2022 Canadian Cardiovascular Society Guideline for Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors for Cardiorenal Risk Reduction in Adults.

This guideline synthesizes clinical trial data supporting the role of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors (SGLT2i) for treatment of heart failure (HF), chronic kidney disease, and for optimizing prevention of cardiorenal morbidity and mortality in patients with type 2 diabetes. It is on the basis of a companion systematic review and meta-analysis guided by a focused set of population, intervention, control, and outcomes (PICO) questions that address priority cardiorenal end points. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system and a modified Delphi process were used.

Facilitating barriers: Contextual factors and self-management of type 2 diabetes in urban settings.

Urban environments create unique challenges for the management of type 2 diabetes (T2D). City living is associated with unhealthy occupational, nutritional, and physical activity patterns. However, it has also been linked to behaviours that promote health, such as walking and cycling for transportation.

CardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management.

A sea change in the management of diabetes is occurring with the publication of clinical trials showing unequivocal cardiovascular (CV) protection through the use of certain antihyperglycemic agents. This change is similar to the change that occurred when lipid lowering with statins was first shown to have CV benefits, an event necessitating changes in training and the proactive treatment of lipids by CV specialists. As was the case then, many CV specialists currently feel poorly equipped to address diabetes with this new information even though diabetes is common in CV practice.

A Practical Guide to the Use of Glucose-Lowering Agents With Cardiovascular Benefit or Proven Safety.

Patients with type 2 diabetes continue to have a high residual risk for cardiovascular events despite intensive risk factor modification. Recent clinical trials have shown that the antihyperglycemic agents empagliflozin and liraglutide reduce cardiovascular events. Other drugs have been shown to have cardiovascular safety.

Diabetes for Cardiologists: Practical Issues in Diagnosis and Management.

Diabetes mellitus (DM), a chronic metabolic disease characterized by hyperglycemia, is a profound cardiovascular (CV) risk factor. It compounds the effects of all other risk factors, leads to premature micro- and macrovascular disease, facilitates development of heart failure, worsens the clinical course of all CV diseases, and shortens life expectancy. Established DM, unrecognized DM, and dysglycemia that may progress to DM are all commonly present at the time of presentation of overt CV disease.

The Role of Hypoglycemia in Cardiovascular Outcomes in Diabetes.

Intensive glucose management, targeting lower glycated hemoglobin (A1C) levels, has been shown to reduce the microvascular complications of diabetes, but the effect on cardiovascular (CV) outcomes is less clear. Observational follow-up of intensive glucose management studies suggest possible long-term CV benefits, but no clear reduction in CV events has been seen over 3 to 5 years. Intensive glucose management also increases the risk for hypoglycemia, particularly in patients with longstanding diabetes, cognitive impairment and hypoglycemia unawareness.

Evaluation of protocol-guided scheduled basal-nutritional-correction insulin over standard care for vascular surgery patients.

Background: Practice guidelines have recommended scheduled basal, nutritional and correction insulin to manage hyperglycemia in the hospital setting. For many decades, however, the primary practice has been sliding scale insulin.

Objective: To evaluate the efficacy and safety of an institution-specific basal-nutritional-correction insulin preprinted order (BNC-PPO).

Reduced progression of diabetic microvascular complications with islet cell transplantation compared with intensive medical therapy.

Background: The effect of islet cell transplantation (ICT) on the progression of diabetic microvascular complications is not well understood.

Methods: We have conducted a prospective, crossover, cohort study comparing ICT with intensive medical therapy on the progression of diabetic nephropathy, retinopathy, and neuropathy.

Results: The rate of decline in glomerular filtration rate is slower after ICT than on medical therapy.

The First Step First Bite Program: guidance to increase physical activity and daily intake of low-glycemic index foods.

Practical lifestyle interventions are needed to help people with type 2 diabetes increase their physical activity and follow nutrition therapy guidelines. This study examined whether combining instructions to walk more and to eat more low-glycemic index (GI) foods (First Step First Bite Program) improved hemoglobin A1c and anthropometric and cardiovascular health outcomes in people with type 2 diabetes vs the First Step Program (instruction only on walking). Subjects were randomly assigned to the First Step Program or First Step First Bite Program (n=22 in each group) and attended four weekly group meetings with minimal follow-up during weeks 5 to 16.

Quality of life after islet transplant: impact of the number of islet infusions and metabolic outcome.

The health-related quality of life (HRQL; Health Utilities Index Mark 2) and the fear of hypoglycemia (Hypoglycemia Fear Survey) were assessed after islet transplant; the impact of a single islet infusion and of the metabolic outcome were determined. A control group included 166 patients with type 1 diabetes. Islet transplant had no impact on overall HRQL.

Assessment of glycemic control after islet transplantation using the continuous glucose monitor in insulin-independent versus insulin-requiring type 1 diabetes subjects.

Background: The aim of this study was to assess and compare glycemic control using the continuous glucose monitor (CGMS, Medtronic Minimed, Northridge, CA) in type 1 diabetes mellitus (T1DM) subjects who are insulin-independent versus those who require insulin after islet transplantation alone (ITA).

Methods: Glycemic control was assessed using 72-h CGMS in eight T1DM subjects who were insulin-independent after ITA (ITA-II), eight T1DM subjects who were C-peptide-positive but insulin-requiring after ITA (ITA-IR), and eight non-transplanted (NT) T1DM subjects.

Results: Standard deviation of glucose values was not significantly different between ITA-II and ITA-IR subjects (ITA-II, 1.

Sirolimus-induced ulceration of the small bowel in islet transplant recipients: report of two cases.

Sirolimus (SRL) has been used for most islet recipients over the past 5 years. It provides balanced immunosuppression in combination with low-dose calcineurin inhibitors, while avoiding corticosteroids. This regimen decreases the risk of nephrotoxicity, neurotoxicity and diabetogenicity.

Proteinuria developing after clinical islet transplantation resolves with sirolimus withdrawal and increased tacrolimus dosing.

Sirolimus is a potent immunosuppressant, which may permit the avoidance of nephrotoxic calcineurin inhibitors (CNI). However, cases of proteinuria associated with sirolimus have been reported following renal transplantation. Here, we report three cases of proteinuria (1, 2 and 7 g/day) developing during therapy with sirolimus plus low-dose tacrolimus following clinical islet transplantation (CIT) in type I diabetic subjects.

Five-year follow-up after clinical islet transplantation.

Islet transplantation can restore endogenous beta-cell function to subjects with type 1 diabetes. Sixty-five patients received an islet transplant in Edmonton as of 1 November 2004. Their mean age was 42.

Strategic opportunities in clinical islet transplantation.

More than 471 patients with type 1 diabetes have received islet transplants at 43 institutions worldwide in the past 5 years. High rates of insulin independence have been observed at 1 year in the leading islet transplant centers, and an international multicenter trial has demonstrated reproducible success of the approach. Loss of insulin independence by 5 years in the majority of recipients remains of concern, and immunosuppressant drug side effects necessitate stringent inclusion criteria for islet-alone candidates that have the most severe, unstable glycemic control despite optimal insulin therapy.

Coronary artery disease is common in nonuremic, asymptomatic type 1 diabetic islet transplant candidates.

Objective: Coronary artery disease (CAD) is the most common cause of death in patients with type 1 diabetes. Asymptomatic CAD is common in uremic diabetic patients, but its prevalence in nonuremic type 1 diabetic patients is unknown. The prevalence of CAD was determined by coronary angiography and the performance of noninvasive cardiac investigation evaluated in type 1 diabetic islet transplant (ITX) candidates with preserved renal function.

Beta-score: an assessment of beta-cell function after islet transplantation.

Objective: Success after islet transplantation can be defined in terms of insulin independence, C-peptide secretion, or glycemic control. These measures are interdependent and all need to be considered in evaluating beta-cell function after islet transplantation. For the current study, a composite beta-score was developed that provides an integrated measure of beta-cell function success after islet transplantation.

Islet transplantation for type 1 diabetes: An overview.

Islet transplantation is a method of restoring endogenous insulin secretion in individuals with type 1 diabetes by transplanting insulin-secreting islet cells from cadaveric donor pancreases into eligible recipients. Since 2000, the one-year insulin independence rate observed in islet transplant recipients has risen from less than 10% to approximately 80%. However, the continued requirement for at least two donor pancreases for each islet transplant recipient, the occurrence of suboptimal islet engraftment, the need for chronic immunosuppressive therapy and a decline in islet function over time continue to make this procedure unsuitable for the majority of patients with type 1 diabetes.

Magnetic resonance-defined perinephric edema after clinical islet transplantation: a benign finding associated with mild renal impairment.

Immunosuppression with sirolimus and low-dose tacrolimus has facilitated successful clinical islet transplantation (CIT). Because the long-term effects on the kidney are unknown and immunosuppressant drugs can be nephrotoxic, CIT is currently restricted to patients with preserved renal function or a functioning renal transplant. The impact of CIT on the native kidney of islet-alone recipients was assessed with magnetic resonance imaging (MRI).