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

Slow-Growing Lung Mass in a Patient With Multiple Endocrine Neoplasia Type I: Consider Carcinoid Tumor | Annals of Internal Medicine: Clinical Cases

A 23-year-old man with multiple endocrine neoplasia type 1 (MEN 1) with pancreatic tail masses and Cushing syndrome (status after transsphenoidal adenomectomy) presented with a slow-growing, asymptomatic right lower lung lobe mass confirmed to be an atypical carcinoid tumor by pathologic staging following successful basilar segmentectomy with mediastinal lymphadenectomy. Pulmonary carcinoid tumor (PCT) is a rare neoplasm in patients with MEN 1, but there is limited data on trends in atypical versus typical carcinoid tumors in these patients. This case emphasizes the need to characterize these trends given the implications for metastatic potential and 5-year survival, which can help guide screening recommendations in these patients.

Aortic Thrombus in Severe Disseminated Lyme Disease | Annals of Internal Medicine: Clinical Cases

Lyme carditis with atrioventricular dissociation is a rare yet well-recognized complication of disseminated Lyme disease. Other cardiac and noncardiovascular conditions have been reported with disseminated Lyme disease. We present a case of severe disseminated Lyme carditis with an acute arterial thrombus, in the absence of an alternative or more common cause, which required urgent surgical intervention. To our knowledge, arterial thrombus is a previously unreported complication of disseminated Lyme carditis.

Multimodal Imaging for the Diagnosis of Accessory Mitral Valve Tissue | Annals of Internal Medicine: Clinical Cases

Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly often diagnosed in childhood and is associated with left ventricular outflow tract obstruction. We present a case of an asymptomatic adult man in his 60s with an incidental finding of AMVT. A transthoracic echocardiography and transesophageal echocardiography initially raised suspicion of AMVT, but the precise origin of the anomaly was established using a dynamic 4-dimensional cardiac computed tomography scan, ultimately confirming the diagnosis. This case highlights the potential value of multimodality imaging in the diagnosis of AMVT and rules out other differential diagnoses.

The Importance of Detecting the Signs of Primary Hyperoxaluria—Cardiac Oxalosis in Primary Hyperoxaluria Type 1 | Annals of Internal Medicine: Clinical Cases

A 27-year-old man presented with influenza-like symptoms and rapidly progressing respiratory failure requiring mechanical ventilation and venovenous extracorporeal membrane oxygenation on the day of admission. With a medical history consisting of only 2 episodes of kidney stones, this patient's sudden multiorgan failure affecting kidneys, heart, lungs, and liver posed a diagnostic challenge. A myocardial biopsy revealing crystalloid myocardial deposits led to the diagnosis of cardiac oxalosis due to primary hyperoxaluria. Because of the rarity of this genetic disease, it is frequently overlooked in patients, causing delays in diagnosis and treatment. This case demonstrates the dire and potentially irreversible consequences this may cause.

An Unusual Cause for Progressively Worsening Dyspnea | Annals of Internal Medicine: Clinical Cases

A 66-year-old female presented with progressive dyspnea and was found to have a large interatrial septal lipoma that grew to extend to the proximal superior vena cava (SVC), leading to extrinsic compression that caused the impedance of blood flow. The patient had operative removal of the lipoma with subsequent improvement in exercise tolerance.

Correction: Chronic Pulmonary Silicone Embolism Syndrome Following Saline Breast Implants | Annals of Internal Medicine: Clinical Cases

Correction: Diabetic Striatopathy: A Rare Case Report of Chorea, Hyperglycemia, Basal Ganglia (C-H-BG) Syndrome | Annals of Internal Medicine: Clinical Cases