To investigate whether coronary artery calcium (CAC) modifies the association between hormone therapy (HT) use and cardiovascular disease (CVD) events.

A total of 3,235 female participants free of clinical CVD at baseline were included from the Multi-Ethnic Study of Atherosclerosis and monitored for incident CVD. HT status was self-reported and categorized as never, former, and current users. Cox proportional hazards regression models were fit to examine the relationships between HT and CVD outcomes, with and without CAC (as categories), including standard risk factors as covariates.

Participants were 63.4 ± 9.8 years of age, and 90% were postmenopausal. There were 1,024 (32%) current, 1,618 (50%) never, and 593 (18%) former HT users. Current HT users were significantly younger, more likely to be White, had lower prevalence of diabetes mellitus, and higher education and income levels. During the 14.4-year follow-up period, 734 deaths (14.8 per 1000 person-years) and 454 CVD events (10.1 per 1000 person-years) were identified. In multivariable Cox regression analysis including CAC, current HT use versus never use was associated with lower risk for all-cause death (hazard ratio [HR]: 0.70, 95% CI: 0.58-0.86) and in current versus former users (HR: 0.77, 95% CI: 0.61-0.98). Former users did not differ significantly from never users in risk of death or cardiovascular outcomes. Addition of CAC to adjusted models did not meaningfully modify the association between HT status and all-cause death (HR: without CAC: 0.69 [0.57-0.85]; HR with CAC: 0.70 [0.58-0.86]).

Women who received HT have a significantly lower risk of all-cause death compared with never and former users, with CVD and coronary heart disease outcomes trending lower but not reaching statistical significance after adjustment. CAC did not modify the observed association between HT and mortality.

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) carry side-effects such as dizziness and nausea related to increased vagal tone. This study investigated associations between GLP-1 RA use and the risk of vagal activity related (VAR) events.

Using the Danish health registers, patients with type 2 diabetes mellitus (T2DM) first-time initiated on GLP-1 RA (exposure) or SGLT-2i (active control) were identified between January 2010 and October 2022. Standardized 1-year absolute risks of VAR events (syncope, fractures, bradyarrhythmia, or cardiac device implantation) were computed to compare risk associated with GLP-1 RA and SGLT-2i initiation. Complementary analyses in patients treated for obesity were performed as well.

During the study period, 50 076 and 73 138 patients with T2DM were initiated on GLP-1 RA (47% women, median age: 59 years [IQR: 50-68]) or SGLT-2i (39% women, median age: 64 years [IQR: 55-72]). Comorbidity was equally prevalent. The standardized 1-year absolute risk of syncope was 0.58% (95% CI: 0.51%-0.66%) among patients initiated on GLP-1 RA and comparable to patients initiated on SGLT-2i (0.56% [95% CI: 0.50%-0.62%]). 1-year risks of fractures, bradyarrhythmia, and cardiac device implantation were equally low and with corresponding standardized risk ratios of 0.90 (95% CI: 0.79-1.01), 0.97 (95% CI: 0.67-1.28), and 0.86 (95% CI: 0.62-1.10), respectively. No associations were found in the group treated for obesity either.

In nationwide cohorts of patients treated for T2DM or obesity, initiation of GLP-1 RA was not associated with an elevated risk of VAR events. Despite a proposed argumentation of vagal activity, GLP-1 RA use was not associated with an increased risk in real-life users.

Diabetic foot ulcers (DFUs) are a serious complication of diabetes mellitus. Statins are widely used for treatment of dyslipidaemia and prevention of cardiovascular events. They also exert multiple pleiotropic effects, including improvement of endothelial function, and promotion of angiogenesis and tissue repair. Accumulating evidence suggests that these properties may be beneficial in diabetic wound healing. The aim of this comprehensive review was to summarise preclinical and clinical data regarding the potential role of statins in DFUs management. Experimental studies consistently demonstrated that statins promote wound healing through several mechanisms, including increased nitric oxide bioavailability, vascular endothelial growth factor (VEGF)-mediated angiogenesis, improved endothelial function, and increased collagen synthesis and deposition. Emerging drug-delivery strategies, including topical formulations and tissue-engineered scaffolds, further improved therapeutic efficacy. Clinical evidence remains limited but encouraging. Observational studies have reported inconsistent findings, whereas randomised controlled trials suggest that statins may reduce ulcer recurrence and accelerate wound healing without significant safety concerns. Overall, the evidence supports a strong biological rationale for the use of statins as adjunctive therapy in DFUs. However, further research is required to establish their clinical efficacy, dosage, route of administration and treatment duration.

Tirzepatide has demonstrated good efficacy and safety in the management of type 2 diabetes (T2D) in clinical trials. As the importance of early intensive intervention is known, the tirzepatide benefit for early glycemic and weight management (T-BEAT) study investigated the real-world effectiveness of tirzepatide in participants with early stage T2D in Japan.

This in-progress, noninterventional, multicenter, observational study assesses the glycemic control of tirzepatide (5-15 mg once weekly) or oral semaglutide (7-14 mg once daily) in participants with T2D who were naive to oral antidiabetes drugs (OADs) (diet and exercise only) or received OAD monotherapy, excluding oral semaglutide. The primary endpoint is the mean change in glycated hemoglobin (HbA1c) from baseline after up to 12 months of treatment. Patient-reported treatment satisfaction and other secondary endpoints are also being investigated. Baseline characteristics of the participants are reported.

In the tirzepatide group (N = 290), mean participant age was 55.2 (standard deviation [SD] 13.4) years, 45.2% were female, and the mean body weight, body mass index (BMI), and baseline HbA1c were 79.6 (SD 13.2) kg, 29.3 (SD 3.5) kg/m², and 8.0% (SD 0.8), respectively. In the oral semaglutide group (N = 279), the mean participant age was 58.8 (SD 13.3) years, 35.5% were female, and the mean body weight, BMI, and baseline HbA1c were 77.2 (SD 12.3) kg, 28.2 (SD 3.0) kg/m², and 7.8% (SD 0.7), respectively. In both groups, dyslipidemia was the most common comorbidity (62.1% and 67.7%); 40.7% and 38.0% of participants, respectively, concomitantly used OADs; and sodium glucose co-transporter 2 inhibitors and biguanides were the most common OADs.

The T-BEAT study assesses the real-world effectiveness of tirzepatide over a 12-month treatment period in participants with early stage T2D. This study's results are expected to provide valuable information to physicians, enabling them to make informed decisions in routine clinical practice.

This study evaluated the use of transient elastography (TE) to assess the severity of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), in patients with type 2 diabetes mellitus (T2DM), with the aim of exploring the cross-sectional association between hepatic steatosis and prevalent coronary heart disease (CHD) in this population.

A total of 104 patients with T2DM were included. TE measurements were obtained using FibroScan^® (Paris, France) to determine liver stiffness values, reflecting the degree of hepatic fibrosis, and the controlled attenuation parameter (CAP), which quantifies hepatic steatosis. The presence of CHD was evaluated by coronary computed tomography angiography (CTA), with invasive coronary angiography reserved for definitive confirmation in cases with CTA findings suggestive of significant stenosis. Statistical analyses comprised univariate and multivariate logistic regression models, along with receiver operating characteristic (ROC) curve analysis. The events-per-variable ratio was approximately 10. Internal validation was performed using 1,000-fold bootstrap resampling.

Based on coronary CTA findings, patients were categorized into a CHD group (n = 50) and a non-CHD group (n = 54). Both univariate and multivariate logistic regression analyses identified CAP values (p < 0.001) and glycosylated hemoglobin (HbA1c) levels (p < 0.001) as variables independently associated with prevalent CHD among patients with T2DM. The area under the ROC curve (AUC) for CAP in discriminating CHD status was 0.828, whereas the AUC for HbA1c was 0.695. Combined analysis of CAP and HbA1c yielded an AUC of 0.848. Although the absolute increase in AUC was modest, integrated discrimination improvement (IDI = 0.023, p = 0.038) and category‑free net reclassification improvement (NRI = 0.186, p = 0.041) indicated meaningful reclassification of CHD status, supporting the incremental value of the combined model.

CAP, a quantitative indicator reflecting MASLD severity, is strongly associated with prevalent CHD in patients with T2DM. The combined assessment of CAP and HbA1c enhances the accuracy of CHD status discrimination in this population.

Both diabetes mellitus (DM) and obesity are established risk factors for heart failure (HF). While obesity worsens DM outcomes, it may paradoxically confer survival benefits in HF patients. This study investigated the impact of obesity-DM interaction on clinical outcomes in HF.

We pooled data from two prospective Korean HF registries (KorHF, n = 3,200; KorAHF, n = 5,625). Patients were classified by BMI (≤ / > 23 kg/m²) and DM status. Primary endpoints were in-hospital and one-year post-discharge mortality. Among 8,383 patients (mean age 68.2 years; 52.0% male; mean BMI 23.3 kg/m²), 34.0% had DM. Patients were categorized as overweight non-diabetic (31%), overweight diabetic (19%), lean non-diabetic (35%), and lean diabetic (15%). Lean diabetic patients had the worst baseline characteristics and outcomes, while overweight non-diabetic patients had the most favorable profile. In this retrospective analysis, after multivariable adjustment, overweight diabetic patients had a significantly lower one-year mortality risk than lean diabetic patients (adjusted HR 0.65, 95% CI 0.53-0.79; P < 0.001), as did overweight non-diabetic patients. The association between overweight status and in-hospital mortality was attenuated and no longer statistically significant after adjustment (overweight diabetic: adjusted OR 0.68, 95% CI 0.45-1.03, P = 0.069). No significant BMI × DM interaction was observed.

Overweight status was associated with better prognosis in HF patients regardless of DM status, confirming the obesity paradox in both diabetic and non-diabetic HF populations. This obesity paradox was robust for one-year mortality but, after multivariable adjustment, was not independently associated with in-hospital mortality. Given the observational design, these findings should be interpreted as associations rather than evidence of a causal effect.

KorAHF, ClinicalTrials.gov NCT01389843 (propectively registered); KorHF, ClinicalTrials.gov NCT04329234 (prospectively registered).

To provide evidence-informed guidance to assist with shared decision making in the use of advanced technology for the management of adults with diabetes mellitus.

An international task force composed of AACE members with expertise in diabetology and endocrinology reviewed the recent evidence and developed updated guidance for advanced diabetes technology. Relevant studies were identified through a literature review process, and evidence was summarized with key practice points for use of technology in relevant populations. Consensus on the document was obtained through virtual meetings and communications with the task force.

The task force deliberated on areas where evidence supports the use of advanced diabetes technology in different populations of individuals with diabetes mellitus. Also discussed were best practices and implementation considerations for the successful adoption of diabetes technology by individuals with all types of diabetes and their health care professionals.

This consensus statement aims to provide updated information for health care professionals involved in care for adults with diabetes mellitus. It reviews current evidence that informs best practices in the use of continuous glucose monitoring devices, automated insulin-delivery systems, and other insulin delivery devices, in addition to emerging technologies such as continuous ketone monitoring.

Current data on characteristic changes in the amino acid profile of plasma and urine as an integral metabolic indicator of key stages of metabolic dysfunction have been summarized. At different stages of metabolic dysfunction, including insulin resistance, metabolic syndrome, type 2 diabetes mellitus, as well as associated conditions (cardiovascular diseases and chronic kidney disease) both universal and specific (characteristic of specific pathologies) amino acid patterns are formed. The degree of independent contribution of amino acids to pathogenesis and the clinical applicability of individual amino acid metabolites have not been fully studied. Combined profiles and amino acid ratios, reflecting the early manifestations of metabolic pathologies, demonstrate the greatest potential. Amino acid profiling is considered a promising research tool that requires further validation, standardization, and clarification of its mechanisms before possible implementation in routine clinical practice.

Metabolic syndrome (MetS) is a cardiometabolic disorder defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). It is closely linked with type 2 diabetes mellitus (T2DM). The main features of this condition include central obesity, high triglyceride levels, low high-density lipoprotein cholesterol (HDL-C), high blood pressure, and impaired fasting glucose. The bidirectional relationship between MetS and T2DM significantly increases the risk of cardiovascular and metabolic diseases. This review examines the role of sodium-glucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide- 1 (GLP-1) receptor agonists in addressing the different issues associated with MetS. It also discusses their effect on blood sugar control and their benefits for heart and kidney health in people with T2DM.

This study conducted a thorough review of clinical trials, meta-analyses, and guideline recommendations to gather evidence about how SGLT-2 inhibitors and GLP-1 receptor agonists work and their benefits in managing MetS in T2DM.

Both SGLT-2 inhibitors and GLP-1 receptor agonists have shown improvements in body weight, lipid levels, blood pressure control, and blood sugar management. Furthermore, there is strong evidence supporting their protective effects on heart and kidney health, underlining their importance as key treatments for high-risk patients with T2DM and MetS.

Several clinical studies have examined the role of SGLT-2 inhibitors and GLP-1 receptor agonists in addressing MetS, including central obesity, hypertriglyceridemia, low HDL levels, fasting hyperglycaemia, and hypertension.

SGLT-2 inhibitors and GLP-1 receptor agonists form an effective strategy for managing MetS in the context of T2DM. Their broad effects on metabolism and well-known heart and kidney benefits make them vital parts of modern treatment for cardiometabolic conditions.

A 71-year-old patient with known metastatic melanoma undergoing treatment with the immune checkpoint inhibitors Ipilimumab/Nivolumab presented with a rapid deterioration in general condition over the past 24 hours. Approximately three weeks after starting ICI-the-rapy, thyroiditis was diagnosed, which progressed to a substitution-requiring hypothyroidism. Currently, laboratory tests revealed severe keto-acidosis with acute blood sugar derangement (51 mmol/l) despite only a mildly elevated HbA1c (6.3 %). We hereby diagnosed fulminant ICI- associated type 1 diabetes mellitus. Symptoms improved under insulin therapy.