensive drugs reduced risk for new-onset type 2 diabetes; effect varies by antihypertensive class

Source Citation Nazarzadeh M, Bidel Z, Canoy D, et al. Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis. Lancet. 2021;398:1803-10. 34774144

Annals Graphic Medicine - Not the Needle! A Day in the Life of Someone Living With Diabetes

Tirzepatide Versus Intensified Conventional Care After 2 Years of Treatment in Early Type 2 Diabetes: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 0, No 0

Background: Initiation of treatment with tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist (GLP-1RA), early after a diagnosis of type 2 diabetes (T2D) may establish better and more durable glycemic control than current treatment approaches per guidelines and clinical practice. Objective: To assess the efficacy and safety of tirzepatide versus intensified conventional care (ICC) in participants with early T2D who have inadequate glycemic control with diet, exercise, and metformin. Design: Randomized, open-label, parallel-group, phase 4 trial (SURPASS-EARLY). (ClinicalTrials.gov: NCT05433584) Setting: 78 sites in 10 countries. Participants: 794 adults with at most 4 years of T2D history treated with metformin. Intervention: Tirzepatide (15 mg or maximum tolerated dose) or ICC (including GLP-1RAs but excluding tirzepatide) used in clinical practice and supported by local treatment guidelines. Measurements: The primary objective was to show the noninferiority of tirzepatide to ICC for change in hemoglobin A1c (HbA1c) from baseline to 2 years. Secondary objectives were to show the superiority of tirzepatide for change in HbA1c, weight, and waist circumference. Results: Tirzepatide was superior to ICC for mean changes from baseline to 2 years in HbA1c (−1.99 percentage points [95% CI, −2.12 to −1.87 percentage points] vs. −1.32 percentage points [CI, −1.44 to −1.19 percentage points]; estimated treatment difference [ETD], −0.68 percentage points [CI, −0.84 to −0.51 percentage points]; P < 0.001), weight (ETD, −8.0 kg [CI, −9.39 to −6.50 kg]; P < 0.001), and waist circumference (ETD, −6.2 cm [CI, −7.54 to −4.93 cm]; P < 0.001) (treatment regimen estimand). More participants achieved normoglycemia (HbA1c <5.7%) with tirzepatide (60.2%) than ICC (24.0%). The most common adverse events were gastrointestinal in both groups. Limitation: Open-label design. Conclusion: In participants with early T2D uncontrolled with metformin, tirzepatide treatment resulted in superior reductions in HbA1c, weight, and waist circumference, and more participants achieved normoglycemia (HbA1c <5.7%) with tirzepatide than ICC after 2 years. Primary Funding Source: Eli Lilly and Company.

In adults with obesity but without type 2 diabetes, tirzepatide increased weight loss at 72 wk compared with semaglutide

Clinical Impact Ratings GIM/FP/GP: 6 out of 7 Endocrinology: 6 out of 7

Aplasia Cutis Congenita in the Setting of Maternal Cystic Fibrosis | Annals of Internal Medicine: Clinical Cases

Aplasia cutis congenita is a rare scalp defect. An affected neonate was delivered after in utero exposure beginning in the midtrimester to elexacaftor/tezacaftor/ivacaftor for maternal cystic fibrosis management. Although aplasia cutis congenita has many potential etiologies, maternal cystic fibrosis transmembrane regulator modulator therapy has not been implicated.

Hyperplastic Polyps Discovered Because of Unprovoked Acute Upper Gastrointestinal Bleeding as an Unusual Presentation of Malignancy | Annals of Internal Medicine: Clinical Cases

Gastric hyperplastic polyps are small (<1 cm), asymptomatic, and found incidentally on esophagogastroduodenoscopy. Patients can present with dyspepsia, abdominal pain, anemia from chronic occult bleeding, and, rarely, acute upper gastrointestinal bleeding. Helicobacter pylori, autoimmune gastritis, and long-term use of proton-pump inhibitors can increase the risk for hyperplastic polyps. Dysplasia and carcinoma in the surrounding gastric mucosa with concomitant hyperplastic polyps can be seen but carcinoma and dysplasia within the hyperplastic polyp itself are extremely rare. We report on a 70-year-old White woman who presented with melena from what appeared to be hyperplastic polyps on esophagogastroduodenoscopy, but pathology reported frank intramucosal adenocarcinoma.