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The Lancet
Journal Prestige (SJR): 14.934
Citation Impact (citeScore): 9
Number of Followers: 2776  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
Published by Elsevier Homepage  [3183 journals]
  • Use of tear gas for crowd control in Hong Kong
    • Abstract: Publication date: Available online 14 October 2019Source: The LancetAuthor(s): Emily Ying Yang Chan, Kevin Kei Ching Hung, Heidi Hoi Yi Hung, Colin A Graham
       
  • CRASH-3: a win for patients with traumatic brain injury
    • Abstract: Publication date: Available online 14 October 2019Source: The LancetAuthor(s): Andrew P Cap
       
  • The Man Who Saw Everything, Deborah Levy. Hamish Hamilton (2019), 208,
           £14·99, ISBN: 9780241268025
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Margaret McCartney
       
  • Management of frailty: opportunities, challenges, and future directions
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Elsa Dent, Finbarr C Martin, Howard Bergman, Jean Woo, Roman Romero-Ortuno, Jeremy D WalstonSummaryFrailty is a complex age-related clinical condition characterised by a decline in physiological capacity across several organ systems, with a resultant increased susceptibility to stressors. Because of the heterogeneity of frailty in clinical presentation, it is important to have effective strategies for the delivery of care that range across the continuum of frailty severity. In clinical practice, we should do what works, starting with frailty screening, case identification, and management of frailty. This process is unarguably difficult given the absence of an adequate evidence base for individual and health-system interventions to manage frailty. We advocate change towards individually tailored interventions that preserve an individual's independence, physical function, and cognition. This change can be addressed by promoting the recognition of frailty, furthering advancements in evidence-based treatment options, and identifying cost-effective care delivery strategies.
       
  • Percutaneous coronary intervention versus coronary artery bypass grafting
           in patients with three-vessel or left main coronary artery disease:
           10-year follow-up of the multicentre randomised controlled SYNTAX trial
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Daniel J F M Thuijs, A Pieter Kappetein, Patrick W Serruys, Friedrich-Wilhelm Mohr, Marie-Claude Morice, Michael J Mack, David R Holmes, Nick Curzen, Piroze Davierwala, Thilo Noack, Milan Milojevic, Keith D Dawkins, Bruno R da Costa, Peter Jüni, Stuart J Head, Filip Casselman, Bernard de Bruyne, Evald Høj Christiansen, Juan M. Ruiz-Nodar, Paul VermeerschSummaryBackgroundThe Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease, and reported results up to 5 years. We now report 10-year all-cause death results.MethodsThe SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to the PCI group or CABG group. Patients with a history of PCI or CABG, acute myocardial infarction, or an indication for concomitant cardiac surgery were excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause death, which was assessed according to the intention-to-treat principle. Prespecified subgroup analyses were performed according to the presence or absence of left main coronary artery disease and diabetes, and according to coronary complexity defined by core laboratory SYNTAX score tertiles. This study is registered with ClinicalTrials.gov, NCT03417050.FindingsFrom March, 2005, to April, 2007, 1800 patients were randomly assigned to the PCI (n=903) or CABG (n=897) group. Vital status information at 10 years was complete for 841 (93%) patients in the PCI group and 848 (95%) patients in the CABG group. At 10 years, 244 (27%) patients had died after PCI and 211 (24%) after CABG (hazard ratio 1·17 [95% CI 0·97–1·41], p=0·092). Among patients with three-vessel disease, 151 (28%) of 546 had died after PCI versus 113 (21%) of 549 after CABG (hazard ratio 1·41 [95% CI 1·10–1·80]), and among patients with left main coronary artery disease, 93 (26%) of 357 had died after PCI versus 98 (28%) of 348 after CABG (0·90 [0·68–1·20], pinteraction=0·019). There was no treatment-by-subgroup interaction with diabetes (pinteraction=0·66) and no linear trend across SYNTAX score tertiles (ptrend=0·30).InterpretationAt 10 years, no significant difference existed in all-cause death between PCI using first-generation paclitaxel-eluting stents and CABG. However, CABG provided a significant survival benefit in patients with three-vessel disease, but not in patients with left main coronary artery disease.FundingGerman Foundation of Heart Research (SYNTAXES study, 5–10-year follow-up) and Boston Scientific Corporation (SYNTAX study, 0–5-year follow-up).
       
  • Department of Error
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s):
       
  • A role for palliative care in advancing health in conflict settings
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Rachel Coghlan, Mhoira Leng, Omar Shamieh, Khamis Elessi, Liz Grant
       
  • Abortion as a moral good'
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Desmond O'Neill
       
  • p16 status and choice of chemotherapy in the KEYNOTE-040 study –
           Authors' reply
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Ezra E W Cohen, Denis Soulières, Ramona F Swaby, Kevin J Harrington
       
  • p16 status and choice of chemotherapy in the KEYNOTE-040 study
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Sander Bins, Ron H J Mathijssen
       
  • p16 status and choice of chemotherapy in the KEYNOTE-040 study
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Wei Wei, Mei Ji, Chang-ping Wu, Xin Yang
       
  • Insulin dosing guidance to optimise type 2 diabetes management –
           Authors' reply
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Richard M Bergenstal, Mary L Johnson, Eran Bashan, Israel Hodish
       
  • Insulin dosing guidance to optimise type 2 diabetes management
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Rajesh Garg
       
  • Hyaluronan-selected sperm should not be considered an add-on –
           Author's reply
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): David Miller
       
  • Hyaluronan-selected sperm should not be considered an add-on
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Lodovico Parmegiani
       
  • Stuart B Levy
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Adam Marcus
       
  • Hypothyroidism to Graves' disease and late appearance of pretibial
           myxoedema
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Eveline Bruinstroop, Irina Cairo, Paul Drillenburg, P Sytze van Dam
       
  • Liu Bolin: artist for the Anthropocene
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Selina Lo
       
  • AMR in the Middle East: “a perfect storm”
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Sharmila Devi
       
  • Offline: Touch—the first language
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Richard Horton
       
  • Medicalising policy problems: the mental health needs of unaccompanied
           migrant young people
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Elaine Chase, Habib Rezaie, Gul Zada
       
  • A new era for neuromyelitis optica spectrum disorder
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Elizabeth Silbermann, Dennis Bourdette
       
  • Improved patient selection for implantable defibrillators
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Sana M Al-Khatib
       
  • Dual antithrombotic therapy for atrial fibrillation and PCI
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Davide Capodanno, Dominick J Angiolillo
       
  • Expansion or contraction of stenting in coronary artery disease'
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): David P Taggart, Domenico Pagano
       
  • Bringing frailty into all realms of medicine
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): The Lancet
       
  • National health care in Portugal: a new opportunity
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): The Lancet
       
  • E-cigarettes: time to realign our approach'
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): The Lancet
       
  • Frailty: implications for clinical practice and public health
    • Abstract: Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Emiel O Hoogendijk, Jonathan Afilalo, Kristine E Ensrud, Paul Kowal, Graziano Onder, Linda P FriedSummaryFrailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future.
       
  • Protecting children's rights: why governments must be bold to tackle
           childhood obesity
    • Abstract: Publication date: Available online 10 October 2019Source: The LancetAuthor(s): Oliver T Mytton, Claire Fenton-Glynn, Emma Pawson, Russell M Viner, Sally C Davies
       
  • Accountability for respectful maternity care
    • Abstract: Publication date: Available online 8 October 2019Source: The LancetAuthor(s): Patience A Afulani, Cheryl A Moyer
       
  • Department of Error
    • Abstract: Publication date: Available online 7 October 2019Source: The LancetAuthor(s):
       
  • Department of Error
    • Abstract: Publication date: Available online 7 October 2019Source: The LancetAuthor(s):
       
  • Improving survival of infants with low birthweight cared for outside
           hospitals
    • Abstract: Publication date: Available online 4 October 2019Source: The LancetAuthor(s): Nathalie Charpak, Juan G Ruiz-Pelaez
       
  • Immunotherapy: a new era in small-cell lung cancer
    • Abstract: Publication date: Available online 4 October 2019Source: The LancetAuthor(s): Thorsten Oliver Goetze
       
  • Scanning early catches the worm: abdominal ultrasound as a possible
           screening method for intestinal cestodes
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Hiroki Kitamoto, Satoko Inoue, Koji Okamoto, Tetsuro Inokuma
       
  • Identifying optimal doses of heart failure medications in men compared
           with women: a prospective, observational, cohort study
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Bernadet T Santema, Wouter Ouwerkerk, Jasper Tromp, Iziah E Sama, Alice Ravera, Vera Regitz-Zagrosek, Hans Hillege, Nilesh J Samani, Faiez Zannad, Kenneth Dickstein, Chim C Lang, John G Cleland, Jozine M Ter Maaten, Marco Metra, Stefan D Anker, Pim van der Harst, Leong L Ng, Peter van der Meer, Dirk J van Veldhuisen, Sven MeyerSummaryBackgroundGuideline-recommended doses of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and β blockers are similar for men and women with heart failure with reduced ejection fraction (HFrEF), even though there are known sex differences in pharmacokinetics of these drugs. We hypothesised that there might be sex differences in the optimal dose of ACE inhibitors or ARBs and β blockers in patients with HFrEF.MethodsWe did a post-hoc analysis of BIOSTAT-CHF, a prospective study in 11 European countries of patients with heart failure in whom initiation and up-titration of ACE inhibitors or ARBs and β blockers was encouraged by protocol. We included only patients with left ventricular ejection fraction less than 40%, and excluded those who died within the first 3 months. Primary outcome was a composite of time to all-cause mortality or hospitalisation for heart failure. Findings were validated in ASIAN-HF, an independent cohort of 3539 men and 961 women with HFrEF.FindingsAmong 1308 men and 402 women with HFrEF from BIOSTAT-CHF, women were older (74 [12] years vs 70 [12] years, p
       
  • A community-based comprehensive intervention to reduce cardiovascular risk
           in hypertension (HOPE 4): a cluster-randomised controlled trial
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Jon-David Schwalm, Tara McCready, Patricio Lopez-Jaramillo, Khalid Yusoff, Amir Attaran, Pablo Lamelas, Paul A Camacho, Fadhlina Majid, Shrikant I Bangdiwala, Lehana Thabane, Shofiqul Islam, Martin McKee, Salim YusufSummaryBackgroundHypertension is the leading cause of cardiovascular disease globally. Despite proven benefits, hypertension control is poor. We hypothesised that a comprehensive approach to lowering blood pressure and other risk factors, informed by detailed analysis of local barriers, would be superior to usual care in individuals with poorly controlled or newly diagnosed hypertension. We tested whether a model of care involving non-physician health workers (NPHWs), primary care physicians, family, and the provision of effective medications, could substantially reduce cardiovascular disease risk.MethodsHOPE 4 was an open, community-based, cluster-randomised controlled trial involving 1371 individuals with new or poorly controlled hypertension from 30 communities (defined as townships) in Colombia and Malaysia. 16 communities were randomly assigned to control (usual care, n=727), and 14 (n=644) to the intervention. After community screening, the intervention included treatment of cardiovascular disease risk factors by NPHWs using tablet computer-based simplified management algorithms and counselling programmes; free antihypertensive and statin medications recommended by NPHWs but supervised by physicians; and support from a family member or friend (treatment supporter) to improve adherence to medications and healthy behaviours. The primary outcome was the change in Framingham Risk Score 10-year cardiovascular disease risk estimate at 12 months between intervention and control participants. The HOPE 4 trial is registered at ClinicalTrials.gov, NCT01826019.FindingsAll communities completed 12-month follow-up (data on 97% of living participants, n=1299). The reduction in Framingham Risk Score for 10-year cardiovascular disease risk was −6·40% (95% CI 8·00 to −4·80) in the control group and −11·17% (−12·88 to −9·47) in the intervention group, with a difference of change of −4·78% (95% CI −7·11 to −2·44, p
       
  • Pharmacological treatments for generalised anxiety disorder –
           Authors' reply
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Nick Freemantle, April Slee, Irwin Nazareth
       
  • Pharmacological treatments for generalised anxiety disorder
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Qi Zhou, Nan Yang, Kehu Yang, Janne Estill, Yaolong Chen
       
  • Pharmacological treatments for generalised anxiety disorder
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Klaus Munkholm, Kim Boesen, Asger S Paludan-Müller
       
  • Fresh versus frozen blastocyst transfer – Authors' reply
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Daimin Wei, Heping Zhang, Richard S Legro, Zi-Jiang Chen
       
  • Fresh versus frozen blastocyst transfer
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Matheus Roque, Giuliano Bedoschi, Gustavo N Cecchino, Sandro C Esteves
       
  • Fresh versus frozen blastocyst transfer
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Tjitske Zaat, Femke Mol, Madelon van Wely, Jack Wilkinson, Sebastiaan Mastenbroek
       
  • Semaglutide in weight management – Author's reply
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): John P H Wilding
       
  • Semaglutide in weight management
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Ying Xiao, Lin Sun
       
  • Preventing unnecessary disability after stroke in Scotland
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Shelagh B Coutts
       
  • Allison Milner
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Andrew Green
       
  • Exploring the recovery of survivors of trafficking through art
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Aarathi Prasad
       
  • Brexit and medicine shortages in the UK
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Talha Burki
       
  • Polio returns to the Philippines
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Jacqui Thornton
       
  • Offline: Extinction or rebellion'
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Richard Horton
       
  • The Global Fund's Sixth Replenishment Conference: a challenge for France,
           a challenge for global health
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Stéphanie Tchiombiano, Jean-François Delfraissy, François Dabis, Santé mondiale 2030
       
  • Gambling harm: a global problem requiring global solutions
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Gerda Reith, Heather Wardle, Ian Gilmore
       
  • Sex-based differences in medications for heart failure
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Heather P Whitley, Warren D Smith
       
  • Superiority of biodegradable polymer sirolimus-eluting stents in STEMI
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Clemens von Birgelen, Rosaly Anne Buiten
       
  • Parallel community solutions for cardiovascular risk reduction
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Tazeen H Jafar, Zainab Samad, Gerald S Bloomfield
       
  • Housing and homelessness as a health crisis
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): The Lancet
       
  • No health care without social care
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): The Lancet
       
  • Russia's alcohol policy: a continuing success story
    • Abstract: Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): The Lancet
       
  • Rewarding Canadian science has a gender equity problem
    • Abstract: Publication date: Available online 3 October 2019Source: The LancetAuthor(s): Jocalyn Clark, Richard Horton
       
  • Triple therapy in a single inhaler: a new option for uncontrolled asthma
    • Abstract: Publication date: Available online 30 September 2019Source: The LancetAuthor(s): J Mark FitzGerald, Mohsen Sadatsafavi
       
  • Department of Error
    • Abstract: Publication date: Available online 30 September 2019Source: The LancetAuthor(s):
       
  • Launching the Universal Health Coverage Legal Solutions Network
    • Abstract: Publication date: Available online 30 September 2019Source: The LancetAuthor(s): Lawrence O Gostin, Aleksandra Blagojevic, Simon Bland, Mandeep Dhaliwal, Ranieri Guerra, John T Monahan
       
  • Do we need any new TAVR device'
    • Abstract: Publication date: Available online 27 September 2019Source: The LancetAuthor(s): Didier Tchetche
       
  • NIRS-intravascular imaging to predict coronary events
    • Abstract: Publication date: Available online 27 September 2019Source: The LancetAuthor(s): David Erlinge
       
  • Department of Error
    • Abstract: Publication date: Available online 26 September 2019Source: The LancetAuthor(s):
       
  • Italian university rectors for health and environment: the U4ALL
           initiative
    • Abstract: Publication date: Available online 26 September 2019Source: The LancetAuthor(s): Alessandro Miani, Prisco Piscitelli, Antonio Felice Uricchio, Elio Franzini, Francesco Frati, Renato Lauro, Vincenzo Zara, Gianni Profita, Angelo Deiana, Annamaria Colao, Gaetano Manfredi
       
  • Governing health futures 2030: growing up in a digital world—a joint The
           Lancet and Financial Times Commission
    • Abstract: Publication date: Available online 20 September 2019Source: The LancetAuthor(s): Ilona Kickbusch, Anurag Agrawal, Andrew Jack, Naomi Lee, Richard Horton
       
  • The collective pushback on women's health and rights
    • Abstract: Publication date: Available online 20 September 2019Source: The LancetAuthor(s): Katja Iversen, Francoise Girard, Roopa Dhatt, Courtney Carson
       
  • Department of Error
    • Abstract: Publication date: Available online 19 September 2019Source: The LancetAuthor(s):
       
  • A new treatment for chronic rhinosinusitis with nasal polyps
    • Abstract: Publication date: Available online 19 September 2019Source: The LancetAuthor(s): Whitney W Stevens
       
  • Department of Error
    • Abstract: Publication date: Available online 18 September 2019Source: The LancetAuthor(s):
       
  • Department of Error
    • Abstract: Publication date: Available online 18 September 2019Source: The LancetAuthor(s):
       
  • Glycaemic durability of an early combination therapy with vildagliptin and
           metformin versus sequential metformin monotherapy in newly diagnosed type
           2 diabetes (VERIFY): a 5-year, multicentre, randomised, double-blind trial
           
    • Abstract: Publication date: Available online 18 September 2019Source: The LancetAuthor(s): David R Matthews, Päivi M Paldánius, Pieter Proot, YannTong Chiang, Michael Stumvoll, Stefano Del Prato, VERIFY study groupSummaryBackgroundEarly treatment intensification leading to sustained good glycaemic control is essential to delay diabetic complications. Although initial combination therapy has been suggested to offer more opportunities than a traditional stepwise approach, its validity remains to be determined.MethodsVildagliptin Efficacy in combination with metfoRmIn For earlY treatment of type 2 diabetes (VERIFY) was a randomised, double-blind, parallel-group study of newly diagnosed patients with type 2 diabetes conducted in 254 centres across 34 countries. The study consisted of a 2-week screening visit, a 3-week metformin-alone run-in period, and a 5-year treatment period, which was further split into study periods 1, 2, and 3. Patients aged 18–70 years were included if they had type 2 diabetes diagnosed within 2 years prior to enrolment, and centrally confirmed glycated haemoglobin A1c (HbA1c) of 48–58 mmol/mol (6·5–7·5%) and a body-mass index of 22–40 kg/m2. Patients were randomly assigned in a 1:1 ratio either to the early combination treatment group or to the initial metformin monotherapy group, with the help of an interactive response technology system and simple randomisation without stratification. Patients, investigators, clinical staff performing the assessments, and data analysts were masked to treatment allocation. In study period 1, patients received either the early combination treatment with metformin (stable daily dose of 1000 mg, 1500 mg, or 2000 mg) and vildagliptin 50 mg twice daily, or standard-of-care initial metformin monotherapy (stable daily dose of 1000 mg, 1500 mg, or 2000 mg) and placebo twice daily. If the initial treatment did not maintain HbA1c below 53 mmol/mol (7·0%), confirmed at two consecutive scheduled visits which were 13 weeks apart, patients in the metformin monotherapy group received vildagliptin 50 mg twice daily in place of the placebo and entered study period 2, during which all patients received the combination therapy. The primary efficacy endpoint was the time from randomisation to initial treatment failure, defined as HbA1c measurement of at least 53 mmol/mol (7·0%) at two consecutive scheduled visits, 13 weeks apart from randomisation through period 1. The full analysis set included patients who received at least one randomised study medication and had at least one post-randomisation efficacy parameter assessed. The safety analysis set included all patients who received at least one dose of randomised study medication. This study is registered with ClinicalTrials.gov, NCT01528254.FindingsTrial enrolment began on March 30, 2012, and was completed on April 10, 2014. Of the 4524 participants screened, 2001 eligible participants were randomly assigned to either the early combination treatment group (n=998) or the initial metformin monotherapy group (n=1003). A total of 1598 (79·9%) patients completed the 5-year study: 811 (81·3%) in the early combination therapy group and 787 (78·5%) in the monotherapy group. The incidence of initial treatment failure during period 1 was 429 (43·6%) patients in the combination treatment group and 614 (62·1%) patients in the monotherapy group. The median observed time to treatment failure in the monotherapy group was 36·1 (IQR 15·3–not reached [NR]) months, while the median time to treatment failure time for those receiving early combination therapy could only be estimated to be beyond the study duration at 61·9 (29·9–NR) months. A significant reduction in the relative risk for time to initial treatment failure was observed in the early combination treatment group compared with the monotherapy group over the 5-year study duration (hazard ratio 0·51 [95% CI 0·45–0·58]; p
       
  • VERIFY the role of initial combination therapy in patients with type 2
           diabetes
    • Abstract: Publication date: Available online 18 September 2019Source: The LancetAuthor(s): Ofri Mosenzon, Gil Leibowitz
       
  • Department of Error
    • Abstract: Publication date: Available online 18 September 2019Source: The LancetAuthor(s):
       
  • A perfect storm in the Caribbean requires a concerted response
    • Abstract: Publication date: Available online 17 September 2019Source: The LancetAuthor(s): Sandeep Maharaj, Terence Seemungal, Martin McKee
       
  • Picturing health: podoconiosis—stepping out of neglect
    • Abstract: Publication date: Available online 16 September 2019Source: The LancetAuthor(s): Alexander Kumar, Kebede Deribe, Nebiyu Negussu, Gail Davey
       
  • Extension of the CONSORT and SPIRIT statements
    • Abstract: Publication date: Available online 16 September 2019Source: The LancetAuthor(s): Xiaoxuan Liu, Livia Faes, Melanie J Calvert, Alastair K Denniston, CONSORT/SPIRIT-AI Extension Group
       
  • Advances in β-cell replacement therapy for the treatment of type 1
           diabetes
    • Abstract: Publication date: Available online 15 September 2019Source: The LancetAuthor(s): Marie-Christine Vantyghem, Eelco J P de Koning, François Pattou, Michael R RickelsSummaryThe main goal of treatment for type 1 diabetes is to control glycaemia with insulin therapy to reduce disease complications. For some patients, technological approaches to insulin delivery are inadequate, and allogeneic islet transplantation is a safe alternative for those patients who have had severe hypoglycaemia complicated by impaired hypoglycaemia awareness or glycaemic lability, or who already receive immunosuppressive drugs for a kidney transplant. Since 2000, intrahepatic islet transplantation has proven efficacious in alleviating the burden of labile diabetes and preventing complications related to diabetes, whether or not a previous kidney transplant is present. Age, body-mass index, renal status, and cardiopulmonary status affect the choice between pancreas or islet transplantation. Access to transplantation is limited by the number of deceased donors and the necessity of immunosuppression. Future approaches might include alternative sources of islets (eg, xenogeneic tissue or human stem cells), extrahepatic sites of implantation (eg, omental, subcutaneous, or intramuscular), and induction of immune tolerance or encapsulation of islets.
       
  • Advances in technology for management of type 1 diabetes
    • Abstract: Publication date: Available online 15 September 2019Source: The LancetAuthor(s): Roy W Beck, Richard M Bergenstal, Lori M Laffel, John C PickupSummaryTechnological advances have had a major effect on the management of type 1 diabetes. In addition to blood glucose meters, devices used by people with type 1 diabetes include insulin pumps, continuous glucose monitors, and, most recently, systems that combine both a pump and a monitor for algorithm-driven automation of insulin delivery. In the next 5 years, as many advances are expected in technology for the management of diabetes as there have been in the past 5 years, with improvements in continuous glucose monitoring and more available choices of systems that automate insulin delivery. Expansion of the use of technology will be needed beyond endocrinology practices to primary-care settings and broader populations of patients. Tools to support decision making will also need to be developed to help patients and health-care providers to use the output of these devices to optimise diabetes management.
       
  • Changing the landscape for type 1 diabetes: the first step to prevention
    • Abstract: Publication date: Available online 15 September 2019Source: The LancetAuthor(s): Colin M Dayan, Maria Korah, Danijela Tatovic, Brian N Bundy, Kevan C HeroldSummaryOver several decades, studies have described the progression of autoimmune diabetes, from the first appearance of autoantibodies until, and after, the diagnosis of clinical disease with hyperglycaemia and insulin dependence. Despite the improved management of type 1 diabetes with exogenous insulin, most patients do not meet clinical glycaemic goals, and diabetes remains an important medical problem that affects children and adults. Clinical and preclinical studies have suggested strategies to prevent the diagnosis of type 1 diabetes in people at risk, but the outcomes of previous clinical trials have not met their primary endpoints of disease prevention or delay. The results from the TN-10 teplizumab prevention trial show that the diagnosis of type 1 diabetes can be delayed by treatment with a FcR non-binding monoclonal antibody to CD3 in people at high risk for disease. This Series paper discusses how this clinical achievement raises new questions about for whom, and when, immunological strategies might be developed to prevent type 1 diabetes, and how to achieve this goal.
       
  • Comparing antibiotic, silver, and standard ventriculoperitoneal shunts
    • Abstract: Publication date: Available online 12 September 2019Source: The LancetAuthor(s): Ann Marie Flannery
       
 
 
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