The American journal of medicine
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Review
Injecting New Ideas Into Managing Type 2 Diabetes: Evolving Roles of GLP-1 Receptor Agonists.
Type 2 diabetes is a progressive disease that often requires therapeutic intensification. Patients with type 2 diabetes frequently experience complications related to hyperglycemia, treatment-induced hypoglycemia, and comorbidities. Management of patients with type 2 diabetes is complicated and must be individualized, though guidelines from both the American Diabetes Association and the American Association of Clinical Endocrinologists/American College of Endocrinology provide treatment algorithms detailing therapeutic escalation with both oral and injectable therapies according to glycated hemoglobin (A1c) level. ⋯ These incretin-based therapies, available in both daily and weekly formulations, have been shown to significantly reduce A1c levels, body weight, and cardiovascular risk factors. In this 4-part series, 2 expert physicians discuss clinical profiles of GLP-1 receptor agonists, strategies to reduce cardiovascular risk in type 2 diabetes, barriers to the use of injectable noninsulin therapies, and practical recommendations for noninsulin injectable therapies. These accredited educational programs are available online at https://glp1cme.elsevierresource.com/.
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The world is currently grappling with the potentially life-threatening coronavirus disease 2019 (COVID-19), marking it as the most severe health crisis in the modern era. COVID-19 has led to a pandemic, with the World Health Organization (WHO) predicting that individuals with diabetes are at a higher risk of contracting the virus compared to the general population. This review aims to provide a practical summary of the long-term impacts of COVID-19 on patients with diabetes. Specifically, it focuses on the effects of SARS-CoV-2 on different types of diabetic patients, the associated mortality rate, the underlying mechanisms, related complications, and the role of vitamin D and zinc in therapeutic and preventive approaches. ⋯ Diabetes increases the morbidity and mortality risk for patients with COVID-19. Efforts are globally underway to explore therapeutic interventions aimed at reducing the impact of diabetes on COVID-19.
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Review Case Reports
A Case-Based Approach to the Management of Patients with Chronic Coronary Disease: Updates from the 2023 AHA/ACC Guidelines.
The 2023 American Heart Association (AHA)/American College of Cardiology (ACC) Multisociety Guideline for the Management of Patients with Chronic Coronary Disease presents important updates to the care of patients with chronic coronary disease. The recommendations of these guidelines inform the care for patients with 1) asymptomatic coronary artery disease, 2) stable angina or equivalent symptoms (e.g., dyspnea upon exertion), 3) symptomatic nonobstructive coronary disease including coronary microvascular dysfunction and vasospasm, and 4) left ventricular (LV) systolic dysfunction with known coronary artery disease. In this review, we aim to demonstrate key recommendations in the 2023 guideline using the following four hypothetical cases.
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Pulmonary hypertension (PH) is a disease that is generally first encountered by primary care physicians. Usually, patients present with dyspnea on exertion and a loss of exercise tolerance, although they can have symptoms of chest discomfort, syncope, or edema. Most patients are diagnosed with 2 dimensional doppler echocardiography although echo is not 100% sensitive nor specific in making this diagnosis. ⋯ This is best performed by those that specialize in management of this disease. It is important to diagnose patients who have pulmonary hypertension due to pulmonary artery hypertension and patients with chronic thromboembolic pulmonary hypertension as these patients require specialized treatment that is most effective if started early in the disease course. This review discusses issues related to diagnosis and appropriate referral of patients with pulmonary hypertension.
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Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have become central in managing obesity and type 2 diabetes, primarily through appetite suppression and metabolic regulation. This review explores the mechanisms underlying GLP-1 RA-induced weight loss, focusing on central and peripheral pathways. Centrally, GLP-1 RAs modulate brain regions controlling appetite, influencing neurotransmitter and peptide release to regulate hunger and energy expenditure. ⋯ They also reduce triglycerides and low-density lipoprotein cholesterol, mitigate adipose tissue inflammation, and minimize ectopic fat deposition, promoting overall metabolic health. Emerging dual and triple co-agonists, targeting GLP-1 alongside glucose-dependent insulinotropic polypeptide, and glucagon pathways, may enhance weight loss and metabolic flexibility. Understanding these mechanisms is crucial as the therapeutic landscape evolves, offering clinicians and researchers insights to optimize the efficacy of current and future obesity treatments.