Cardiopulmonary outcomes in people with impaired lung function: the role of metabolic syndrome

Impaired lung function, either with airflow limitation or with preserved ratio impaired spirometry (PRISm), is common globally and associated with increased cardiorespiratory morbidity, cause-specific mortality and overall mortality.1,2 In this context, understanding the impact of metabolic syndrome on cardiopulmonary outcomes is clinically important, given the growing global prevalence of metabolic syndrome, driven in part by the increasing obesity rates, and its associations with major adverse cardiovascular events and all-cause mortality

Clinical and Cost Implications of Insulin Degludec in Patients with Type 1 Diabetes and Problematic Hypoglycemia:A Quality Improvement Project

Introduction To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal–bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness. Methods Patients with T1D who were aged ≥ 18 years, were on a basal–bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness. Results Six months of follow-up data were available for 42 patients. At 6 months, there was a significant reduction in median (interquartile range) HbA1c, from 8.6 (8.0–9.3)% [70 (64–78) mmol/mol] to 8.4 (7.9–8.9)% [68 (63–74) mmol/mol]; p < 0.05. Median daily basal insulin dose reduced significantly from 30.0 (14.7–45.0) to 25.5 (14.0–30.2) units; p < 0.0001. Data from hospital records showed reductions in the frequency of episodes of severe hypoglycemia from eight in the 6 months preceding degludec initiation to two in the 6 months following initiation. In the same period, diabetic ketoacidosis (DKA) episodes reduced from two before degludec initiation to no episodes after initiation. No patients reported worsening treatment satisfaction after switching to degludec. Considering the reductions in the basal dose required and the frequency of hypoglycemia episodes, we estimate that switching such patients to degludec from other basal insulins could provide significant savings in direct healthcare costs. Conclusion In patients with T1D, switching to degludec was associated with an improvement in HbA1c and reductions in basal insulin dose, severe hypoglycemia, and DKA. When used in appropriate patients, degludec could lead to significant cost savings

Exenatide once weekly: clinical outcomes and patient satisfaction

Exenatide once-weekly is effective, well tolerated in patients with T2DM and should be a useful addition to the available range of anti-diabetes treatments

Managing idiopathic intracranial hypertension in pregnancy: practical advice

Idiopathic intracranial hypertension (IIH) is more common in women of reproductive age who have obesity, yet there is little information on its management specifically in pregnancy. Women with IIH should plan their pregnancy including discussing contraception before pregnancy, recognising that hormonal contraceptives are not contraindicated. Potentially teratogenic medications including acetazolamide and topiramate are not recommended during pregnancy or in those with immediate plans to conceive; prescribing acetazolamide in pregnancy must only follow discussion with the patient and their obstetrician. Ideally, patients should aim to achieve disease remission or control before pregnancy, through optimising their weight. Although weight gain is expected in pregnancy, excessive weight gain may exacerbate IIH and increase maternal and fetal complications; evidence-based recommendations for non-IIH pregnancies may help in guiding optimal gestational weight gain. The vast majority of women with IIH can have a normal vaginal delivery, with spinal or epidural anaesthesia if needed, provided the papilloedema is stable or the IIH is in remission