Publication highlights: 10-17 July 2023

1. Understanding the Role of the Gut #Microbiome in #Diabetes

This systematic review aimed to assess and identify any dietary and therapeutic agents that may alter the #microbiota and potentially target and modulate insulin sensitivity. It was found that the #gutmicrobiome had a significantly strong relationship in diabetic individuals. In small pilot studies, the use of prebiotics and probiotic supplementation showed reductions in inflammatory markers, which was not a substitute for drug therapy but did find mild improvements in insulin resistance, but not significant enough to warrant treatment in diabetic individuals.?Plant-based diets (which are fiber-rich) vs. Animal-based diets (which have more fat and protein-rich components) have inverse relations in terms of inflammatory cytokine activation. With the use of drugs like metformin and post-bariatric surgery, microbial diversity has been noted and can help restore intestinal dysbiosis observed in diabetic individuals.

2. Impact of the SGLT2-inhibitor empagliflozin on inflammatory biomarkers after acute myocardial infarction-– a post-hoc analysis of the #EMMY trial

Patients after #acute #myocardialinfarction (AMI), received either 10?mg #empagliflozin once daily or placebo over a period of 26 weeks as an add-on to standard guideline-recommended therapy starting within 72?h after percutaneous coronary intervention. The endpoints investigated were the mean change in inflammatory biomarkers such as high-sensitive c-reactive protein (hsCRP), interleukin-6 (IL-6), neutrophils, leukocytes, neutrophile/lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) from baseline to 26 weeks. Trajectories of inflammatory biomarkers showed a pronounced decline after AMI, but Empagliflozin treatment did not impact this decline indicating no central role in blunted systemic inflammation mediating beneficial effects.

3. Bromocriptine as a Therapeutic Modality in the Treatment of Diabetes Mellitus

The Food and Drug Administration (FDA) approved #bromocriptine, with a different mechanism of action than the traditional medications for the treatment of #diabetes in 2009 but has not been used as either first-line therapy or add-on therapy. This systematic review evaluated the mechanism of action, efficacy, and safety of bromocriptine in patients with #diabetes as monotherapy?and compared its efficacy as an add-on therapy with some of the first-line treatments for #diabetes like metformin, sulfonylureas, and teneligliptin. There was a clinical improvement in reducing HbA1C with a progressive increase in the once-daily dosage of bromocriptine quick release (BCQR) in treatment-naive DM patients. Administration of Bromocriptine mesylate in patients failing treatment with sulfonylurea, metformin, and at least one oral hypoglycemic agent, showed significant improvement in HbA1c with a progressive increase in once-daily dosage levels. BCQR?was also found to improve blood glucose levels at the end of 4 weeks. There were benefits of bromocriptine as an add-on therapy to metformin with significant improvement in #HbA1c, FPG, and PPPG when compared to metformin alone. However, only few trials have been conducted to evaluate bromocriptine for the treatment of diabetes.

4. Effect of omega-3 fatty acid and vitamin D supplementation on electrocardiographic risk profiles

This randomized clinical trial?examined the effect of 1?g of marine #omega3fattyacids per day, comprising 460?mg eicosapentanoic acid (EPA) and 380?mg of docosahexaenoic acid (DHA), and 2000?IU #VitaminD3?per day on #ECG characteristics associated with atrial and ventricular arrhythmias among individuals age 50?years or greater. A total of 911 study participants underwent ECGs at baseline and again at 2?years after the randomization. Supplementation with omega-3 FA (1?g of EPA + DHA per day) caused several nominally significant changes in ECG parameters over 2-years of follow-up. The PR interval significantly increased and the P-wave duration decreased to a lesser extent in patients randomized to EPA + DHA as compared to placebo. There were also borderline significant net positive differences in change in P-wave amplitude in the Omega-3 FA supplementation arm.?In the Vitamin D supplementation arm, the Cornell mV, a measure of left ventricular hypertrophy, increased to a lesser degree than what was observed in the placebo arm. ?Thus, randomized treatment with omega-3 FA supplements resulted in changes in the ECG that are potentially indicative of an increased vagal tone and/or slowing of intra-atrial and atrioventricular conduction. Vitamin D3?supplementation resulted in modest reductions in progressive LV voltage suggestive of a potential antihypertrophic effect.

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