Sodium Glucose Cotransporter-2 (SGLT-2) Inhibitor Related Diabetic Ketoacidosis

Diabetic ketoacidosis is a rare but serious and life-threatening acute complication of diabetes mellitus. It is characterized by ketoacidosis with other findings and should be treated immediately. In this case, a 33-year-old diabetic patient who admitted to the emergency department with diabetic ketoacidosis is presented. The patient was prescribed empagliflozin (sodium glucose cotransporter inhibitor-2) a month ago. The SGLT-2 inhibitors have been approved for use in the treatment of type 2 DM and are still not used in the treatment of type 1 DM. There are such reports of unusual side effects related SGLT-2 inhibitors, in the literature and among them, ketoacidosis is a rare and important side effect

Lithium intoxication related multiple temporary ecg changes: A case report

Lithium is a widely used mood stabilizer, which may cause cardiac side effects. In this article, we present the case of a 39-year-old woman who had presented with pre-syncope and developed multiple ECG abnormalities that are caused by lithium intoxication and are disappeared after hemodialysis

Efficacy and safety of oral semaglutide with flexible dose adjustment versus sitagliptin in type 2 diabetes (PIONEER 7): a multicentre, open-label, randomised, phase 3a trial

Background: Oral semaglutide is the first oral formulation of a glucagon-like peptide-1 (GLP-1) receptor agonist developed for the treatment of type 2 diabetes. We aimed to compare the efficacy and safety of flexible dose adjustments of oral semaglutide with sitagliptin 100 mg. Methods: In this 52-week, multicentre, randomised, open-label, phase 3a trial, we recruited patients with type 2 diabetes from 81 sites in ten countries. Patients were eligible if they were aged 18 years or older (19 years or older in South Korea), had type 2 diabetes (diagnosed ≥90 days before screening), HbA1c of 7·5–9·5% (58–80 mmol/mol), and were inadequately controlled on stable daily doses of one or two oral glucose-lowering drugs (for 90 days or more before screening). Participants were randomly assigned (1:1) by use of an interactive web-response system, stratified by background glucose-lowering medication at screening, to oral semaglutide with flexible dose adjustments to 3, 7, or 14 mg once daily or sitagliptin 100 mg once daily. To approximate treatment individualisation in clinical practice, oral semaglutide dose could be adjusted on the basis of prespecified HbA1c and tolerability criteria. Two efficacy-related estimands were prespecified: treatment policy (regardless of treatment discontinuation or use of rescue medication) and trial product (on treatment and without use of rescue medication) for participants randomly assigned to treatment. The primary endpoint was achievement of HbA1c of less than 7% (53 mmol/mol) at week 52 and the confirmatory secondary efficacy endpoint was change in bodyweight from baseline to week 52. Safety was assessed in all participants who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT02849080, and European Clinical Trials Database, EudraCT number 2015-005593-38, and an open-label extension is ongoing. Findings: Between Sept 20, 2016, and Feb 7, 2017, of 804 patients assessed for eligibility, 504 were eligible and randomly assigned to oral semaglutide (n=253) or sitagliptin (n=251). Most participants were male (285 [57%] of 504) with a mean age of 57·4 years (SD 9·9). All participants were given at least one dose of their allocated study drug except for one participant in the sitagliptin group. From a mean baseline HbA1c of 8·3% (SD 0·6%; 67 mmol/mol [SD 6·4]), a greater proportion of participants achieved an HbA1c of less than 7% with oral semaglutide than did with sitagliptin (treatment policy estimand: 58% [134 of 230] vs 25% [60 of 238]; and trial product estimand: 63% [123 of 196] vs 28% [52 of 184]). The odds of achieving an HbA1c of less than 7% was significantly better with oral semaglutide than sitagliptin (treatment policy estimand: odds ratio [OR] 4·40, 95% CI 2·89–6·70, p<0·0001; and trial product estimand: 5·54, 3·54–8·68, p<0·0001). The odds of decreasing mean bodyweight from baseline to week 52 were higher with oral semaglutide than with sitagliptin (estimated mean change in bodyweight, treatment policy estimand: −2·6 kg [SE 0·3] vs −0·7 kg [SE 0·2], estimated treatment difference [ETD] −1·9 kg, 95% CI −2·6 to −1·2; p<0·0001; and trial product estimand: −2·9 kg [SE 0·3] vs −0·8 kg [SE 0·3], ETD −2·2 kg, −2·9 to −1·5; p<0·0001). Adverse events occurred in 197 (78%) of 253 participants in the oral semaglutide group versus 172 (69%) of 250 in the sitagliptin group, and nausea was the most common adverse event with oral semaglutide (53 [21%]). Two deaths occurred in the sitagliptin group during the trial. Interpretation: Oral semaglutide, with flexible dose adjustment, based on efficacy and tolerability, provided superior glycaemic control and weight loss compared with sitagliptin, and with a safety profile consistent with subcutaneous GLP-1 receptor agonists. Funding: Novo Nordisk A/S

Temporomandibular Disorders

Objective: The aim of this study was to assess a possible relationship between temporomandibular disorders [TMD] and serum levels of sulfhydryl [SH] groups and ceruloplasmin [CP], paraoxonase-1 [PON1], and arylesterase [ARE] activities. Method: This study included patients with TMD and healthy normal controls [HNC]. After clinical and radiographic examinations, the patient group was given a visual analog scale to determine severity of pain. Serum samples of the subjects were obtained to calculate certain antioxidant components. The CP, PON1, and ARE activities and serum levels of SH groups were measured. Results: There were 31 patients with TMD and 35 HNC. Serum levels of SH and ARE activity of the TMD group were significantly lower than those of the HNC group [P 0.05]. The difference between CP and PON1 activity of the TMD and HNC groups were not statistically significant [P 0.05]. No association was found between antioxidant levels and severity of pain and the type of the TMD. Conclusions: Antioxidant components may be associated with TMD, implying possible systemic inflammatory and oxidative aspect of TMD

Jugend-Check zum Entwurf eines Sechsundzwanzigsten Gesetzes zur Änderung des Bundesausbildungsförderungsgesetzes (26. BAföGÄndG) (Stand: 09.01.2019)

Mit dem 26. BAföG-Änderungsgesetz werden die BAföG-Sätze an aktuelle Entwicklungen angepasst und das Ziel verfolgt, förderungsberechtigte Personen wieder besser zu erreichen. Der Gesetzentwurf sieht eine Erhöhung der Bedarfssätze in zwei Stufen, jeweils zum Wintersemester bzw. zum Schuljahresbeginn, vor. 2019 werden diese Sätze um fünf Prozent und 2020 um zwei Prozent angehoben, vgl. § 12 Abs. 1 und 2, § 13 Abs. 1 BAföG. So wird der monatliche Grundbedarf für Studierende beispielsweise von 399 Euro pro Monat auf 419 Euro bzw. 427 Euro in den Jahren 2019 und 2020 festgesetzt. Zudem wird die Wohnkostenpauschale für Studierende sowie für Schülerinnen und Schüler, die Fachschulklassen , Abendgymnasien oder Kollegs besuchen und nicht bei ihren Eltern wohnen, von derzeit 250 Euro auf 325 Euro pro Monat erhöht, vgl. § 13 Abs. 2 BAföG. Des Weiteren werden die Einkommensfreibeträge in drei Schritten erhöht: 2019 um 7 Prozent, 2020 um 3 Prozent und 2021 um 6 Prozent. Damit steigt z.B. der Grundfreibetrag von Elterneinkommen von derzeit 1.715 Euro im Monat in drei Schritten auf 2.000 Euro im Jahr 2021, § 25 Abs. 1 Nr. 1 BAföG. Zudem werden 2020 die Freibeträge für eigenes Vermögen des Auszubildenden von 7.500 Euro auf 8.200 Euro angehoben, § 29 Abs. 1 Nr. 1 BAföG. Im Zuge der Erhöhung der Bedarfssätze werden ebenso die Kranken- und Pflegeversicherungszuschläge angehoben, wobei erstmals die Zusatzbelastungen durch erhobene Zusatzbeiträge der Krankenkassen Berücksichtigung finden, vgl. § 13a BAföG. Die monatliche Mindestrate zur Rückzahlung der Ausbildungsförderung (BAföG) wird in Anlehnung an die vorgenommenen Neuregelungen auf 130 Euro im Monat angehoben, § 18 Abs. 3 BAföG. In diesem Zusammenhang wird die maximale Rückzahlungsdauer des Darlehens auf 20 Jahre begrenzt, § 18 Abs. 3 BAföG. Dies gilt fortan auch für diejenigen, die für eine gewisse Dauer von den Zahlungen befreit wurden. Zudem wird die Rückzahlung auf 77 Monatsraten begrenzt, § 18 Abs. 13 BAföG. Zum Wintersemester 2019/2020 wird ein zinsfreies Staatsdarlehen (Volldarlehen) eingeführt, welches das verzinsliche Bankdarlehen der Kreditanstalt für Wiederaufbau (KfW) ersetzt. Dieses verzinsliche Darlehen wird derzeit häufig als „Hilfe zum Studienabschluss“ in Anspruch genommen, nachdem die BAföG-Förderungsdauer durch Überschreiten der Regelstudienzeit endet. Letztlich soll die zweijährige Berichtspflicht der Bundesregierung von 2019 auf 2021 verschoben werden, § 35 S. 4 BAföG. Der Bericht bildet die Grundlage zur Anpassung der Bedarfssätze und Freibeträge. Weiterhin wird der Katalog der Ausbildungsstätten, die in den Förderungsbereich des BAföG einbezogen sind, um private Berufsakademien ohne Hochschuleigenschaft, sog. Akademien im tertiären Bereich, ergänzt, vgl. § 2 Abs. 1 S.1 Nr. 5 und 6 BAföG