SGLT2 inhibitors as add on therapy in type 2 diabetes: a real world study

Abstract Background: Type 2 diabetes mellitus (T2DM) is a progressive chronic disease associated with severe microvascular and macrovascular complications. Our aim is to assess the real world effectiveness of SGT" inhibitors in achieving metabolic therapeutic goals. Methods: A retrospective, observational study. Inclusion criteria for patients were a previous diagnosis of type 2 diabetes mellitus, age > 18 years, patients receiving either dapagliflozin 10 mg and/or canagliflozin 300 mg. We excluded pregnant patients, patients with type 1 diabetes mellitus and acute metabolic complications of diabetes. Patients included in the analysis were enrolled in a health plan at least 6 months prior to the index date (baseline period) and in the 6 months following the index date (follow-up period). Achievement of glycated hemoglobin goals were established as <7%. Results: We screened 2870 Mexican patients; 288 (10.03% received SGLT2 inhibitors). Mean age for both groups of patients was 57.68±11.06 years. The dapagliflozin control rate was 19.56% and the canagliflozin control rate 18.96%. Monotherapy with SGLT2 inhibitors was used in 21 patients (6.25%). Overall HbA1c goals were met in 56 patients (19. 44%) with similar results with dapagliflozin or canagliflozin. The combination of SGLT2 inhibitors and sulfonylureas had the highest control rate (30.30%) compared to other regimens. Monotherapy was present in 6.25%. Insulin requirement was associated with poor control (2.8% vs. 18.05%, P<0.05, 95% CI [0.07, 0.84]). Combination therapy with DPP4 inhibitors was associated with better control (P<0.05, 95% CI, [1.10, 3.92]). Conclusion: No difference between the drugs was observed. Real-world effectiveness data of SGLT2 inhibitors show that the percentage of patients reaching metabolic goals is low. SLGT2 inhibitors were used more frequently as combined therapy. Keywords: Dapagliflozin, Canagliflozin, Diabetes Mellitus, Type 2, Effectiveness research, comparative, Hemoglobin A, Glycosylate

Tendencies in medical publications

To describe the trends of research design in publications from high-impact medical journals. Methods: A cross-sectional, descriptive study was conducted by searching the 2011 electronic publications of the journals: New England Journal of Medicine, Journal of the American Medical Association, The Lancet, British Medical Journal, and Annals of Internal Medicine. Studies were classified as primary and secondary. The journal impact factor was taken from the Journal Citation Report website. Descriptive statistics were used to analyze and interpret the data. Results: We analyzed 1130 publications: 804 primary and 326 secondary studies, which represented 71.2% and 28.8% of the total publications, respectively. Among the primary studies, randomized clinical trials (30.4%) were the most prevalent, followed by cohort studies (21.9%) and case reports (9.0%). Conclusions: These findings can have implications in Evidence-Based Medicine programs. Literature review should focus on reviewing secondary articles first, then experimental studies and finally, observational studie

Múltiples miradas para renovar una agenda urbana en crisis

La crisis actual de las ciudades en América Latina y el Caribe no es resultado exclusivo de la pandemia. La actual coyuntura acelera e intensifica las desigualdades y demuestra la persistencia, emergencia y fracturas que caracterizan la dinámica de su producción y reproducción en la región. Así, la crisis urbana posee una historicidad propia, es estructural y está directamente asociada con el carácter no sostenible del modelo de urbanización latinoamericano. La vivienda, el agua y saneamiento, la protección social, el acceso al equipamiento urbano, entre otras, han cobrado una importancia renovada en la actual coyuntura, atravesadas por la matriz de desigualdades multidimensionales y entramadas que caracteriza a las sociedades latinoamericanas y caribeñas