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Journal JAMA

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Christianne L. Roumie, Jonathan Chipman, Jea Young Min, Amber J. Hackstadt, Adriana M. Hung, Robert A. Greevy, Carlos G. Grijalva, Tom Elasy, Marie R. Griffin
Published: 19 September 2019
JAMA pp 1-11; doi:10.1001/jama.2019.13206

Abstract:In 2012, there were approximately 30 million US adults diagnosed as having type 2 diabetes, of whom 20% also had impaired kidney function.1 Metformin is the initial recommended diabetes treatment based on the beneficial results reported in 1998 from the UK Prospective Diabetes Study (UKPDS) 34.2,3 The UKPDS demonstrated that metformin reduced the incidence of macrovascular complications compared with sulfonylureas or insulin independent of glycemic control.2,4 Several large observational studies support the UKPDS findings.4-7
Deborah J. Wexler
Published: 19 September 2019
JAMA; doi:10.1001/jama.2019.14533

Julio Rosenstock, Steven E. Kahn, Odd Erik Johansen, Bernard Zinman, Mark A. Espeland, Hans J. Woerle, Egon Pfarr, Annett Keller, Michaela Mattheus, David Baanstra, et al.
Published: 19 September 2019
JAMA; doi:10.1001/jama.2019.13772

Abstract:When choosing medications to manage type 2 diabetes, cardiovascular safety, glucose-lowering potency, hypoglycemia risk, effect on body weight, and cost are important considerations.1-3 Most guidelines state that metformin should be first-line therapy followed by various options for second-line treatment if sufficient glycemic control is not achieved after metformin monotherapy.1-3 Sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors are the most commonly used second-line glucose-lowering treatments in many countries.4 Sulfonylureas are used mainly based on their low cost, well-established glucose-lowering action, and a long-standing experience in clinical practice. However, sulfonylureas are associated with increased risk of hypoglycemia1,3,5-7 and modest weight gain.1,5 In addition, there is an ongoing controversy regarding their long-term cardiovascular safety, based on early data from the University Group Diabetes Program in the 1960s8 and multiple observational and smaller studies indicating conflicting results.9,10
Akshay S. Desai, Scott D. Solomon, Amil M. Shah, Brian L. Claggett, James C. Fang, Joseph Izzo, Kevin McCague, Cheryl A. Abbas, Ricardo Rocha, Gary F. Mitchell, et al.
Published: 17 September 2019
JAMA, Volume 322, pp 1077-10; doi:10.1001/jama.2019.12843

Abstract:Among patients with heart failure and reduced ejection fraction (HFrEF) enrolled in the Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) Trial,1 angiotensin receptor–neprilysin inhibition (ARNI) with sacubitril-valsartan reduced the primary composite outcome of cardiovascular death or heart failure hospitalization relative to angiotensin-converting enzyme (ACE) inhibition with enalapril. The benefits of sacubitril-valsartan were apparent early after randomization, consistent across all examined subgroups, and unrelated to differential changes in blood pressure over the course of the trial.1,2 Treatment guidelines have been updated to encourage substitution of ARNI for ACE inhibitors/angiotensin receptor blockers (ARBs) in patients with symptomatic HFrEF.3
James L. Januzzi, Margaret F. Prescott, Javed Butler, G. Michael Felker, Alan S. Maisel, Kevin McCague, Alexander Camacho, Ileana L. Piña, Ricardo A. Rocha, Amil M. Shah, et al.
Published: 17 September 2019
JAMA, Volume 322, pp 1085-11; doi:10.1001/jama.2019.12821

Abstract:In the Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality in Heart Failure (PARADIGM-HF) Study,1 long-term therapy with sacubitril-valsartan (a combination angiotensin receptor/neprilysin inhibitor [ARNI]) lowered rates of cardiovascular death or heart failure (HF) hospitalization compared with enalapril. Other outcomes, such as mortality and quality of life, were also favorably affected by ARNI therapy. Despite the clinical benefits of sacubitril-valsartan, uncertainty regarding the mechanism(s) of benefit remains.
Michael C. Izzo, Guri Bronner, Carol L. Shields
Published: 17 September 2019
JAMA, Volume 322; doi:10.1001/jama.2019.12691

Beverly E. Sha
Published: 17 September 2019
JAMA, Volume 322; doi:10.1001/jama.2019.12739

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