CVOT Summit Report 2023: new cardiovascular, kidney, and metabolic outcomes.

The 9th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on November 30-December 1, 2023. This reference congress served as a platform for in-depth discussions and exchange on recently completed outcomes trials including dapagliflozin (DAPA-MI), semaglutide (SELECT and STEP-HFpEF) and bempedoic acid (CLEAR Outcomes), and the advances they represent in reducing the risk of major adverse cardiovascular events (MACE), improving metabolic outcomes, and treating obesity-related heart failure with preserved ejection fraction (HFpEF). A broad audience of endocrinologists, diabetologists, cardiologists, nephrologists and primary care physicians participated in online discussions on guideline updates for the management of cardiovascular disease (CVD) in diabetes, heart failure (HF) and chronic kidney disease (CKD); advances in the management of type 1 diabetes (T1D) and its comorbidities; advances in the management of CKD with SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists (nsMRAs); and advances in the treatment of obesity with GLP-1 and dual GIP/GLP-1 receptor agonists. The association of diabetes and obesity with nonalcoholic steatohepatitis (NASH; metabolic dysfunction-associated steatohepatitis, MASH) and cancer and possible treatments for these complications were also explored. It is generally assumed that treatment of chronic diseases is equally effective for all patients. However, as discussed at the Summit, this assumption may not be true. Therefore, it is important to enroll patients from diverse racial and ethnic groups in clinical trials and to analyze patient-reported outcomes to assess treatment efficacy, and to develop innovative approaches to tailor medications to those who benefit most with minimal side effects. Other keys to a successful management of diabetes and comorbidities, including dementia, entail the use of continuous glucose monitoring (CGM) technology and the implementation of appropriate patient-physician communication strategies. The 10th Cardiovascular Outcome Trial Summit will be held virtually on December 5-6, 2024 ( http://www.cvot.org ).

Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management.

Type 2 diabetes is one of the most relevant risk factors for heart failure, the prevalence of which is increasing worldwide. The aim of the review is to highlight the current perspectives of the pathophysiology of heart failure as it pertains to type 2 diabetes. This review summarizes the proposed mechanistic bases, explaining the myocardial damage induced by diabetes-related stressors and other risk factors, i.e., cardiomyopathy in type 2 diabetes. We highlight the complex pathology of individuals with type 2 diabetes, including the relationship with chronic kidney disease, metabolic alterations, and heart failure. We also discuss the current criteria used for heart failure diagnosis and the gold standard screening tools for individuals with type 2 diabetes. Currently approved pharmacological therapies with primary use in type 2 diabetes and heart failure, and the treatment-guiding role of NT-proBNP are also presented. Finally, the influence of the presence of type 2 diabetes as well as heart failure on COVID-19 severity is briefly discussed.

Is Insulin Therapy Safe?

BACKGROUND: After 98 years of insulin therapy, issues of safety remain of concern. AREAS OF UNCERTAINTY: Uncertainty has been expressed variously in regard of arterial cell wall proliferation, promotion of proliferative retinopathy, promotion of tumor growth, and for pregnancy. Immunological issues have been little studied since the advent of highly purified insulins in the 1970s. A specific topic is whether hypoglycemia, severe or otherwise, might promote cardiac thrombotic or dysrhythmic events. DATA SOURCES: A literature review in these areas is difficult because nearly all clinical trials with insulin refer to adverse events. However, the specific topics aforementioned allow for some informed literature searching supplemented by finger-searching of published articles, notably in connection with the insulin analogues. THERAPEUTIC UNDERSTANDINGS: Safety data for pregnancy are weak because of power problems, but there are no signals for added maternal or fetal risk. Clinical-outcome trials that assess insulin against other glucose-lowering therapies or with significantly different insulin preparations in different arms are few and are sometimes conducted at modest dosage but fail to suggest promotion of arterial disease. Concern over growth-promoting activity of insulin glargine turned out to be ill-founded when the circulating moiety after injection was noted to have a lower IGF-1:insulin activity than human insulin, and a direct study of retinopathy progression or meta-analysis of malignancy incidence failed to show signals of concern. It does seem that severe hypoglycemia can cause death in some people with type 1 diabetes, although the tissue mechanism is unknown, but reducing severe hypoglycemia in type 2 diabetes does not protect against arterial events. Both symptomatic and severe hypoglycemia can however be reduced by use of more recently marketed insulin analogues, and this improves tolerability if not safety. CONCLUSIONS: In conclusion, although insulin therapy clearly gives health benefits, the evidence for long-term harm is absent or weak.

A controlled intervention study of changing health-providers' attitudes toward personal lifestyle habits and health-promotion skills.

OBJECTIVE: Data regarding health providers' personal lifestyle and the differential effect of a short-term personal lifestyle experience intervention program on health providers are limited. METHODS: We conducted a controlled study aimed at changing personal attitudes toward lifestyle habits among 323 health professionals: 136 (42%) physicians, 140 (43%) dietitians, and 47 (15%) nurses and health promoters. In the intervention group (n = 209) individuals participated in a 2-d intensive self-experience workshop in an isolated location emphasizing healthy lifestyle and behavior-modifying techniques. Intervention and control groups were followed for 6 mo. RESULTS: At baseline, avoidance of salt, trans-fatty acids, saturated fats, and processed meat was more frequent among dietitians (P < 0.05 versus physicians). The physicians reported a lower intake of olive/canola oil, nuts/almonds, dietary fibers, vegetables, and fruits (P < 0.05). Furthermore, physicians reported lower confidence in lifestyle primary prevention and felt less useful engaging in health-promotion activities (P < 0.05 versus other health professionals). After 6 mo, waist circumference decreased in the intervention group (-1.3 versus +1.8 cm in control group, P < 0.01). The effect was more prominent among physicians. A modest differential effect of the intervention program was shown in health-promotion activities. CONCLUSION: Approaches toward primary prevention can be improved by an intervention program focusing on personal changes of health care providers. Physicians who are less likely to personally adhere to and believe in lifestyle primary prevention are more likely to benefit from this platform.