Dudley McArdle

An authority for crisis coordination and accountability

The demand for better coordination and control is heard during and after every major international disaster. We now have the potential framework to meet this demand and we should respond. The World Health Assembly altered WHO’s role in disasters after the outbreak of severe acute respiratory syndrome with the 2005 International Health Regulations (IHR) Treaty. WHO changed from a mainly passive responder during short-term infectious disease crises to an unprecedented active authority with a mandate to address long-term prevention, preparedness, and response roles and responsibilities. This treaty obliges WHO to obtain expert advice on any declared public health emergency of international concern. As a drug class, GLP-1 receptor agonists improve glycaemia by stimulating insulin secretion and the inhibition of glucagon release, but only when glucose concentrations are raised, thus conferring a lower risk of hypoglycaemia than that noted with sulphonylureas. Moreover, exenatide twice daily reduces postprandial glucose excursions by delaying gastric emptying. GLP-1 receptor agonists induce weight loss in most patients, but are associated with gastrointestinal sideeff ects and have been linked to pancreatitis, although with confl icting conclusions from the clinical controlled trials and use of diff erent databases. These drugs display cardioprotection and reduce blood pressure and markers of infl ammation, but increase heart rates. Analyses of phase 2 and phase 3 trials with exenatide twice daily versus placebo or insulin showed no evidence of cardiovascular harm with exenatide. Additionally, a retrospective analysis of cardiovascular events using the LifeLink database from 2005 to 2009 showed that patients given exenatide twice daily were signifi cantly less likely to have a cardiovascular event (p=0·01) or cardiovascular-related hospital admission (p=0·02) than were those given other glucose-lowering drugs. After the lesson learned from rosiglitazone, the US Food and Drug Administration now requires the assessment of cardiovascular risks of new diabetic drugs both before and after approval, and results of cardiovascular outcome studies for the diff erent GLP-1 receptor agonists are expected after 2015.