Eleni Bekiari

Efficacy and safety of empagliflozin for type 2 diabetes: a systematic review and meta-analysis.

To assess the efficacy and safety of the novel sodium‐glucose cotransporter 2 (SGLT2) inhibitor empagliflozin compared with placebo or other antidiabetic agents in patients with type 2 diabetes.

Efficacy and safety of once‐weekly glucagon‐like peptide 1 receptor agonists for the management of type 2 diabetes: a systematic review and meta‐analysis of randomized controlled trials

To assess the efficacy and safety of recently approved once‐weekly glucagon‐like peptide 1 receptor agonists (GLP‐1 RAs) in patients with type 2 diabetes.

Update on long-term efficacy and safety of dapagliflozin in patients with type 2 diabetes mellitus

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of antihyperglycaemic agents with an insulin-independent mode of action. Dapagliflozin is a member of the SGLT2 inhibitors class that has received marketing authorization in Europe and the US for use in patients with type 2 diabetes. This review summarizes current evidence from clinical trials assessing the clinical efficacy and safety of dapagliflozin, and presents data regarding its cost-effectiveness. Treatment with dapagliflozin results in similar reduction in haemoglobin A1c with other oral antihyperglycaemic drugs, which is preserved over 4 years of treatment. However, compared with most antidiabetic agents, dapagliflozin provides additional clinical benefits including body weight loss and blood pressure reduction. Moreover, treatment with dapagliflozin does not increase risk for hypoglycaemia, but is associated with increased incidence of mild to moderate urinary and genital tract infections. A pivotal outcomes trial of dapagliflozin is expected to clarify its effect on cardiovascular endpoints, whilst a causative relationship between dapagliflozin and select malignancies is unlikely. Finally, based on recent economic evaluations dapagliflozin seems to be a cost-effective option for type 2 diabetes in some settings.

Glycaemic Control is Correlated with Well-Being Index (WHO-5) in Subjects with Type 2 Diabetes

UNLABELLED The aim of this study was to examine the potential correlation of WHO-5 well-being index with glycaemic control and chronic complications in subjects with type 2 diabetes. The study included 156 subjects (73 men, mean age 64.05+/-9.11 years, mean diabetes duration 12.22+/-5.61 years). Well-being was assessed by the WHO-5 score via a validated questionnaire comprising 5 questions (Q1-Q5). HbA (1c) showed a significant negative correlation with overall WHO-5 score (r (s)=-0.248, p=0.002) and individual Q1-Q4 scores (r (s)=-0.262, p=0.001; r (s)=-0.248, p=0.002; r (s)=-0.207, p=0.009 and r (s)=-0.169, p=0.035 respectively). Subjects with adequate glycaemic control (HbA (1c) < 7%, n=67) had a significantly higher WHO-5 score in comparison to those with inadequate glycaemic control (HbA (1c) >or= 7%, n=89) (mean+/-SD: 19.69+/-5.47 vs. mean+/-SD: 17.11+/-6.38, p=0.011). Finally, WHO-5 score was significantly (p=0.013) lower in subjects with neuropathic pain than in those without neuropathic pain. CONCLUSIONS In type 2 diabetic subjects, glycaemic control shows a significant correlation with well-being, while neuropathic pain is associated with lower well-being score.

A simple plaster for screening for diabetic neuropathy: A diagnostic test accuracy systematic review and meta-analysis

OBJECTIVE Neuropad is an adhesive indicator test applied at the plantar surface of the foot that detects sweating through color change. We examined the diagnostic accuracy of this simple plaster as triage test for screening for clinically relevant diabetic sensorimotor polyneuropathy in adult outpatients with type 1 or type 2 diabetes. MATERIALS/METHODS Systematic review and meta-analysis of diagnostic accuracy studies. We searched Medline, Embase, Cochrane Library, Biosis Previews, Web of Science, Scopus and gray literature without date or language restrictions. We pooled estimates of sensitivity and specificity, and fitted hierarchical models to produce summary receiver operating characteristic curves. We assessed methodological quality of included studies utilizing the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS Eighteen studies with 3470 participants met the inclusion criteria. Average sensitivity and specificity were 86% (95% CI 79 to 91) and 65% (95% CI 51 to 76) respectively. Likelihood ratios (LRs) were LR+=2.44 and LR-=0.22. Subgroup analyses per reference standard utilized provided similar estimates. Most studies were at risk of bias for patient selection and use of index or reference test, and had concerns regarding applicability due to patient selection. CONCLUSION The adhesive indicator test has reasonable sensitivity and could be used for triage of diabetic neuropathy to rule out foot at risk. Patients who tested positive should be referred to specialized care to establish a definite diagnosis. There is insufficient evidence for effectiveness on patient-important outcomes and cost-effectiveness of implementation in the diagnostic pathway compared with the standard clinical examination.

Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis.

Abstract Objective To evaluate the efficacy and safety of artificial pancreas treatment in non-pregnant outpatients with type 1 diabetes. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Medline, Embase, Cochrane Library, and grey literature up to 2 February 2018. Eligibility criteria for selecting studies Randomised controlled trials in non-pregnant outpatients with type 1 diabetes that compared the use of any artificial pancreas system with any type of insulin based treatment. Primary outcome was proportion (%) of time that sensor glucose level was within the near normoglycaemic range (3.9-10 mmol/L). Secondary outcomes included proportion (%) of time that sensor glucose level was above 10 mmol/L or below 3.9 mmol/L, low blood glucose index overnight, mean sensor glucose level, total daily insulin needs, and glycated haemoglobin. The Cochrane Collaboration risk of bias tool was used to assess study quality. Results 40 studies (1027 participants with data for 44 comparisons) were included in the meta-analysis. 35 comparisons assessed a single hormone artificial pancreas system, whereas nine comparisons assessed a dual hormone system. Only nine studies were at low risk of bias. Proportion of time in the near normoglycaemic range (3.9-10.0 mmol/L) was significantly higher with artificial pancreas use, both overnight (weighted mean difference 15.15%, 95% confidence interval 12.21% to 18.09%) and over a 24 hour period (9.62%, 7.54% to 11.7%). Artificial pancreas systems had a favourable effect on the proportion of time with sensor glucose level above 10 mmol/L (−8.52%, −11.14% to −5.9%) or below 3.9 mmol/L (−1.49%, −1.86% to −1.11%) over 24 hours, compared with control treatment. Robustness of findings for the primary outcome was verified in sensitivity analyses, by including only trials at low risk of bias (11.64%, 9.1% to 14.18%) or trials under unsupervised, normal living conditions (10.42%, 8.63% to 12.2%). Results were consistent in a subgroup analysis both for single hormone and dual hormone artificial pancreas systems. Conclusions Artificial pancreas systems are an efficacious and safe approach for treating outpatients with type 1 diabetes. The main limitations of current research evidence on artificial pancreas systems are related to inconsistency in outcome reporting, small sample size, and short follow-up duration of individual trials.

Eosinophilic pneumonia associated with heroin inhalation: a case report

ZusammenfassungMedikamente sind eine bekannte Ursache für eine Lungeneosinophilie. Es gibt einige Fallberichte über Patienten mit akuter eosinophiler Pneumonie in Verbindung mit Kokainkonsum. Veränderte Gewohnheiten des Heroinkonsums, mit Verschiebung vom intravenösen Gebrauch zum Heroinrauchen/Inhalation, können zu häufigerem Auftreten einer Heroin-verursachten Lungeneosinophilie führen. Berichtet wird der Fall eines Patienten, der ungefähr 10 Jahre lang Heroin inhaliert hatte. Er präsentierte sich mit Fieber, Husten, Atemnot und pleuritischem Schmerz in der Brust. Die Röntgenuntersuchung des Thorax zeigte einen einseitigen Pleuraerguß mit segmentaler Atelektase. Die Analyse des Pleuraergusses und der bronchoalveolaren Lavage zeigte eine signifikante Eosinophilie, womit die Diagnose einer eosinophilen Pneumonie gegeben war. Durch Heroinabstinenz und Kortikosteroidbehandlung konnte eine schnelle Genesung erzielt werden.SummaryDrugs are known to be a cause of pulmonary eosinophilia and several case reports of acute eosinophilic pneumonia associated with the use of cocaine have been reported. The changing pattern of heroin use, with a shift from intravenous use to smoking/inhalation of the substance, may lead to increased prevalence of heroin-induced pulmonary eosinophilia. We report on a case of a patient who had been inhaling heroin for about ten years. He presented with fever, cough, dyspnea and pleuritic chest pain. Chest radiograph showed unilateral pleural effusion with segmental atelectasis. Examination of pleuritic fluid aspirate and bronchoalveolar lavage fluid revealed significant eosinophilia. He was diagnosed with acute eosinophilic pneumonia. Rapid remission was achieved after heroin abstinence and initiation of corticosteroid treatment.

Insulin sensitivity assessment with euglycemic insulin clamp in adult β-thalassaemia major patients

Objective:  To assess insulin sensitivity in young adult normoglycemic β‐thalassaemia major patients.

Is Deferasirox Implicated in Multiple Organ Failure in a Patient With Homozygous β-Thalassemia?

We herein report a case of a thalassemic-patient who was on deferasirox chelation therapy and admitted to the emergency department because of fever, diffuse abdominal pain and altered mental status. Despite the appropriate treatment he died two days later due to cardiac arrest. As we failed to recognize any etiology and the patients’ relatives denied a post mortem examination due to religious reasons, we cannot provide any additional data. However, we are wondering whether this incident might be related to deferasirox.

Effect of Glucose and Insulin on Oxidized Low-Density Lipoprotein Phagocytosis by Human Monocytes: A Pilot Study:

We assessed the effect of glucose and insulin on human monocytes. Monocytes were isolated from 16 healthy obese and 10 lean healthy participants. Insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp. Obese participants were subdivided into 2 subgroups: insulin sensitive (IS) and insulin resistant (IR). Monocyte oxidized low-density lipoprotein (oxLDL) phagocytosis was assessed pre and poststimulation in vitro with glucose or insulin. Experiments were repeated after incubation with a Na+/H+ exchanger-1 inhibitor ([NHE-1]; cariporide) or rosiglitazone. Glucose increased oxLDL phagocytosis in all groups studied (at 1 or 3 hours incubation; P = .037-.002). Insulin increased oxLDL phagocytosis in all groups studied after 1-hour incubation (P = .027-.015) but not at 3 hours. Incubation with cariporide attenuated oxLDL phagocytosis except in the obese IS group. Rosiglitazone eliminated glucose- and insulin-induced increase in oxLDL phagocytosis in all studied groups. Glucose and insulin induce oxLDL phagocytosis.