Canagliflozin and Cardiovascular and Renal Events: NEJM

Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal.



Semaglutide and CV Outcomes

Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375:1834-1844

In patients with type 2 diabetes who were at high cardiovascular risk, the rate of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke was significantly lower among patients receiving semaglutide than among those receiving placebo, an outcome that confirmed the noninferiority of semaglutide.

WHO Atlas on coronary heart disease world wide prevalence – a summary

 “Misfortunes always come in by a door that has been left open for them.” Czechoslovakian proverb

The World Health Organization’s Atlas for Heart Disease and Stroke illustrates that globally in 2002 coronary heart disease (CHD) accounted for 6.8% and 5.3% of Disability Adjusted Life Years (DALYs) in men and women respectively. DALYs are the same as years of life lost to disability and death, and therefore suggest a more meaningful way of projecting disease burden as opposed to simply the resulting death. The burden of CHD is expected to rise from 47 million DALYs in 1990 to 82 million DALYs in 2020 [1]. These figures are similar to HIV/AIDS and unipolar depressive disorders. CHD is now the leading cause of death worldwide and knows no borders. 3.8 million men and 3.6 million women die from CHD each year [2].

The basis of CHD is regarded to be atherosclerosis. Hypercholesterolemia is a major contributor to atherosclerosis. The incidence of CHD is much lower in rural China and Japan where average plasma cholesterol concentration is 4.0 mmol/l as compared to the United Kingdom where it is 5.9 mmol/l and CHD is a major cause of death [3].

1.            WHO. Global burden of coronary heart disease. Cardiovascular Disease, The Atlas of Heart Disease and Stroke  2011 2011 [cited 2011; Available from:

2.            WHO. Deaths from coronary heart disease. Cardiovascular Disease, The Atlas of Heart Disease and Stroke  2011  [cited 2011; Available from:

3.            Chaudhury M, Chapter 9. Risk factors for cardiovascular disease. Health Survey for England 2003, ed. Sproston K. Vol. 2. 2004, London: The Stationary Office.

Recent articles of interest

Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med 2012; 366:1567-1576

Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes. N Engl J Med 2012; 366:1577-1585

Acute headache and visual field defect. BMJ 2012;344:e2229

Diagnosis and management of primary hyperparathyroidism. BMJ 2012;344:e1013

Out-of-Hospital Administration of Intravenous Glucose-Insulin-Potassium in Patients With Suspected Acute Coronary Syndromes. JAMA 2012; doi: 10.1001/jama.2012.426

Metformin and insulin versus insulin alone for type 2 diabetes

BMJ 2012;344:e1771

“The researchers say the combination leads to better blood sugar control, less weight gain and less need for insulin. However, they also suggest that more trials are needed to provide firm evidence about the long term benefits and harms of the combination and specifically about the risks of premature death.” – BMJ Press Release

DKA at diagnosis of diabetes

Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults

In this systematic review, Usher-Smith and colleagues looked at 46 studies of more than 24 000 children from 31 countries. They found that multiple factors affect the risk of developing diabetic ketoacidosis at the onset of type 1 diabetes in children and young adults, and there is potential time, scope, and opportunity to intervene between symptom onset and development of diabetic ketoacidosis for both parents and clinicians. In a linked editorial, Sasigarn A Bowden says that the findings from this study should heighten the awareness of clinicians caring for children and adolescents and continuing education should be provided on the presentation of diabetes.” –