Studies in diabetes

Question 1

EMPA-REG CV risk reduction study found what?

Answer 1

death from CV 38% RRR
hospitalizations for HF 35% RRR
death from any cause 32% RRR

*** Black/African-American ancestry also did worse with empa vs. placebo for primary outcome.

Question 2

What side effects were noted in the EMPA-REG study?

Answer 2

Harm: increased risk of genital infections in both males (NNH=29/3yrs) and females (NNH=14/3yrs).

DKA = no difference between groups

Question 3

How did EMPA-REG about effect on A1c, BP and weight?

Answer 3

Empaglifozin also lowered BP 
(SBP reduced by 3-4mm Hg; 
DBP reduced by1-2 mm Hg) 
aq1c reduced by 0.6%
weight (reduced 1-2kg) more than seen in placebo group.

Question 4

What happened in ACCORD?

Answer 4

ACCORD (aggressive vs standard glycemic control), was stopped early due to a lower risk of mortality in the less aggressive control group (A1C mean ~ 7.5%).

Question 5

Who were the study participants in EMPA-REG?

Answer 5

MAIN POINTS: T2DM, BMI ≤ 45, established CVD,

rest:
Age ≥18yrs
eGFR ≥30mL/min/1.73m2,
no glucose-lowering tx for ≥12wks before randomization + A1C of 7-9%, or received stable glucose-lowering tx (Metformin ~74%; Insulin ~48%) for ≥12wks before randomization + A1C of 7-10%

Question 6

What did IRIS - Pioglitazone ACTOS after Ischemic Stroke or Transient Ischemic Attack in Patients with Insulin Resistance find?

Answer 6

For every 100 patients with recent history of stroke, transient ischemic attack (TIA) and insulin resistance, but
NOT diabetes, giving pioglitazone 45mg daily for ~5 years will result in approximately 3 less cases of stroke or
MI, 4 less cases of diabetes, 2 extra cases of serious bone fracture, 7 extra cases of weight gain > 13.6kg, and 11
extra cases of edema

Question 7

PROACTIVE (pioglitazone) - what did this trial show?

Answer 7

5238 patients with diabetes [type 2] and a history of
macrovascular complications:
- CV composite endpoints show some benefit
- Weight gain, edema always worse with pioglitazone vs. placebo

Question 8

West of Scotland Coronary Prevention Study (WOSCOPS) showed what with respect to statins and diabetes?

Answer 8

decrease in the incidence of new-onset diabetes with statin therapy

Question 9

JUPITER Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin find?

Answer 9

showed an increase in incident diabetes. Several meta-analyses suggest that there is indeed a small overall increase in diabetes with chronic statin use and that this risk may be related to the statin dose

Question 10

DAWN studies

Answer 10

People with diabetes have major psychosocial issues and distress associated with poor self management which are not effectively addressed in current health care systems
Looked at D
Looked at families
Looked at health care providers.

Question 11

DAWN studies

Answer 11

People with diabetes have major psychosocial issues and distress associated with poor self management which are not effectively addressed in current health care systems
Looked at D
Looked at families
Looked at health care providers.

Question 12

DAWN studies

Answer 12

People with diabetes have major psychosocial issues and distress associated with poor self management which are not effectively addressed in current health care systems
Looked at D
Looked at families
Looked at health care providers.

Question 13

DAWN studies

Answer 13

People with diabetes have major psychosocial issues and distress associated with poor self management which are not effectively addressed in current health care systems
Looked at D
Looked at families
Looked at health care providers.

Question 14

DPS and DPP trial

Showed what about prediabtets?

Answer 14

Lifestyle interventions could lower risk of pre to type 2 by 58%