Background: Glucagon-like peptide 1 agonists differ in chemical structure, duration of action and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. Methods: We randomly assigned patients with type 2 diabetes and cardiovascular disease to the addition of once-weekly subcutaneous injection of albiglutide (30 mg to 50 mg) or matching placebo to standard care. We hypothesized that albiglutide would be noninferior to placebo for the primary outcome of first occurrence of cardiovascular death, myocardial infarction, or stroke. If noninferiority was confirmed by an upper limit of the 95% confidence interval for the hazard ratio of less than 1.30, closed-testing for superiority was prespecified. Findings: Overall, 9463 participants were followed for a median of 1.6 years. The primary composite outcome occurred in 338 of 4731 patients (7.1%; 4.6 events per 100 person-years) in the albiglutide group and in 428 of 4732 patients (9.0%; 5.9 events per 100 person-years) in the placebo group (hazard ratio, 0.78; 95% confidence interval [CI ], 0.68 to 0.90), indicating that albiglutide, was superior to placebo (P<0.0001 for noninferiority, P=0.0006 for superiority). The incidence of acute pancreatitis (albiglutide 10 patients and placebo 7 patients), pancreatic cancer (6 and 5), medullary thyroid carcinoma (0 and 0), and other serious adverse events did not differ significantly between the two groups. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. (Funded by GlaxoSmithKline; Harmony Outcomes ClinicalTrials.gov number, NCT02465515.) noninferiority; P = 0.06 for superiority). There seems to be variation in the results of existing trials with GLP-1 receptor agonists, which if correct, might reflect drug structure or duration of action, patients studied, duration of follow-up or other factors.
Aim. Many questions about the relationship between endothelial dysfunction and morphological substrate of hemostasis damage that occur during the progress of type 2 diabetes mellitus and arterial hypertension require clarifi cation and further advance. Methods and results. In 87 patients with insuffi cient glycemic compensation associations between endothelial dysfunction, degree of renal function damage, lipidemic profi le and morphological changes of vascular-platelet hemostasis were identifi ed using clinical, laboratory, morphological methods and correlational analysis. Conclusion. It has been established that in the insuffi cient glycemic control against the background of signifi cant strengthening relationships between indicators of endothelial dysfunction and damaged platelet hemostasis (up to r=+0.95) signifi cant correlations of ultrastructural characteristics of platelets with clinical and laboratory signs of nephropathic and dyslipidemic changes are formed.
Background and aims: to identify heart rate variability (HRV) and blood pressure (BP) in patients with type 1 diabetes depending on the duration of disease and glycemic control.Materials and methods: 43 patients were examined. All patients were divided into 2 groups according to the level of НвА1с: group 1 (n=21) with НвА1с ≤ 7.5% and group 2 (n=22) with НвА1с > of 7.5%. All patients underwent daily monitoring of electrocardiogram Holter and ambulatory BP monitoring within 24 hours in parallel with long term monitoring of blood glucose.Results: Hyppoglycemia is characterized by significant decrease root mean square difference between adjacent RR intervals (RMSSD) (r = −0.531; p = 0.003) and number of consecutive RR intervals, the difference between them is more than 50 ms expressed as a percentage of total number of RR-intervals (pNN50%) (r = the −0.503; p = 0.005) and increase of Low Frequency/High Frequency Ratio (LF/HF) (r = 0552; p = 0.002). Patients with hypoglycemia had significantly higher daily diastolic pressure area index (DPAI24) (p = 0.016), and daily diastolic pressure time index DPTI24 (p = 0.025).Conclusion: our findings demonstrate the need to reduce the frequency of hypoglycemia episodes in patients with T1DM.
Мета дослідження — оцінка інсулінорезистентності (ІР), а також можливості її корекції у пацієнтів із тривалим стажем цукрового діабету (ЦД) 1-го типу. Матеріали і методи. Обстежено 33 пацієнти з ЦД 1-го типу. В основну групу було включено 17 пацієнтів з великою (від 15 до 31 року) тривалістю ЦД 1-го типу віком від 40 до 50 років. Групу порівняння склали 16 хворих (9 жінок і 7 чоловіків) з ЦД 1-го типу віком від 20 до 35 років при тривалості ЦД від 5 до 12 років. Хворі обох груп перебували на базисно-болюсній інсулінотерапії. Результати. Аналіз потреби пацієнтів в інсуліні показав, що в основній групі хворих потреба в інсуліні перевищувала рекомендовані значення і була вірогідно вищою, ніж в контрольній групі (відповідно 1,04 ± 0,03 і 0,62 ± 0,02 ОД/кг, р = 0,0001). Було виявлено прямий кореляційний зв’язок між дозою інсуліну і величиною ІМТ у хворих основної групи (r = 0,87, р = 0,07). Збільшення дози інсуліну сприяє підвищенню маси тіла хворих, що, у свою чергу, посилює процеси ІР і потребує збільшення дози інсуліну, формуючи хибне коло. Висновки. Серед причин формування інсулінорезистентності у цієї категорії хворих можна виділити неадекватну інсулінотерапію з використанням високих доз інсуліну, наявність генетичної схильності до формування інсулінорезистентності. Застосування метформіну в комбінації з інсулінотерапією і модифікацією способу життя справляло позитивний вплив на показники вуглеводного обміну і масу тіла пацієнтів.
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