Patient Education

Aspirin is useful in diabetes but increases the risk of bleeding

Aspirin is useful in diabetes but increases the risk of bleeding

The major randomized clinical trial, ASCEND, shows that aspirin 100 mg daily lowers the rates of cardiovascular events by 12% in patients with diabetes but increases the risk of bleeding by 30%.

A group of 15,000 participants with diabetes but without baseline CVD were followed for about 7 years.

Case by case clinical judgment would be key in evaluating CVD benefits vs. bleeding risks of aspirin use in patients with diabetes.

GT

Vascepa (fish oil) reduces ischemic cardiovascular events in high risk patients

Vascepa (fish oil) reduces ischemic cardiovascular events in high risk patients

The current study is of a major clinical significance as it shows that EPA lowers ischemic cardiovascular events by 25% in high rick CVD patients who are already receiving statin therapy. The EPA treated patients, however, experienced more hospitalizations for atrial fibrillation and a higher propensity for serious bleeding than placebo. Findings are remarkable as they come from a major randomized clinical trial (REDUCE IT). About 8,000 patients were followed for 5 years.

This outcome data is in accordance with established observation and notion that hypertriglyceridemia is an independent risk factor for cardiovascular disease, mainly via increased inflammation and concentration of the non-HDL cholesterol. Prior clinical studies have also shown that EPA lowers non-HDL cholesterol more than DHA.

Omega-3s, EPA and DHA, are two key ingredients of fish oil. A stable and pure form of EPA has been FDA approved for very high serum triglyceride >500 mg/dL since 2012. It is marketed under the brand-name vascepa. Lovaza, a mixture of EPA and DHA, has also been approved by FDA since 2004 for severe hypertriglyceridemia.

I anticipate that in the future NLA, ACC/AHA, AACE and ADA guidelines will reflect and incorporate the current findings of REDUCE IT.

GT

New FDA Approval: Subcutaneous Testosterone Pen

New FDA Approval: Subcutaneous Testosterone Pen

FDA has now approved the first subcutaneous testosterone auto-injector pen (Xyosted) for symptomatic patients with low testosterone levels. It is self-administered once weekly. It comes in three doses, 50 mg, 75, and 100 mg. Recommended starting dose is 75 mg per week. It can increase blood pressure, thus caution is advised in patients predisposed to hypertension and those at increased risk for cardiovascular events. Patients need to be monitor carefully after its initiation. Xyosted is not approved for women or males younger than age 18.

GT

Intramuscular testosterone injection

Intramuscular testosterone injection

Patients with low testosterone levels could have decreased libido, erections and stamina. They could also suffer from reduced bone mass, muscle mass, and physical capacity. Intramuscular testosterone injection is an efficient and safe way to help patients with testosterone deficiency. The following video shows how to self-administer the testosterone injection.

GT

Mortality and CVD in patients with diabetes type 1 and type 2

Mortality and CVD in patients with diabetes type 1 and type 2

In Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls. 

Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls.

NEJM

Sotagliflozin effects on diabetes type 1

Sotagliflozin effects on diabetes type 1

Among patients with type 1 diabetes who were receiving insulin, the proportion of patients who achieved a glycated hemoglobin level lower than 7.0% with no severe hypoglycemia or diabetic ketoacidosis was larger in the group that received sotagliflozin than in the placebo group. However, the rate of diabetic ketoacidosis was higher in the sotagliflozin group.

NEJM

How to use trulicity pen for diabetes

How to use trulicity pen for diabetes

Trulicity is a GLP-1 receptor agonist. It increases intracellular cAMP in beta cells leading to glucose-dependent insulin release. It also decreases glucagon secretion and slows gastric emptying.

Trulicity is supplied as a solution for subcutaneous injection. The recommended initiating dose is 0.75 mg once weekly. The maximum recommended dose is 1.5 mg once weekly. Administered once weekly, any time of day, with or without food. Trulicity should be injected subcutaneously in the abdomen, thigh, or upper arm.

FDA

Frailty and exercise in aging population

Frailty and exercise in aging population

A structured exercise program was not associated with a decreased risk for frailty among older adults. However, the beneficial effect of the exercise program on reducing major mobility disability was not affected by whether the participants were frail at baseline.

AIM