3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p<0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p<0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

CURRENT AND HISTORICAL USE OF ALPHA-CHLORALOSE ON WILD TURKEYS

Alpha-chloralose (AC) has been used as an anesthetic since 1897 to capture or sedate wildlife, including waterfowl, wood-pigeon (Columba palumbus), and black bear (Ursus americana). The first use of AC in the United States was for the capture of house sparrows (Passer domesticus), red-winged blackbirds (Agelaius phoeniceus), and wild turkeys (Meleagris gallopavo) in 1964. Prior to the 1990s, AC was not registered by the Food and Drug Administration (FDA) for use as an immobilizing agent in the United States for wild animals that might be used for human consumption. In 1992, the FDA granted the US Department of Agriculture (USDA), Animal and Plant Health Inspection Service (APHIS), Wildlife Services (WS) an Investigative New Animal Drug for AC to capture waterfowl, American coots (Fulica americana), and pigeons (rock doves, Columba livia). During the late 1990s, ravens (Corvus corax) were added the species list on which AC could be used. In 2004, the FDA authorized the addition of sandhill cranes (Grus canadensis) to the list. Knowing that AC had been used on turkeys, the Arizona Game and Fish Department requested WS assistance in reintroducing Gould’s turkeys (Meleagris gallopavo mexicana) to southeastern Arizona. To reduce stress on the birds during handling and testing, we sedated turkeys at the rate of 2.04 g of AC per 1 cup of cracked corn for up to 3 turkeys. In 2003 and 2004, wild turkeys were sedated during quarantine trials, fully recovered from the sedation and were available for relocation. Based on these data and a review of the published literature, we recommend that AC should be considered for future sedations of wild turkeys and that wild turkeys be considered for inclusion on the current Investigative New Animal Drug (INAD) label for AC

On the delineation of tropical vegetation types with an emphasis on forest/savanna transitions

Background: There is no generally agreed classification scheme for the many different vegetation formation types occurring in the tropics. This hinders cross-continental comparisons and causes confusion as words such as 'forest' and 'savanna' have different meanings to different people. Tropical vegetation formations are therefore usually imprecisely and/or ambiguously defined in modelling, remote sensing and ecological studies.Aims: To integrate observed variations in tropical vegetation structure and floristic composition into a single classification scheme.Methods: Using structural and floristic measurements made on three continents, discrete tropical vegetation groupings were defined on the basis of overstorey and understorey structure and species compositions by using clustering techniques.Results: Twelve structural groupings were identified based on height and canopy cover of the dominant upper stratum and the extent of lower-strata woody shrub cover and grass cover. Structural classifications did not, however, always agree with those based on floristic composition, especially for plots located in the forest-savanna transition zone. This duality is incorporated into a new tropical vegetation classification scheme.Conclusions: Both floristics and stand structure are important criteria for the meaningful delineation of tropical vegetation formations, especially in the forest/savanna transition zone. A new tropical vegetation classification scheme incorporating this information has been developed. © 2013 Copyright 2013 Botanical Society of Scotland and Taylor & Francis