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The Lancet Diabetes and Endocrinology
Journal Prestige (SJR): 9.705
Citation Impact (citeScore): 6
Number of Followers: 183  
 
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ISSN (Online) 2213-8587
Published by Elsevier Homepage  [3184 journals]
  • Empowering women with PCOS
    • Abstract: Publication date: Available online 6 September 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): The Lancet Diabetes & Endocrinology
       
  • Tackling metabolic risk: opportunities and challenges
    • Abstract: Publication date: Available online 6 September 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): The Lancet Diabetes & Endocrinology
       
  • SGLT2 inhibitors for the prevention of kidney failure in patients with
           type 2 diabetes: a systematic review and meta-analysis
    • Abstract: Publication date: Available online 5 September 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Brendon L Neuen, Tamara Young, Hiddo J L Heerspink, Bruce Neal, Vlado Perkovic, Laurent Billot, Kenneth W Mahaffey, David M Charytan, David C Wheeler, Clare Arnott, Severine Bompoint, Adeera Levin, Meg J JardineSummaryBackgroundThe effects of sodium-glucose co-transporter-2 (SGLT2) inhibitors on kidney failure, particularly the need for dialysis or transplantation or death due to kidney disease, is uncertain. Additionally, previous studies have been underpowered to robustly assess heterogeneity of effects on kidney outcomes by different levels of estimated glomerular filtration rate (eGFR) and albuminuria. We aimed to do a systematic review and meta-analysis to assess the effects of SGLT2 inhibitors on major kidney outcomes in patients with type 2 diabetes and to determine the consistency of effect size across trials and different levels of eGFR and albuminuria.MethodsWe did a systematic review and meta-analysis of randomised, controlled, cardiovascular or kidney outcome trials of SGLT2 inhibitors that reported effects on major kidney outcomes in people with type 2 diabetes. We searched MEDLINE and Embase from database inception to June 14, 2019, to identify eligible trials. The primary outcome was a composite of dialysis, transplantation, or death due to kidney disease. We used random-effects models to obtain summary relative risks (RRs) with 95% CIs and random-effects meta-regression to explore effect modification by subgroups of baseline eGFR, albuminuria, and use of renin–angiotensin system (RAS) blockade. This review is registered with PROSPERO (CRD42019131774).FindingsFrom 2085 records identified, four studies met our inclusion criteria, assessing three SGLT2 inhibitors: empagliflozin (EMPA-REG OUTCOME), canagliflozin (CANVAS Program and CREDENCE), and dapagliflozin (DECLARE–TIMI 58). From a total of 38 723 participants, 252 required dialysis or transplantation or died of kidney disease, 335 developed end-stage kidney disease, and 943 had acute kidney injury. SGLT2 inhibitors substantially reduced the risk of dialysis, transplantation, or death due to kidney disease (RR 0·67, 95% CI 0·52–0·86, p=0·0019), an effect consistent across studies (I2=0%, pheterogeneity=0·53). SGLT2 inhibitors also reduced end-stage kidney disease (0·65, 0·53–0·81, p
       
  • Diabetic kidney disease 2.0: the treatment paradigm shifts
    • Abstract: Publication date: Available online 5 September 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Richard E Gilbert
       
  • Research digest: observing risks and benefits of diet and supplements
    • Abstract: Publication date: Available online 3 September 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Robert A Hegele
       
  • NICE guidance on dapagliflozin with insulin for type 1 diabetes
    • Abstract: Publication date: Available online 2 September 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Amanda I Adler, Sharlene Ting, Ross Dent, Nick Latimer
       
  • Personalising osteoporosis treatment for patients at high risk of fracture
    • Abstract: Publication date: Available online 22 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Sundeep Khosla
       
  • Correction to Lancet Diabetes Endocrinol 2019; 7: 665–67
    • Abstract: Publication date: September 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 9Author(s):
       
  • Lifestyle intervention and impaired glucose tolerance in the Da Qing study
           – Authors' reply
    • Abstract: Publication date: September 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 9Author(s): Guangwei Li, Ping Zhang, Peter H Bennett
       
  • Lifestyle intervention and impaired glucose tolerance in the Da Qing study
    • Abstract: Publication date: September 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 9Author(s): Shen Tian, Hao Li, Juan Wu, Kai-nan Wu, Ling-quan Kong
       
  • Clusters provide a better holistic view of type 2 diabetes than simple
           clinical features – Authors' reply
    • Abstract: Publication date: September 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 9Author(s): John M Dennis, Beverley M Shields, William E Henley, Angus G Jones, Andrew T Hattersley
       
  • Clusters provide a better holistic view of type 2 diabetes than simple
           clinical features
    • Abstract: Publication date: September 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 9Author(s): Emma Ahlqvist, Tiinamaija Tuomi, Leif Groop
       
  • Type 1 diabetes technology: advances and challenges
    • Abstract: Publication date: September 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 9Author(s): The Lancet Diabetes & Endocrinology
       
  • Practical definitions of severe versus familial hypercholesterolaemia and
           hypertriglyceridaemia for adult clinical practice
    • Abstract: Publication date: Available online 21 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Ankit Garg, Vinay Garg, Robert A Hegele, Gary F LewisSummaryDiagnostic scoring systems for familial hypercholesterolaemia and familial chylomicronaemia syndrome often cannot differentiate between adults who have extreme dyslipidaemia based on a simple monogenic cause versus people with a more complex cause involving polygenic factors and an environmental component. This more complex group of patients carries a substantial risk of atherosclerotic cardiovascular disease in the case of marked hypercholesterolaemia and pancreatitis in the case of marked hypertriglyceridaemia. Complications are mainly a function of the degree of disturbance in lipid metabolism resulting in elevated lipid levels, so the added value of knowing the precise genetic cause in clinical decision making is unclear and does not lead to clinically meaningful benefit. We propose that for severe elevations of plasma low density lipoprotein cholesterol or triglyceride, the primary factor driving intervention should be the biochemical perturbation rather than the clinical risk score. This underscores the importance of expanding the definition of severe dyslipidaemias and to not rely solely on clinical scoring systems to identify individuals who would benefit from appropriate treatment approaches. We advocate for the use of simple, practical, clinical, and largely biochemically based definitions for severe hypercholesterolaemia (eg, LDL cholesterol>5 mmol/L) and severe hypertriglyceridaemia (triglyceride>10 mmol/L), which complement current definitions of familial hypercholesterolaemia and familial chylomicronaemia syndrome. Irrespective of the precise genetic cause, individuals diagnosed with severe hypercholesterolaemia and severe hypertriglyceridaemia require intensive therapy, including special consideration for new effective but more expensive therapies.
       
  • The CGM grey market: a reflection of global access inequity
    • Abstract: Publication date: Available online 16 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Oana Onisie, Hamish Crocket, Martin de Bock
       
  • Metabolic health in the Middle East and north Africa
    • Abstract: Publication date: Available online 14 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Fereidoun Azizi, Farzad Hadaegh, Farhad Hosseinpanah, Parvin Mirmiran, Atieh Amouzegar, Hengameh Abdi, Golaleh Asghari, Donna Parizadeh, Seyed Ali Montazeri, Mojtaba Lotfaliany, Farzin Takyar, Davood KhaliliSummaryThe Middle East and north Africa are home to different populations with widely varying cultures, histories, and socioeconomic settings. Hence, their health status, health management, and access to appropriate health care differ accordingly. In this Review, we examine data on the historical and prospective status of metabolic diseases in this region including obesity, diabetes, hypertension, dyslipidaemia, and non-alcoholic fatty liver disease. Women in the Middle East and north Africa have the highest risk of metabolic diseases of all women globally, whereas men rank second of all men in this respect. Metabolic risk factors are responsible for more than 300 deaths per 100 000 individuals in this region, compared with a global mean of fewer than 250. Physical inactivity, especially in women, and an unhealthy diet (ie, low consumption of whole grains, nuts, and seafoods) stand out. More than one in every three women are obese in most countries of the region. Prevention programmes have not fully been achieved in most of these countries and the projected future is not optimistic. Comprehensive surveillance and monitoring of metabolic diseases, robust multisectoral systems that support primordial and primary preventions, continuous education of health-care providers, as well as collaboration between countries for joint projects in this region are urgently needed to overcome the paucity of data and to improve the metabolic health status of inhabitants in the Middle East and north Africa.
       
  • GLP-1 receptor agonists and cardiovascular outcomes: an updated synthesis
    • Abstract: Publication date: Available online 14 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Eberhard Standl
       
  • Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor
           agonists in patients with type 2 diabetes: a systematic review and
           meta-analysis of cardiovascular outcome trials
    • Abstract: Publication date: Available online 14 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Søren L Kristensen, Rasmus Rørth, Pardeep S Jhund, Kieran F Docherty, Naveed Sattar, David Preiss, Lars Køber, Mark C Petrie, John J V McMurraySummaryBackgroundGlucagon-like peptide-1 (GLP-1) receptor agonists differ in their structure and duration of action and have been studied in trials of varying sizes and with different patient populations, with inconsistent effects on cardiovascular outcomes reported. We aimed to synthesise the available evidence by doing a systematic review and meta-analysis of cardiovascular outcome trials of these drugs.MethodsWe searched MEDLINE (via PubMed) and the Cochrane Central Register of Controlled Trials for eligible placebo-controlled trials reporting major adverse cardiovascular events (MACE; ie, cardiovascular death, stroke, or myocardial infarction) up to June 15, 2019. We did a meta-analysis using a random-effects model to estimate overall hazard ratios (HRs) for MACE, its components, death from any cause, hospital admission for heart failure, kidney outcomes, and key safety outcomes (severe hypoglycaemia, pancreatitis, and pancreatic cancer). We also examined MACE in several subgroups based on patient characteristics (history of cardiovascular disease, BMI, age, baseline HbA1c, and baseline estimated glomerular filtration rate), trial duration, treatment dosing interval, and structural homology.FindingsOf 27 publications screened, seven trials, with a combined total of 56 004 participants, were included: ELIXA (lixisenatide), LEADER (liraglutide), SUSTAIN-6 (semaglutide), EXSCEL (exenatide), Harmony Outcomes (albiglutide), REWIND (dulaglutide), and PIONEER 6 (oral semaglutide). Overall, GLP-1 receptor agonist treatment reduced MACE by 12% (HR 0·88, 95% CI 0·82–0·94; p
       
  • Treading one's own path
    • Abstract: Publication date: Available online 8 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Fiona Mitchell
       
  • Pre-pregnancy weight and preterm birth: a causal relation'
    • Abstract: Publication date: Available online 5 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Emily Oken, Izzuddin M Aris, Jessica G Young
       
  • A paradigm shift in bariatric surgery outcome evaluation'
    • Abstract: Publication date: Available online 2 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Xabier Unamuno, Piero Portincasa, Gema Frühbeck
       
  • Long-term adverse events after sleeve gastrectomy or gastric bypass: a
           7-year nationwide, observational, population-based, cohort study
    • Abstract: Publication date: Available online 2 August 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Jérémie Thereaux, Thomas Lesuffleur, Sébastien Czernichow, Arnaud Basdevant, Simon Msika, David Nocca, Bertrand Millat, Anne Fagot-CampagnaSummaryBackgroundConcerns are rising about the late adverse events following gastric bypass and sleeve gastrectomy. We aimed to assess, over a 7-year period, the late adverse events after gastric bypass and sleeve gastrectomy compared with matched control groups.MethodsIn this nationwide, observational, population-based, cohort study, we used data extracted from the French National Health Insurance (Système National des Données de Santé) database. All patients undergoing gastric bypass or sleeve gastrectomy in France in 2009, except those who had undergone bariatric surgery in the previous 4 years before inclusion, were matched with control patients with obesity in terms of age, sex, BMI category, baseline antidiabetic therapy, and baseline insulin therapy. Exclusion criteria for the control group included cancer, pregnancy, chronic infectious disease, serious acute or chronic disease in 2008–09, or previous (2005–09) or forthcoming (2010–11) bariatric surgery. The incidence rate was calculated for each type of adverse event leading to inpatient hospital admission over a 7-year period; incidence rate ratios (with 95% CIs) were computed to compare the rate of complications among the bariatric surgery and control groups. Risks of complications during follow-up were compared using Cox proportional-hazards regression analyses. Data were analysed according to the intention-to-treat methodology.FindingsFrom Jan 1, 2009, to Dec 31, 2009, 8966 patients who underwent bariatric surgery (7359 [82%] women; mean age 40·4 years [SD 11·3]) and 8966 matched controls (7359 [82%] women; mean age 40·9 years [11·4]) were included in analyses 4955 (55%) off 8966 patients in the bariatric surgery group had a primary gastric bypass and 4011 (45%) patients had sleeve gastrectomy. With a mean follow-up of 6·8 years (SD 0·2), mortality was lower in the gastric bypass group than in its control group (hazard ratio 0·64 [95% CI 0·52–0·78]; p
       
  • Triac in the treatment of Allan–Herndon–Dudley syndrome
    • Abstract: Publication date: Available online 31 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Andrew J Bauer
       
  • Correction to Lancet Diabetes Endocrinol 2019; 7: 618–28
    • Abstract: Publication date: Available online 29 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s):
       
  • Testosterone for women: green light for sex, amber light for health'
    • Abstract: Publication date: Available online 25 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Rossella E Nappi
       
  • Heterogeneity of diabetes: heralding the era of precision medicine
    • Abstract: Publication date: Available online 22 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Stefano Del Prato
       
  • Risk of diabetes-associated diseases in subgroups of patients with
           recent-onset diabetes: a 5-year follow-up study
    • Abstract: Publication date: Available online 22 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Oana P Zaharia, Klaus Strassburger, Alexander Strom, Gidon J Bönhof, Yanislava Karusheva, Sofia Antoniou, Kálmán Bódis, Daniel F Markgraf, Volker Burkart, Karsten Müssig, Jong-Hee Hwang, Olof Asplund, Leif Groop, Emma Ahlqvist, Jochen Seissler, Peter Nawroth, Stefan Kopf, Sebastian M Schmid, Michael Stumvoll, Andreas F H PfeifferSummaryBackgroundCluster analyses have proposed different diabetes phenotypes using age, BMI, glycaemia, homoeostasis model estimates, and islet autoantibodies. We tested whether comprehensive phenotyping validates and further characterises these clusters at diagnosis and whether relevant diabetes-related complications differ among these clusters, during 5-years of follow-up.MethodsPatients with newly diagnosed type 1 or type 2 diabetes in the German Diabetes Study underwent comprehensive phenotyping and assessment of laboratory variables. Insulin sensitivity was assessed using hyperinsulinaemic-euglycaemic clamps, hepatocellular lipid content using magnetic resonance spectroscopy, hepatic fibrosis using non-invasive scores, and peripheral and autonomic neuropathy using functional and clinical criteria. Patients were reassessed after 5 years. The German Diabetes Study is registered with ClinicalTrials.gov, number NCT01055093, and is ongoing.Findings1105 patients were classified at baseline into five clusters, with 386 (35%) assigned to mild age-related diabetes (MARD), 323 (29%) to mild obesity-related diabetes (MOD), 247 (22%) to severe autoimmune diabetes (SAID), 121 (11%) to severe insulin-resistant diabetes (SIRD), and 28 (3%) to severe insulin-deficient diabetes (SIDD). At 5-year follow-up, 367 patients were reassessed, 128 (35%) with MARD, 106 (29%) with MOD, 88 (24%) with SAID, 35 (10%) with SIRD, and ten (3%) with SIDD. Whole-body insulin sensitivity was lowest in patients with SIRD at baseline (mean 4·3 mg/kg per min [SD 2·0]) compared with those with SAID (8·4 mg/kg per min [3·2]; p
       
  • Dietary transitions and cardiometabolic mortality among Chinese adults
    • Abstract: Publication date: August 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 8Author(s): Wan Li, Wei Ling, Yi Sui, Hai-Lu Zhao
       
  • Research digest: seeking new lipid drug targets
    • Abstract: Publication date: August 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 8Author(s): Robert A Hegele
       
  • Correction to Lancet Diabetes Endocrinol 2019; 7: 606–17
    • Abstract: Publication date: August 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 8Author(s):
       
  • Correction to Lancet Diabetes Endocrinol 2019; 7: 590–92
    • Abstract: Publication date: August 2019Source: The Lancet Diabetes & Endocrinology, Volume 7, Issue 8Author(s):
       
  • Correction to Lancet Diabetes Endocrinol 2019; 7: 528–39
    • Abstract: Publication date: Available online 15 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s):
       
  • Correction to Lancet Diabetes Endocrinol 2019; 7: 515–27
    • Abstract: Publication date: Available online 15 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s):
       
  • 2 years of calorie restriction and cardiometabolic risk (CALERIE):
           exploratory outcomes of a multicentre, phase 2, randomised controlled
           trial
    • Abstract: Publication date: Available online 11 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): William E Kraus, Manjushri Bhapkar, Kim M Huffman, Carl F Pieper, Sai Krupa Das, Leanne M Redman, Dennis T Villareal, James Rochon, Susan B Roberts, Eric Ravussin, John O Holloszy, Luigi Fontana, CALERIE InvestigatorsSummaryBackgroundFor several cardiometabolic risk factors, values considered within normal range are associated with an increased risk of cardiovascular morbidity and mortality. We aimed to investigate the short-term and long-term effects of calorie restriction with adequate nutrition on these risk factors in healthy, lean, or slightly overweight young and middle-aged individuals.MethodsCALERIE was a phase 2, multicentre, randomised controlled trial in young and middle-aged (21–50 years), healthy non-obese (BMI 22·0–27·9 kg/m2) men and women done in three clinical centres in the USA. Participants were randomly assigned (2:1) to a 25% calorie restriction diet or an ad libitum control diet. Exploratory cardiometabolic risk factor responses to a prescribed 25% calorie restriction diet for 2 years were evaluated (systolic, diastolic, and mean blood pressure; plasma lipids; high-sensitivity C-reactive protein; metabolic syndrome score; and glucose homoeostasis measures of fasting insulin, glucose, insulin resistance, and 2-h glucose, area-under-the curve for glucose, and insulin from an oral glucose tolerance test) analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00427193.FindingsFrom May 8, 2007, to Feb 26, 2010, of 238 participants that were assessed, 218 were randomly assigned to and started a 25% calorie restriction diet (n=143, 66%) or an ad libitum control diet (n=75, 34%). Individuals in the calorie restriction group achieved a mean reduction in calorie intake of 11·9% (SE 0·7; from 2467 kcal to 2170 kcal) versus 0·8% (1·0) in the control group, and a sustained mean weight reduction of 7·5 kg (SE 0·4) versus an increase of 0·1 kg (0·5) in the control group, of which 71% (mean change in fat mass 5·3 kg [SE 0·3] divided by mean change in weight 7·5 kg [0·4]) was fat mass loss. Calorie restriction caused a persistent and significant reduction from baseline to 2 years of all measured conventional cardiometabolic risk factors, including change scores for LDL-cholesterol (p
       
  • Calorie restriction in an obesogenic environment: reality or fiction'
    • Abstract: Publication date: Available online 11 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Frank B Hu
       
  • Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a
           position statement
    • Abstract: Publication date: Available online 10 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Ian J Neeland, Robert Ross, Jean-Pierre Després, Yuji Matsuzawa, Shizuya Yamashita, Iris Shai, Jaap Seidell, Paolo Magni, Raul D Santos, Benoit Arsenault, Ada Cuevas, Frank B Hu, Bruce Griffin, Alberto Zambon, Philip Barter, Jean-Charles Fruchart, Robert H Eckel, International Atherosclerosis Society, International Chair on Cardiometabolic Risk Working Group on Visceral ObesitySummaryFindings from epidemiological studies over the past 30 years have shown that visceral adipose tissue, accurately measured by CT or MRI, is an independent risk marker of cardiovascular and metabolic morbidity and mortality. Emerging evidence also suggests that ectopic fat deposition, including hepatic and epicardial fat, might contribute to increased atherosclerosis and cardiometabolic risk. This joint position statement from the International Atherosclerosis Society and the International Chair on Cardiometabolic Risk Working Group on Visceral Obesity summarises the evidence for visceral adiposity and ectopic fat as emerging risk factors for type 2 diabetes, atherosclerosis, and cardiovascular disease, with a focus on practical recommendations for health professionals and future directions for research and clinical practice. We discuss the measurement of visceral and ectopic fat, pathophysiology and contribution to adverse health outcomes, response to treatment, and lessons from a public health programme targeting visceral and ectopic fat. We identify knowledge gaps and note the need to develop simple, clinically applicable tools to be able to monitor changes in visceral and ectopic fat over time. Finally, we recognise the need for public health messaging to focus on visceral and ectopic fat in addition to excess bodyweight to better combat the growing epidemic of obesity worldwide.
       
  • Correction to Lancet Diabetes Endocrinol 2019; published online July 8.
           http://dx.doi.org/10.1016/S2213-8587(19)30158-5
    • Abstract: Publication date: Available online 8 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s):
       
  • Baby foods: time to get tough on sugars
    • Abstract: Publication date: Available online 3 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): The Lancet Diabetes & Endocrinology
       
  • Effects of alirocumab on cardiovascular and metabolic outcomes after acute
           coronary syndrome in patients with or without diabetes: a prespecified
           analysis of the ODYSSEY OUTCOMES randomised controlled trial
    • Abstract: Publication date: Available online 1 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Kausik K Ray, Helen M Colhoun, Michael Szarek, Marie Baccara-Dinet, Deepak L Bhatt, Vera A Bittner, Andrzej J Budaj, Rafael Diaz, Shaun G Goodman, Corinne Hanotin, Robert A Harrington, J Wouter Jukema, Virginie Loizeau, Renato D Lopes, Angèle Moryusef, Jan Murin, Robert Pordy, Arsen D Ristic, Matthew T Roe, José TuñónSummaryBackgroundAfter acute coronary syndrome, diabetes conveys an excess risk of ischaemic cardiovascular events. A reduction in mean LDL cholesterol to 1·4–1·8 mmol/L with ezetimibe or statins reduces cardiovascular events in patients with an acute coronary syndrome and diabetes. However, the efficacy and safety of further reduction in LDL cholesterol with an inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) after acute coronary syndrome is unknown. We aimed to explore this issue in a prespecified analysis of the ODYSSEY OUTCOMES trial of the PCSK9 inhibitor alirocumab, assessing its effects on cardiovascular outcomes by baseline glycaemic status, while also assessing its effects on glycaemic measures including risk of new-onset diabetes.MethodsODYSSEY OUTCOMES was a randomised, double-blind, placebo-controlled trial, done at 1315 sites in 57 countries, that compared alirocumab with placebo in patients who had been admitted to hospital with an acute coronary syndrome (myocardial infarction or unstable angina) 1–12 months before randomisation and who had raised concentrations of atherogenic lipoproteins despite use of high-intensity statins. Patients were randomly assigned (1:1) to receive alirocumab or placebo every 2 weeks; randomisation was stratified by country and was done centrally with an interactive voice-response or web-response system. Alirocumab was titrated to target LDL cholesterol concentrations of 0·65–1·30 mmol/L. In this prespecified analysis, we investigated the effect of alirocumab on cardiovascular events by glycaemic status at baseline (diabetes, prediabetes, or normoglycaemia)—defined on the basis of patient history, review of medical records, or baseline HbA1c or fasting serum glucose—and risk of new-onset diabetes among those without diabetes at baseline. The primary endpoint was a composite of death from coronary heart disease, non-fatal myocardial infarction, fatal or non-fatal ischaemic stroke, or unstable angina requiring hospital admission. ODYSSEY OUTCOMES is registered with ClinicalTrials.gov, number NCT01663402.FindingsAt study baseline, 5444 patients (28·8%) had diabetes, 8246 (43·6%) had prediabetes, and 5234 (27·7%) had normoglycaemia. There were no significant differences across glycaemic categories in median LDL cholesterol at baseline (2·20–2·28 mmol/L), after 4 months' treatment with alirocumab (0·80 mmol/L), or after 4 months' treatment with placebo (2·25–2·28 mmol/L). In the placebo group, the incidence of the primary endpoint over a median of 2·8 years was greater in patients with diabetes (16·4%) than in those with prediabetes (9·2%) or normoglycaemia (8·5%); hazard ratio (HR) for diabetes versus normoglycaemia 2·09 (95% CI 1·78–2·46, p
       
  • More aggressive lipid lowering in people with diabetes'
    • Abstract: Publication date: Available online 1 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Frederick J Raal, Farzahna Mohamed
       
  • Correction to Lancet Diabetes Endocrinol 2019; 7: 356–67
    • Abstract: Publication date: Available online 1 July 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s):
       
  • Maternal thyroid function and brain development: time for preconception
           screening'
    • Abstract: Publication date: Available online 28 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Francesco Vermiglio, Mariacarla Moleti
       
  • Maternal thyroid function during pregnancy and child brain morphology: a
           time window-specific analysis of a prospective cohort
    • Abstract: Publication date: Available online 28 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Toyah A Jansen, Tim I M Korevaar, Tessa A Mulder, Tonya White, Ryan L Muetzel, Robin P Peeters, Henning TiemeierSummaryBackgroundAdequate thyroid hormone availability during pregnancy is necessary for optimal fetal brain development. During the first 18–20 weeks of gestation, fetal thyroid hormone availability largely depends on the placental transfer of maternal thyroxine. Although various studies have shown that maternal thyroid dysfunction is associated with suboptimal child neurodevelopmental outcomes, the most vulnerable time window remains to be identified. The aim of this study is to examine the association of maternal thyroid function with child brain morphology and to study whether any association depends on the timing of thyroid assessment.MethodsThis prospective cohort study was part of the Generation R Study in Rotterdam, Netherlands, with a prospective population-based birth cohort. Pregnant women living in Rotterdam with an expected delivery date between April 1, 2002, and Jan 1, 2006, were eligible. Other inclusion criteria were maternal serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) measurement in early or mid-pregnancy (≤18 weeks) and available brain MRI data for child at age 10 years. Exclusion criteria were pre-existing thyroid disorder, thyroid disorder treatment, twin pregnancy, in-vitro fertilisation-induced pregnancy, and suboptimal-quality MRI data or major incidental finding on MRI. The main outcome was the association between maternal TSH and FT4 concentrations with brain MRI outcomes of children. Regression analyses accounted for gestational age at blood sampling, maternal age, ethnicity, education level, smoking, thyroid peroxidase antibody positivity, child sex, age at MRI, and total intracranial volume. Effect modification by gestational age at blood sampling was also investigated.FindingsBetween Dec 1, 2001, and June 30, 2005, 7069 women were enrolled during early or mid-pregnancy (≤18 weeks of gestation), of whom 5088 were not included because they did not have available data on maternal serum TSH or FT4 concentrations (n=1175), their child did not have brain MRI done (n=3377), or they met exclusion criteria (n=536). Thus, 1981 mother–child pairs were included in the study, with TSH and FT4 concentrations measured during pregnancy at a median of 13·1 weeks of gestation (IQR 12·1–14·5) and offspring brain morphology assessed by MRI at a median age of 9·9 years (9·7–10·2). Maternal TSH had an inverted U-shaped association with offspring total grey matter volume (p=0·007) and with cortical grey matter volume (p=0·022). The association of maternal TSH with child total grey matter volume (pinteraction=0·053) and cortical volume (pinteraction=0·086) differed by the duration of gestation. Analyses stratified for gestational age at blood sampling showed an inverted U-shaped association of maternal TSH with child total grey matter volume and cortical grey matter volume, which was most evident at 8 weeks gestation. After about 14 weeks of gestation, TSH was no longer associated with child brain morphology. Maternal FT4 concentrations were not associated with child total grey matter volume after adjusting for total intracranial volume (p=0·75).InterpretationHere, we show that both low and high maternal thyroid function are associated with smaller child total grey matter and cortical volume. To the best of our knowledge, this study is the first to show that an association with a neurodevelopmental outcome is most evident when maternal thyroid function is measured early in pregnancy. These novel findings suggest that embryonic brain development is particularly vulnerable to altered maternal thyroid function.FundingNetherlands Organisation for Health Research and Development and the Sophia Children's Hospital Foundation.
       
  • The role of blood volume in cardiac dysfunction and reduced exercise
           tolerance in patients with diabetes
    • Abstract: Publication date: Available online 26 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): David Montero, Candela Diaz-Canestro, Laura Oberholzer, Carsten LundbySummaryBlood volume is an integral component of the cardiovascular system, and fundamental to discerning the pathophysiology of multiple cardiovascular conditions leading to exercise intolerance. Based on a systematic search of controlled studies assessing blood volume, in this Personal View we describe how hypovolaemia is a prevalent characteristic of patients with diabetes, irrespective of sex, age, and physical activity levels. Multiple endocrine and haematological mechanisms contribute to hypovolaemia in diabetes. The regulation of intravascular volumes is altered by sustained hyperglycaemia and hypertension. Chronic activation of endocrine systems controlling fluid homeostasis, such as the renin–angiotensin–aldosterone system and vasopressin axis, has a role in progressive kidney desensitisation and diabetic nephropathy. Furthermore, albumin loss from the intravascular compartment reduces the osmotic potential of plasma to retain water. Hypovolaemia also affects the loading conditions and filling of the heart in diabetes. The elucidation of modifiable volumetric traits will plausibly have major health benefits in the diabetes population.
       
  • Correction to Lancet Diabetes Endocrinol 2019; 7: 417–19
    • Abstract: Publication date: Available online 17 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s):
       
  • Amos Laar: combating non-communicable diseases in Ghana
    • Abstract: Publication date: Available online 12 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Ray Cavanaugh
       
  • The expanding résumé of SGLT2 inhibitors
    • Abstract: Publication date: Available online 10 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Ian H de Boer
       
  • IDegLira: combining efficacy, durability, and convenience'
    • Abstract: Publication date: Available online 9 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Srikanth Bellary, Abd A Tahrani, Anthony H Barnett
       
  • Diabetes in humanitarian crises: the Boston Declaration
    • Abstract: Publication date: Available online 6 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Sylvia Kehlenbrink, Lindsay M Jaacks, Sigiriya Aebischer Perone, Éimhín Ansbro, Elizabeth Ashbourne, Carol Atkinson, Mark Atkinson, Rifat Atun, Stéphane Besançon, Philippa Boulle, Helen Bygrave, Enrique Caballero, Katy Cooper, Angelica Cristello, Katy Digovich, Shannon Doocy, Senan Ebrahim, Margaret Ewen, Dina Goodman, Lena Hamvas
       
  • Three generational phenotypes of sporadic primary hyperparathyroidism:
           evolution defined by technology
    • Abstract: Publication date: Available online 3 June 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Cristiana Cipriani, John P Bilezikian
       
  • Diabetes in pregnancy and epigenetic mechanisms—how the first 9 months
           from conception might affect the child's epigenome and later risk of
           disease
    • Abstract: Publication date: Available online 22 May 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Line Hjort, Boris Novakovic, Louise G Grunnet, Louise Maple-Brown, Peter Damm, Gernot Desoye, Richard SafferySummaryDiabetes in pregnancy is not only associated with increased risk of pregnancy complications and subsequent maternal metabolic disease, but also increases the risk of long-term metabolic disease in the offspring. At the interface between genetic and environmental factors, epigenetic variation established in utero represents a plausible link between the in utero environment and later disease susceptibility. The identification of an epigenetic fingerprint of diabetes in pregnancy linked to the metabolic health of the offspring might provide novel biomarkers for the identification of offspring most at risk, before the onset of metabolic dysfunction, for targeted monitoring and intervention. In this Personal View, we (1) highlight the scale of the problem of diabetes in pregnancy, (2) summarise evidence for the variation in offspring epigenetic profiles following exposure to diabetes in utero, and (3) outline potential future approaches to further understand the mechanisms by which exposure to maternal metabolic dysfunction in pregnancy is transmitted through generations.
       
  • Correction to Lancet Diabetes Endocrinol 2019; published online May 13.
           https://doi.org/10.1016/S2213-8587(19)30076-2
    • Abstract: Publication date: Available online 22 May 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s):
       
  • Sicker, Fatter, Poorer: The Urgent Threat of Hormone-Disrupting Chemicals
           to Our Health and Future…and What We Can Do About It, Leonardo Trasande.
           Houghton Mifflin Harcourt (2019), 240, US$22·00, ISBN: 978-1328553492
    • Abstract: Publication date: Available online 16 May 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Michele A La Merrill
       
  • Understanding the mechanisms of reversal of type 2 diabetes
    • Abstract: Publication date: Available online 13 May 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Roy Taylor, Ahmad Al-Mrabeh, Naveed SattarSummaryClinical and pathophysiological studies have shown type 2 diabetes to be a condition mainly caused by excess, yet reversible, fat accumulation in the liver and pancreas. Within the liver, excess fat worsens hepatic responsiveness to insulin, leading to increased glucose production. Within the pancreas, the β cell seems to enter a survival mode and fails to function because of the fat-induced metabolic stress. Removal of excess fat from these organs via substantial weight loss can normalise hepatic insulin responsiveness and, in the early years post-diagnosis, is associated with β-cell recovery of acute insulin secretion in many individuals, possibly by redifferentiation. Collectively, these changes can normalise blood glucose levels. Importantly, the primary care-based Diabetes Remission Clinical Trial (DiRECT) showed that 46% of people with type 2 diabetes could achieve remission at 12 months, and 36% at 24 months, mediated by weight loss. This major change in our understanding of the underlying mechanisms of disease permits a reassessment of advice for people with type 2 diabetes.
       
  • Sugar and Tension: Diabetes and Gender in Modern India, Lesley Jo Weaver.
           Rutgers University Press (2018), 202, US$34·95, ISBN: 978-1-9788-0300-8
    • Abstract: Publication date: Available online 10 May 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Latha Palaniappan
       
  • Sophia Zoungas: clinician, researcher, and full-time mum
    • Abstract: Publication date: Available online 9 May 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Tony Kirby
       
  • The importance of high-quality mendelian randomisation studies for
           clinical thyroidology
    • Abstract: Publication date: Available online 7 May 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Marco Medici, Robin Peeters, Alexander Teumer, Peter Taylor
       
  • The Elephant in the Room: One Fat Man's Quest to Get Smaller in a Growing
           America, Tommy Tomlinson. Simon & Schuster (2019), 256, £16·99, ISBN:
           978-1501111617
    • Abstract: Publication date: Available online 24 April 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Stuart W Flint
       
  • Eating NAFTA: Trade, Food Policies, and the Destruction of Mexico, Alyshia
           Gálvez. University of California Press (2018), 288, US$29·95, ISBN:
           978-0520291812
    • Abstract: Publication date: Available online 18 April 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Marion Nestle
       
  • Challenges associated with providing diabetes care in humanitarian
           settings
    • Abstract: Publication date: Available online 14 March 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Philippa Boulle, Sylvia Kehlenbrink, James Smith, David Beran, Kiran JobanputraSummaryThe humanitarian health landscape is gradually changing, partly as a result of the shift in global epidemiological trends and the rise of non-communicable diseases, including diabetes. Humanitarian actors are progressively incorporating care for diabetes into emergency medical response, but challenges abound. This Series paper discusses contemporary practical challenges associated with diabetes care in humanitarian contexts in low-income and middle-income countries, using the six building blocks of health systems described by WHO (information and research, service delivery, health workforce, medical products and technologies, governance, and financing) as a framework. Challenges include the scarcity of evidence on the management of diabetes and clinical guidelines adapted to humanitarian contexts; unavailability of core indicators for surveillance and monitoring systems; and restricted access to the medicines and diagnostics necessary for adequate clinical care. Policy and system frameworks do not routinely include diabetes and little funding is allocated for diabetes care in humanitarian crises. Humanitarian organisations are increasingly gaining experience delivering diabetes care, and interagency collaboration to coordinate, improve data collection, and analyse available programmes is in progress. However, the needs around all six WHO health system building blocks are immense, and much work needs to be done to improve diabetes care for crisis-affected populations.
       
 
 
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