Podcasts about Empagliflozin

Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Episode 211: Understanding HFpEF.  Hyo Mun and Jordan Redden (medical students) explain the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and how it differentiates from HFrEF. Dr. Arreaza asks insightful questions and summarizes some key elements of HFpEF. Written by Hyo Mun, MS4, American University of the Caribbean; and Jordan Redden, MS4, Ross University School of Medicine. Comments and edits by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is EF? Just imagine, the heart is a pump, blood gets into the heart through the veins, the ventricles fill up and then squeeze the blood out. So, the percent of blood that is pumped out is the EF. Let's start at the beginning. What is HFpEF?Mike: HFpEF stands for heart failure with preserved ejection fraction. Basically, these patients squeeze normally—their ejection fraction is 50% or higher—but here's the thing: the heart can't relax and fill the way it should. The muscle gets stiff, almost like a thick leather boot that just won't stretch. And because the ventricle can't fill properly, pressure starts backing up into the lungs and the rest of the body. That's when patients start experiencing shortness of breath, leg swelling, fatigue—all those classic symptoms.Dr. Arreaza: And this is where people get fooled by the ejection fraction.Mike: Exactly. The ejectionfraction tells you total left ventricular emptying, not just forward flow.Jordan: The classic example is severe mitral regurgitation. You can eject 60% of your blood volume and still be in cardiogenic shock because most of that blood is leaking backward into the left atrium instead of going into the aorta. So, you get pulmonary edema, hypotension, fatigue, all with a “normal” EF. Which is honestly terrifying if you're over-relying on echo reports without thinking clinically.Dr. Arreaza: And in HFpEF, functional mitral regurgitation often shows up later in the disease. It's not usually the primary cause; it's more of a marker of advanced disease. Moderate to severe MR in HFpEF independently predicts worse outcomes, including a higher risk of mortality or heart failure hospitalization. So, let's contrast this with HFrEF. How are these two different?Mike: HFrEF—heart failure with reduced ejection fraction—is a pumping problem. The heart muscle is weak and can't contracteffectively. Ejection fraction drops below 40%, and this is your classic systolic dysfunction.Jordan: HFpEF, on the other hand, is diastolic dysfunction. The heart muscle is thick, fibrotic, and noncompliant. It squeezes fine, but it just doesn't relax, even though the EF looks reassuring on paper.Mike: I like to explain it this way: HFrEF is a weak heart that can't squeeze. HFpEF is a stiff heart that can't relax. Totally different problems.Dr. Arreaza: And then there's the gray zone: heart failure with mildly reduced EF, or HFmrEF. That's an EF between 41 and 49% with evidence of elevated filling pressures. It really shares the features of both worlds. So, what actually causes HFpEF versus HFrEF?Jordan: HFpEF is basically what happens when all the problems of modern living catch up with you. You've got chronic hypertension, obesity, diabetes, metabolic syndrome, aging, systemic inflammation—all of these things slowly remodel the heart over years. The muscle gets thick and stiff, and eventually the ventricle just loses its ability to relax. So, HFpEF is really a disease of metabolic dysfunction and chronic stress in the heart. Mike: HFrEF is more about direct injury. Think about myocardial infarctions, ischemic cardiomyopathy, viral myocarditis, alcohol toxicity, chemotherapy like doxorubicin, genetic cardiomyopathies, or chronic uncontrolled tachycardia. These insults actually damage or kill heart muscle cells, leading to a dilated, weak ventricle that can't pump effectively.Dr. Arreaza: So the short version: HFpEF is caused by chronic metabolic and hypertensive stress, while HFrEF is caused mainly by myocardial damage. A question we get a lot: does HFpEF eventually turn into HFrEF? What do you guys think?Mike: In most cases, no. HFpEF patients usually stay HFpEF throughout their disease course. They don't just “burn out” and turn into HFrEF.Jordan: They're generally separate disease entities with different pathophysiology. A patient with HFpEF can develop HFrEF if they have a big myocardial infarction or ongoing ischemia that damages the muscle, but that's not the natural progression.Mike: Interestingly though, the opposite can happen. Some HFrEF patients actually improve their ejection fraction with good medical therapy—that's called HF with improved EF—and it's a great sign that treatment is working.Dr. Arreaza: Another question. How do HFpEF and HFrEF compare to restrictive cardiomyopathy and constrictive pericarditis?Jordan: Clinically, they can all look very similar: dyspnea, edema, fatigue, but the underlying mechanisms are completely different.Mike: In HFpEF, the myocardium itself is stiff from hypertrophy and fibrosis. The problem is intrinsic to the heart muscle, and EF stays preserved. Echoshows diastolic dysfunction with elevated filling pressures.Jordan: In HFrEF, the myocardium is weak. The ventricle is often dilated and contracts poorly, with a reduced EF.Mike: Restrictive cardiomyopathy is different. Here, the myocardium gets infiltrated by abnormal stuff—amyloid, iron, sarcoid—and that makes it extremely stiff. It can look like HFpEF on the surface, but it's usually more severe. On Echo You'll see biatrial enlargement, small ventricles, and preserved EF. And importantly, it's a pathologic diagnosis, so you need advanced imaging or biopsy to confirm it.Jordan: Constrictive pericarditis is another mimic, but here the myocardium is usually normal. The problem is that the pericardium is thickened, calcified, and rigid. This will physically prevent the heart from being filled. Imaging shows pericardial thickening, septal bounce, and respiratory variation in flow, and cath shows equalization of diastolic pressures, which is the hallmark of constrictive pericarditis.Dr. Arreaza: So the takeaway is: HFpEF is a clinical syndrome driven by common metabolic and hypertensive causes, while restrictive and constrictive diseases are specific pathologic entities. If “HFpEF” is unusually severe or not responding to treatment, you need to think beyond HFpEF. Which type of heart failure is more common right now?Mike: Good question, the answer is: HFpEF. It now accounts for up to 60% of all heart failure cases, and it's still rising.Dr. Arreaza: Why is that?Jordan: Because people are living longer, gaining weight, and developing more metabolic syndrome. HFpEF thrives in older, or people with obesity, hypertension, or diabetes: basically, the modern American population. At the same time, better treatment of acute MIs means fewer people are developing HFrEF from massive heart attacks.Mike: HFpEF is the heart failure epidemic of the 21st century. It's honestly the cardiology equivalent of type 2 diabetes.Dr. Arreaza: Let's talk aboutCOVID-19. (2025 and still talking about it) Does it actually increase heart failure risk?Mike: Yes, absolutely. COVID increases both acute and long-term heart failure risk.Jordan: During acute infection, COVID can cause myocarditis, trigger massive inflammation, and precipitate acute decompensated heart failure, especially in patients with pre-existing disease. It also causes microthrombi, which can injure the myocardium.Mike: And after infection, even mild cases are linked to a significantly higher risk of developing new heart failure within the following year. Both HFpEF and HFrEF rates go up.Dr. Arreaza: I remember seeing this in 2021, we had a patient with acute COVID and HFrEF, her EF was about 10%, I lost contact with the patient and at the end I don't know what happened to her. What's the pathophysiology of COVID and heart failure?Mike: COVID causes direct viral injury through ACE2 receptors, triggers massive inflammation that damages the endothelium and heart muscle, leads to microvascular clotting and fibrosis—all mechanisms that promote HFpEF.Jordan: Add autonomic dysfunction, persistent low-grade inflammation, and worsening metabolic syndrome, and you've got a perfect storm for heart failure.Dr. Arreaza: Bottom line: COVID is a cardiovascular disease as much as a respiratory one. If someone had COVID and now has unexplained dyspnea or fatigue, think about heart failure. Get an echo, get a BNP, start treatment. Last big question: why did we have so many therapies for HFrEF but essentially none for HFpEF for years?Mike: HFrEF is mechanistically straightforward. You've got a weak heart with excessive neurohormonal activation going on — so you block RAAS, block the sympathetic system, drop the afterload. The drugs make sense.Jordan: HFpEF is messy. It's not one disease. It's stiffness, fibrosis, inflammation, microvascular dysfunction, metabolic disease, atrial fibrillation, all overlapping. One drug can't fix all of that.Mike: And some drugs that worked beautifully in HFrEF actually made HFpEF worse. Take Beta blockers, for example.  They slow heart rate, which is a problem because HFpEF patients rely on heart rate to maintain their cardiac output.Jordan: The breakthrough came with SGLT-2 inhibitors: diabetes drugs that unexpectedly addressed multiple HFpEF mechanisms at once: volume, metabolism, inflammation, and myocardial energetics.Dr. Arreaza: The miracle drug for HFpEF! Alright, let's wrap up.Mike: Bottom line: HFpEF is common, complex, and dangerous: even if the EF looks “normal.”Jordan: And if you're relying on ejection fraction alone, HFpEF will humble you every time.Dr. Arreaza: If you liked this episode, share it with a friend or a colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

Doctors Lisa and Sara talk to Consultant Nephrologist Dr Darren Green about patients with Type 2 Diabetes who also have Chronic Kidney Disease and Heart Failure.  We go through a hypothetical case to illustrate some of the finer points of management that can commonly get missed or might not be appreciated. A really detailed talk full of useful practice enhancing tips for this complex group of patients.  Disclaimer: All educational content in this podcast was developed as part of the Circulation Health collaborative working project between Boehringer Ingelheim Limited, Greater Manchester Primary Care Provider Board and Health Innovation Manchester. Content has been created by Circulation Health Clinical Leads for educational purposes, reflecting NHS Clinical Lead and guideline-based recommendations. Boehringer Ingelheim had no input into content development. They have provided financial resources to support Podcast recordings related to this project. Darren would like us to make you all aware that he has working relationships with pharmaceutical industry partners. Specifically, that he has received speak fees and consultancy fees from AstraZeneca, GSK, Novartis, Boehringer Ingelheim, Bayer, and Lilly, and has been part of collaborative working agreements with Novartis, Boehringer Ingelheim, and AstraZeneca. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Resources: Dr Kevin Fernando counselling diabetic patients starting an SGLT2 Inhibitors like Dapagliflozin or Empagliflozin: https://www.youtube.com/watch?v=pc99SdtlsyU Diabetes UK counselling sheets on SGLT2 inhibitors: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/treatments/tablets-and-medication/sglt2-inhibitors Kidney Care UK Patient Booklets: https://kidneycareuk.org/get-support/free-resources/patient-information-booklets/ Pumping Marvellous Heart Failure Charity with patient resources: https://pumpingmarvellous.org/ International Society for Nephrology Toolkit for Initiating or Changing RAASi - Renin Angiotensin Aldosterone System Inhibitors (like ACEis such as Lisinopril or Ramipril, or ARBs like Candesartan on Losartan): https://www.theisn.org/initiatives/toolkits/raasi-toolkit/ Royal College of General Practitioners Acute Renal Failure Toolkit: https://elearning.rcgp.org.uk/course/info.php?id=899 CONFIDENCE trial: Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes | New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2410659 ATLAS trial: Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus: https://pubmed.ncbi.nlm.nih.gov/11071803/ Metformin lactic acidosis Metformin in Patients With Type 2 Diabetes and Kidney Disease: A Systematic Review: https://jamanetwork.com/journals/jama/article-abstract/2084896 UK AKI Summit report UKKA AKI Summit Report + Recommendations: https://share.google/7uw1GPQ5sV2riJtiV RCGP AKI follow up  post discharge recommendations: https://bjgpopen.org/content/early/2020/06/15/bjgpopen20X101054/tab-figures-data?versioned=true ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

I know 2026 feels like it ihas been here for months, but only a few weeks ago we were celebrating the nephrology accomplishments of 2025. The New Filtrate came together to review the year.The FiltrateJoel Topf‍ ‍@kidneyboy.bsky.social‬ (COI)Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Editor in Chief of Kidney International Case ReportsAnna Gaddy (@AnnaGaddy) Winner of NephJC Rookie of the Year 2020Nayan Arora (@CaptainChloride.bsky.social)AC (@medpeedskidneys.bsky.social)Vipin Verghese (@vipvargh.bsky.social) co-winner of NephJC Engaged Scientist of the Year in 2021Brian Rifkin (@brianrifkin.bsky.social) Co-Editor in Chief NephJC. Winner of NephJC Rookie of the Year 2021Cristina Popa (@NephroSeeker) Co-Editor in Chief NephJC. Wwinner of NephJC Rookie of the Year 2022 and MVP 2023Editing and Show Notes byAnna Gaddy and Joel TopfThe Kidney Connection written and performed by Tim YauShow NotesTop Stories in Nephrology 2025 (NephJC)First Top sories in Nephrology 2010! (Renal Fellow Network)Links to all of the Top Stories in Nephrology, hosted on NephJC since 2017 (NephJC)1. IgA NephropathyVISIONARY: Sibeprenlimab in IgA Nephropathy — Interim Analysis of a Phase 3 Trial (NEJM)ORIGIN 3: A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (NEJM)APPLAUSE-IgA Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy (NEJM)Aliza M. Thompson, MD, MS (ASN) 2. Lupus NephritisREGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis (NEJM)3. Nobel prize winner and peripheral immune tolerance4. Xenotransplantation5. GLP1ra RevolutionRemodel REMODELing mechanistic trials for kidney disease: a multimodal, tissue-centered approach to understand the renal mechanism of action of semaglutide (Kidney International)SURPASS-CVOT Tirzepatide vs. Dulaglutide Is Associated with Reduced Major Kidney Events in Patients with Type 2 Diabetes, CVD, and Very High-Risk Kidney Diseases (Kidney Week abstract in JASN)Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford (KFF survey)6. GDMT implementation in CKD: lessons learnt from CONFIDENCE and MIRO-CKDConfidence Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes (NEJM)MIRO-CKD Balcinrenone in combination with dapagliflozin compared with dapagliflozin alone in patients with chronic kidney disease and albuminuria: a randomised, active-controlled double-blind, phase 2b clinical trial (The Lancet)7. Flozin Meta analysisSMART-C. SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria. A Meta-Analysis (JAMA)SMART-C. Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria. A Meta-Analysis (JAMA)8. Paradigm Shift: Aiming for CKD Remission9. Fish Oil and DialysisPISCES Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis (NEJM)10. Decline in Dialysis Patients in the United StatesUSRD 2025 Annual Data Report (USRDS)Tubular SecretionSwapnil Hiremath Alien Earth on FX Hulu (Wikipedia)AC A Christmas Carol by Charles Dickens (Wikipedia) and The Muppet Christmas Carol (Wikipedia)Anna Monty Don (Wikipedia)Nayan Back Street Boys at The Sphere (Wikipedia)Brian Marty Supreme (Wikipedia)Cristina The Yellow Tie (Wikipedia)Vipin Stranger Things, good for a four year old? (Wikipedia)Joel Crash Course: The Universe with Katie Mack and John Green (Apple PodCasts)

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Effect of Empagliflozin on Whole Body, Cardiac, and Renal Sympathetic Outflows in Type 2 Diabetes.

Chegou o episódio escolhido por vocês! Marcela Belleza e Joanne Alves convidam Carol Millon para conversar sobe 6 clinicagens de inibidores de SGLT2, as gliflozinas:Indicações além do DMRisco de CAD euglicêmicaQuando não usar?⁠Cuidados com doença aguda (sick day) e hipovolemia⁠Cuidados pré-operatórioRisco de fratura e amputaçãoReferências:1. Bailey CJ, et al. Dapagliflozin add-on to metformin in type 2 diabetes inadequately controlled with metformin: a randomized, double-blind, placebo-controlled 102-week trial. BMC Med. 2013;11:43. Published 2013 Feb 20. doi:10.1186/1741-7015-11-432. Bersoff-Matcha SJ, et al. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019;170(11):764-769. doi:10.7326/M19-00853. Chang HY, et al. Association Between Sodium-Glucose Cotransporter 2 Inhibitors and Lower Extremity Amputation Among Patients With Type 2 Diabetes. JAMA Intern Med. 2018;178(9):1190-1198. doi:10.1001/jamainternmed.2018.3034 4. Clar C, et al. Systematic review of SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes. BMJ Open. 2012 Oct 18;2(5):e001007. doi: 10.1136/bmjopen-2012-001007. PMID: 23087012; PMCID: PMC3488745.5. Das SR, et al. 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020 Sep 1;76(9):1117-1145. doi: 10.1016/j.jacc.2020.05.037. Epub 2020 Aug 5. PMID: 32771263; PMCID: PMC7545583. 6. Fralick M, et al. Risk of amputation with canagliflozin across categories of age and cardiovascular risk in three US nationwide databases: cohort study. BMJ. 2020;370:m2812. Published 2020 Aug 25. doi:10.1136/bmj.m28127. Li D, et al. Urinary tract and genital infections in patients with type 2 diabetes treated with sodium-glucose co-transporter 2 inhibitors: A meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2017;19(3):348-355. doi:10.1111/dom.128258. Neal B, et al. Rationale, design, and baseline characteristics of the Canagliflozin Cardiovascular Assessment Study (CANVAS)--a randomized placebo-controlled trial. Am Heart J. 2013;166(2):217-223.e11. doi:10.1016/j.ahj.2013.05.0079. Nyirjesy P, et al. Evaluation of vulvovaginal symptoms and Candida colonization in women with type 2 diabetes mellitus treated with canagliflozin, a sodium glucose co-transporter 2 inhibitor. Curr Med Res Opin. 2012;28(7):1173-1178. doi:10.1185/03007995.2012.69705310. Perkovic V, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295-2306. doi:10.1056/NEJMoa181174411. Rosenwasser RF, et al. SGLT-2 inhibitors and their potential in the treatment of diabetes. Diabetes Metab Syndr Obes. 2013 Nov 27;6:453-67. doi: 10.2147/DMSO.S34416. PMID: 24348059; PMCID: PMC3848644.12. Sridharan K, Sivaramakrishnan G. Risk of limb amputation and bone fractures with sodium glucose cotransporter-2 inhibitors: a network meta-analysis and meta-regression. Expert Opin Drug Saf. 2025;24(7):797-804. doi:10.1080/14740338.2024.237775513. Ueda P,  et al. Sodium glucose cotransporter 2 inhibitors and risk of serious adverse events: nationwide register based cohort study. BMJ. 2018;363:k4365. Published 2018 Nov 14. doi:10.1136/bmj.k436514. Watts NB, et al. Effects of Canagliflozin on Fracture Risk in Patients With Type 2 Diabetes Mellitus. J Clin Endocrinol Metab. 2016 Jan;101(1):157-66. doi: 10.1210/jc.2015-3167. Epub 2015 Nov 18. PMID: 26580237; PMCID: PMC4701850.15. Zhuo M, et al. Association of Sodium-Glucose Cotransporter-2 Inhibitors With Fracture Risk in Older Adults With Type 2 Diabetes. JAMA Netw Open. 2021;4(10):e2130762. Published 2021 Oct 1. doi:10.1001/jamanetworkopen.2021.3076216. Emerson Cestari Marino, Leandra Anália Freitas Negretto, Rogério Silicani Ribeiro, Denise Momesso, Alina Coutinho Rodrigues Feitosa, Marcos Tadashi Kakitani Toyoshima, Joaquim Custódio da Silva Junior, Sérgio Vencio, Marcio Weissheimer Lauria, João Roberto de Sá, Domingos A. Malerbi, Fernando Valente, Silmara A. O. Leite, Danillo Ewerton Oliveira Amaral, Gabriel Magalhães Nunes Guimarães, Plínio da Cunha Leal, Maristela Bueno Lopes, Luiz Carlos Bastos Salles, Liana Maria Torres de Araújo Azi, Amanda Gomes Fonseca, Lorena Ibiapina M. Carvalho, Francília Faloni Coelho, Bruno Halpern, Cynthia M. Valerio, Fabio R. Trujilho,  Antonio Carlos Aguiar Brandão, Ruy Lyra e Marcello Bertoluci. Rastreamento e Controle da Hiperglicemia no Perioperatório – Posicionamento Conjunto da Sociedade Brasileira de Diabetes (SBD), Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira para o Estudo da Obesidade e Síndrome Metabólica (ABESO). Diretriz Oficial da Sociedade Brasileira de Diabetes (2025). DOI: 10.29327/5660187.2025-10 , ISBN: 978-65-5941-367-6.17. Singh LG, Ntelis S, Siddiqui T, Seliger SL, Sorkin JD, Spanakis EK. Association of Continued Use of SGLT2 Inhibitors From the Ambulatory to Inpatient Setting With Hospital Outcomes in Patients With Diabetes: A Nationwide Cohort Study. Diabetes Care. 2024;47(6):933-940. doi:10.2337/dc23-112918. Mehta PB, Robinson A, Burkhardt D, Rushakoff RJ. Inpatient Perioperative Euglycemic Diabetic Ketoacidosis Due to Sodium-Glucose Cotransporter-2 Inhibitors - Lessons From a Case Series and Strategies to Decrease Incidence. Endocr Pract. 2022;28(9):884-888. doi:10.1016/j.eprac.2022.06.00619. Umapathysivam MM, Morgan B, Inglis JM, et al. SGLT2 Inhibitor-Associated Ketoacidosis vs Type 1 Diabetes-Associated Ketoacidosis. JAMA Netw Open. 2024;7(3):e242744. Published 2024 Mar 4. doi:10.1001/jamanetworkopen.2024.274420. Fleming N, Hamblin PS, Story D, Ekinci EI. Evolving Evidence of Diabetic Ketoacidosis in Patients Taking Sodium-Glucose Cotransporter 2 Inhibitors. J Clin Endocrinol Metab. 2020;105(8):dgaa200. doi:10.1210/clinem/dgaa20021. Neuen BL, Young T, Heerspink HJL, et al. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019;7(11):845-854. doi:10.1016/S2213-8587(19)30256-622. Braunwald E. Gliflozins in the Management of Cardiovascular Disease. N Engl J Med. 2022;386(21):2024-2034. doi:10.1056/NEJMra211501123. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa150472024. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-657. doi:10.1056/NEJMoa161192525. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-357. doi:10.1056/NEJMoa181238926. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008. doi:10.1056/NEJMoa191130327. Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-1424. doi:10.1056/NEJMoa202219028. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa210703829. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. doi:10.1056/NEJMoa202481630. The EMPA-KIDNEY Collaborative Group, Herrington WG, Staplin N, et al. Empagliflozin in...

Federal hükümet, PBS yani İlaç Destek Programı'na kronik böbrek hastalığı için bir ilaç ekleyecek. 65.000'den fazla Avustralyalının, Empagliflozin olarak da bilinen Jardiance 'a daha ucuz erişimden faydalanması bekleniyor.

Doctors Lisa and Sara talk to Consultant Nephrologist Dr Darren Green about patients with Type 2 Diabetes who also have Chronic Kidney Disease and Heart Failure.  We go through a hypothetical case to illustrate some of the finer points of management that can commonly get missed or might not be appreciated. A really detailed talk full of useful practice enhancing tips for this complex group of patients.  Disclaimer: This episode was supported by Greater Manchester NHS who received support from Boehringer.  You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Resources: Dr Kevin Fernando counselling diabetic patients starting an SGLT2 Inhibitors like Dapagliflozin or Empagliflozin: https://www.youtube.com/watch?v=pc99SdtlsyU Diabetes UK counselling sheets on SGLT2 inhibitors: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/treatments/tablets-and-medication/sglt2-inhibitors Kidney Care UK Patient Booklets: https://kidneycareuk.org/get-support/free-resources/patient-information-booklets/ Pumping Marvellous Heart Failure Charity with patient resources: https://pumpingmarvellous.org/ International Society for Nephrology Toolkit for Initiating or Changing RAASi - Renin Angiotensin Aldosterone System Inhibitors (like ACEis such as Lisinopril or Ramipril, or ARBs like Candesartan on Losartan): https://www.theisn.org/initiatives/toolkits/raasi-toolkit/ Royal College of General Practitioners Acute Renal Failure Toolkit: https://elearning.rcgp.org.uk/course/info.php?id=899 CONFIDENCE trial: Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes | New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2410659 ATLAS trial: Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus: https://pubmed.ncbi.nlm.nih.gov/11071803/ Metformin lactic acidosis Metformin in Patients With Type 2 Diabetes and Kidney Disease: A Systematic Review: https://jamanetwork.com/journals/jama/article-abstract/2084896 UK AKI Summit report UKKA AKI Summit Report + Recommendations: https://share.google/7uw1GPQ5sV2riJtiV RCGP AKI follow up  post discharge recommendations: https://bjgpopen.org/content/early/2020/06/15/bjgpopen20X101054/tab-figures-data?versioned=true ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

https://www.tadeclinicagem.com.br/guia/?utm_source=whatsapp&utm_medium=social&utm_term=&utm_content=&utm_campaign=Guia-blackfriday&utm_source_platform=&utm_creative_format=&utm_marketing_tactic=

ကီၢ်စၢဖှိၣ်ပဒိၣ်ကပၢနုာ်ဃုာ်ဝဲဒၣ် ကသံၣ်လၢပှၤအိၣ်ဒီး ကလ့ၢ်တၢ်ဆါယံၤထၢသ့ၣ်တဖၣ်အဂီၢ်ဖဲ Pharmaceutical Benefits Scheme, ကသံၣ်ကသီတၢ်န့ၢ်ဘျုးအတၢ်ရဲၣ်တၢ်ကျဲၤ အပူၤန့ၣ်လီၤ. မ့ၢ်လၢတၢ်အံၤအဃိ ပှၤအီစထြ့လယါဖိအါန့ၢ် ၆၅,ဝဝဝ ဂၤ အိၣ်ဒိးတၢ်မုၢ်လၢ် လၢကဒိးန့ၢ်ဘၣ် တၢ်အဘျုးအဖှိၣ် ခီဖျိလၢကသံၣ်ဒ်သိး Jardiance, လၢအဘၣ်တၢ်သ့ၣ်ညါစ့ၢ်ကီးအီၤဒ်သိး, Empagliflozin န့ၣ် အပှ့ၤကဘၣ်လီၤဒၣ်အဃိန့ၣ်လီၤ.

This issue will review: 1.     Effects of Semaglutide With or Without Concomitant Mineralocorticoid Receptor Antagonist Use in Participants With Type 2 Diabetes and Chronic Kidney Disease: A FLOW Trial Prespecified Secondary Analysis  - Diabetes Care 2.     Orforglipron, an Oral Small-Molecule GLP-1Receptor Agonist, in Early Type 2 Diabetes – NEJM 3.     Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment – NEJM 4.     Dementia Risk in People With Type 1 Diabetes and Associated Risk Factors – Diabetes Care 5.     Impact of baseline GLP-1 Receptor Agonist Use on Albuminuria Reduction and Safety With Simultaneous Initiation of Finerenone and Empagliflozin in Type 2 Diabetes and CKD – Diabetes Care 6.     Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity -  NEJM    Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

Savezna vlada će u Program farmaceutskih beneficija dodati lijek za hroničnu bolest bubrega. Očekuje se da će više od 65.000 Australaca imati koristi od jeftinijeg pristupa lijeku Jardiance, poznatom i kao Empagliflozin.

The federal government will add a medicine for chronic kidney disease into the Pharmaceutical Benefits Scheme. More than 65.000 Australians are expected to benefit from the cheaper access to Jardiance , also known as Empagliflozin. - Hukûmeta federal dê dermanekî nexweşiya gurçikê ya kronîk li Bernameya Feydeyên Dermanan (PBS) zêde bike. Tê payîn ku zêdetirî 65.000 Australî dê dermanê Jardiance, ku wekî Empagliflozin jî tê zanîn, sûdê werbigirin.

Chính phủ liên bang sẽ bổ sung một loại thuốc điều trị bệnh thận mãn tính vào Chương trình Phúc lợi Dược phẩm PBS. Hơn 65.000 người Úc sẽ được hưởng lợi từ việc tiếp cận thuốc Jardiance, còn được gọi là Empagliflozin, với giá rẻ hơn.

The federal government will add a medicine for chronic kidney disease into the Pharmaceutical Benefits Scheme. More than 65.000 Australians are expected to benefit from the cheaper access to Jardiance , also known as Empagliflozin.

The FiltrateJoel Topf @kidneyboy.bsky.social‬Swapnil Hiremath @hswapnil.medsky.socialNayan Arora captainchloride.bsky.socialSopia Ambruso @sophia-kidney.bsky.socialSpecial Guests Brendon Neuen @brendonneuen.bsky.social Associate Professor and Program Lead, Renal and Metabolic at The George Institute for Global Health. Nephrologist and Director of Kidney Trials at Royal North Shore Hospital.Neuen has had three prior appearances on Freely Filtered: EMPA Kidney, DUPLEX and Sparsentan in FSGS, FLOW and SemaglutideMuthiah Vaduganathan @mvaduganathan on X. Cardiologist at Brigham and Women's Hospital and Harvard Medical School. Assistant Professor of Medicine.Editing byJoel TopfThe Kidney Connection written and performed by Tim YauShow NotesDONATE to NephJC! Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes NEJM | NephJC SummaryFIDELIO Bakris et al, NEJM 2020 | NephJC Summary; subgroup throws doubt on efficacy of finerenone in patients on flozinsFIGARO Pitt et al, NEJM 2021; subgroups clearly shows finerenone works, flozins or notNEJM editorial (wrongly) saying do not use Flozins unless on RASi Don't use dual RAS blockade ONTARGET Yusuf et al, NEJM 2008; VA NEPHRON-D Fried et al NEJM 2013Why we cannot study finerenone in HFrEF (RALES Pitt et al NEJM 1999) Muthu is jealous of GFR slope and albuminuria surrogate endpoints and wants to borrow them for HFpEF (Inker et al EHJ 2025)Combination therapy and CV outcomes in hypertension (Wang et al JAMA Card 2024 on low dose combinations and BP; Egan et al Blood Pressure 2022 review of topic) CONFIRMATION HF trial registry entry (Finerenone and Empagliflozin in hospitalized patients with HF)23:20: Nayan and Swap miss a chance to say ‘de-flozination' to discuss stopping a flozin which would allow a patient to be included in the trial Finerenone is a CYP3A4 substrate (Heinig et al Clin Pharmacokinetics 2023); Useful list of CYP3A4 inducers and inhibitors Everyone should get an ABPM (Bugeja et al CMAJ 2022)EASiKIDNEY study design Albuminuria mediates CKD benefits with Finerenone (Agarwal et al Ann Intern Med 2023)GFR slope and Albuminuria and the FDA (Taylor et al eClin Med 2025) Dapagliflozin and Eplerenone combination crossover trial (Provenzano et al JASN 2022)Joel gets promoted! (PBFluids reflection) Bluesky NephJC Chat discussion on ‘renal remission' Withdrawal of Finerenone and worse outcomes from FINEARTS (Vaduganathan et al JACC 2025)Combination therapies Analysis from Brendan and Muthu (Neuen et al Circulation 2024)Do not use KFRE when GFR > 60 (KDIGO Practice Point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2) Finerenone vs Spironolactone trial in Primary Aldosteronism (Hu et al Circulation 2025)FIND CKD trial design (Heerspink et al NDT 2025) FINE-ONE trial design (Heerspink et al Diab Res Practice 2023) Tubular SecretionsNayan keeping his chin up as Yankees lose and Mariners follow (MLB Playoffs)Sophia's adventures with Beekeeping (Royal Jelly?) Brendon loves listening to ‘Susan' by Raye Muthu is back into Taekwondo Swap is still reading Martha Wells (Witch King on GoodReads)Joel will be hiking the Laugavegur trail in Iceland

This issue will review: 1.     Once-weekly Ultra-processed Foods and Diet Quality in Association With Long-term Weight Change and Progression to Type 2 Diabetes Among Individuals With a History of Gestational Diabetes Mellitus—A Prospective Study 2.     Plant-Based Dietary Patterns Associated With Reduced Risk of All-Cause Mortality in Diabetes Subgroups 3.     Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes- NEJM   4.     Risk of Phimosis Associated With SGLT2i Versus GLP-1RA: A Danish Cohort Study 5.     GLP-1 Receptor Agonists and Sight-Threatening Ophthalmic Complications in Patients With Type 2 Diabetes Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

What can help a woman in her mid-40s with breast calcifications? Would taking supplements and enzymes help?My husband suffered from hospital delirium and seven months later is still strugglingIs milk thistle beneficial to take?  I read an article that curcumin is highly toxic to the liver. What say you?

More on lithium orotate for Alzheimer's diseaseMy sister had cow valve surgery and has to take Jardiance.  Are there other alternatives?I'm taking BHRT for hot flashes.  Are there any other drugs I should consider taking?

Join Drs. Neil Skolnik and Sara Wettergreen as they answer one of the most common questions people living with diabetes have: “What diabetes medication is best for me?”   In this episode, they'll explore how choosing the right medication depends on your individual health, lifestyle, and goals. Discover practical tips to better help you work with your care team to make informed decisions and find the best treatment plan for you.   Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health, Abington, PA Sara Wettergreen, PharmD, BCACP, BC-ADM, Assistant Professor, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences; and Ambulatory Care Clinical Pharmacist, UCHealth Lone Tree Primary Care, Aurora, CO Do you have questions or comments you'd like to share with Neil and Sara? Leave a message at (703) 755-7288. Thank you for listening, and don't forget to “follow” Diabetes Day by Day!   Diabetes Medications: Biguanides Brand: Glucophage, Fortamet, Glumetza Generic: Metformin, Metformin XR Sulfonylureas (Second Generation) Brand: Glucotrol, Amaryl, Diaβeta, Glynase Generic: Glipizide, Glipizide XL, Glimepiride, Glyburide Thiazolidinediones (TZDs) Brand: Actos, Avandia Generic: Pioglitazone, Rosiglitazone (no longer available) DPP-4 Inhibitors Brand: Januvia, Onglyza, Tradjenta, Nesina Generic: Sitagliptin, Saxagliptin, Linagliptin, Alogliptin SGLT2 Inhibitors Brand: Invokana, Farxiga, Jardiance, Steglatro, Brenzavvy Generic: Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin, Bexagliflozin GLP-1 Receptor Agonists Brand: Victoza, Trulicity, Ozempic, Rybelsus, Mounjaro (dual GIP/GLP-1) Generic: Liraglutide, Dulaglutide, Semaglutide, Tirzepatide Insulins (selected examples) Brand: Humalog, NovoLog, Apidra, Lantus, Basaglar, Levemir, Tresiba, Humulin N, Novolin N, Humulin R, Novolin R Generic: Insulin lispro, Insulin aspart, Insulin glulisine, Insulin glargine, Insulin detemir, Insulin degludec, NPH insulin, Regular insulin

Dr. Centor discusses outcomes in patients with type 2 diabetes when treated with semaglutide or dulaglutide versus empagliflozin with Drs. Kevin Kip and Anum Saeed.

Send us a textWelcome back Rounds Table Listeners! Today we have a solo episode with Dr. Mike Fralick. This week, he discusses a recently published trial exploring the simultaneous initiation of SGLT2 inhibitors and finerenone (a nonsteroidal mineralocorticoid receptor antagonist) in persons with chronic kidney disease and type 2 diabetes. Here we go!Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes (0:00 – 9:28).Calling keen trainees! (9:29 - 10:28)Trainees, med students, residents: The Rounds Table and Trial Files are looking for keen individuals to support our efforts.Trial Files is a free monthly newsletter on practice-changing trials, delivered straight to your inbox (https://trialfiles.substack.com/).Reach out to fralickmpf@gmail.com if you are interested in getting involved. Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.    Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes 2.    Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension Meta-Analysis 3.    The Diabetes Prevention Program and Its Outcomes Study: NIDDK's Journey Into the Prevention of Type 2 Diabetes and Its Public Health Impact 4.    Comparative effectiveness of alternative second‐line oral glucose‐lowering therapies for type 2 diabetes: a precision medicine approach applied to routine data 5.    Phase 3 Trial of Semaglutide in Metabolic Dysfunction– Associated Steatohepatitis   For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

Listener feedback on cardiac sarcoidosis, SA node ablation, surgical AF ablation, chronic kidney disease protection, and recruiting for clinical trials are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback EHJ paper Mathijssen et al https://doi.org/10.1093/eurheartj/ehaf338 Nordenswan et al https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.006145#tab-contributors II IST HR Case Reports https://doi.org/10.1016/j.hrcr.2025.05.017 Lakkireddy et al https://doi.org/10.1016/j.hrthm.2021.07.010 III Survival After Surgical AF ablation during CABG McClure et al https://doi.org/10.1093/europace/eux336 Schaffer et al https://doi.org/10.1016/j.athoracsur.2025.03.044 IV Finerenone with Empagliflozin in CKD and DM The Confidence Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2410659 V Recruiting for Important Trials and the Stature of EP as a Profession Two UK Cardiology Trials Struggle to Recruit Patients https://www.medscape.com/viewarticle/two-uk-cardiology-trials-struggle-recruit-patients-2025a1000ffs CRAFT HF https://clinicaltrials.gov/study/NCT06505798 BRITISH https://doi.org/10.1016/j.ahj.2023.09.008 PROFID https://profid-project.eu/profid-ehra-trial/ You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The CHALLENGE trial at ASCO 2025 showed that increased physical activity improves survival rates in colon cancer patients, with the exercise group demonstrating better health outcomes and survival rates compared to those receiving only health education. A phase 3 trial in The New England Journal of Medicine found that semaglutide significantly improves liver conditions in MASH patients, showing better resolution of steatohepatitis and fibrosis improvement compared to placebo. Additionally, a study in the NEJM revealed that combining finerenone and empagliflozin offers enhanced kidney protection in patients with chronic kidney disease and type 2 diabetes, significantly reducing urinary albumin levels.

Drs Carol H. Wysham and Liana K. Billings discuss how to incorporate SGLT2 inhibitors and GLP-1 receptor agonists into the management of patients with type 2 diabetes and chronic kidney disease. Relevant disclosures can be found with the episode show notes on Medscape https://www.medscape.com/viewarticle/1002049. The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Type 2 Diabetes Mellitus https://emedicine.medscape.com/article/117853-overview Chronic Kidney Disease (CKD) https://emedicine.medscape.com/article/238798-overview Global, Regional, and National Burden of Chronic Kidney Disease Due to Diabetes Mellitus Type 2 From 1990 to 2021, With Projections to 2036: A Systematic Analysis for the Global Burden of Disease Study 2021 https://pubmed.ncbi.nlm.nih.gov/40034386/ Advantages, Limitations, and Clinical Considerations in Using Cystatin C to Estimate GFR https://pubmed.ncbi.nlm.nih.gov/36514729/ New Creatinine- and Cystatin C-Based Equations to Estimate GFR Without Race https://pubmed.ncbi.nlm.nih.gov/34554658/ Effects of Semaglutide on Chronic Kidney Disease in Patients With Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/38785209/ Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy https://pubmed.ncbi.nlm.nih.gov/30990260/ Dapagliflozin in Patients With Chronic Kidney Disease https://pubmed.ncbi.nlm.nih.gov/32970396/ Empagliflozin in Patients With Chronic Kidney Disease https://pubmed.ncbi.nlm.nih.gov/36331190/ Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 https://pubmed.ncbi.nlm.nih.gov/39651975/ CKD Early Identification & Intervention Toolkit https://kdigo.org/wp-content/uploads/2019/01/ISN_KDIGO_EarlyScreeningBooklet_WEB_updatedOct11.pdf Combination Therapy as a New Standard of Care in Diabetic and Non-Diabetic Chronic Kidney Disease https://pubmed.ncbi.nlm.nih.gov/39907542/ Living With Chronic Kidney Disease and Type 2 Diabetes Mellitus: The Patient and Clinician Perspective https://pubmed.ncbi.nlm.nih.gov/36282450/

In this podcast, Dr. Valentin Fuster explores a study on the effects of SGLT2 inhibitors, like empagliflozin, on erythropoiesis and iron mobilization in heart failure patients. The research reveals how these drugs activate key metabolic pathways, potentially enhancing iron utilization and improving clinical outcomes, with significant implications for treatment in heart failure and chronic kidney disease.

Watch Here : https://www.youtube.com/watch?v=0lswGv0maqE Website: https://vigoroussteve.com/ Consultations: https://vigoroussteve.com/consultations/ eBooks: https://vigoroussteve.com/shop/ YouTube Channel: http://www.youtube.com/user/VigorousSteve/ Workout Clips Channel: https://www.youtube.com/channel/UCWi2zZJwmQ6Mqg92FW2JbiA Instagram: https://instagram.com/vigoroussteve/ TikTok: https://www.tiktok.com/@vigoroussteve Reddit: https://www.reddit.com/r/VigorousSteve/ PodBean: https://vigoroussteve.podbean.com/ Spotify: https://open.spotify.com/show/2wR0XWY00qLq9K7tlvJ000 Patreon: https://www.patreon.com/vigoroussteve

https://www.nejm.org/doi/full/10.1056/NEJMoa2204233

In this episode of Cardio Buzz, we explore the intriguing concept of the 'legacy effect' of medications like those used in treating diabetes, hypertension, hypercholesterolemia, and chronic kidney disease. We'll delve into landmark studies like the UKPDS, Steno-2, and more, examining the lasting impacts of medications such as Repatha, Candesartan, and Empagliflozin. Learn how these drugs contribute to disease regression, modify genes, and prevent non-fatal events to grant long-term protective effects. 00:00 Introduction: The Challenge of Lifelong Medication 00:57 Exploring the Legacy Effect of Medications 01:33 Diabetes Medications: Long-Term Benefits 03:15 Hypertension Medications: Persistent Effects 03:58 Cholesterol Medications: Lasting Impact 04:49 Kidney Disease Medications: Prolonged Benefits 06:12 Understanding the Legacy Effect Mechanism 09:13 Implications and Final Thoughts

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.     Dapagliflozin plus calorie restriction for remission of type 2 diabetes 2.     Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity 3.     Effectiveness of Empagliflozin vs Dapagliflozin for Kidney Outcomes in Type 2 Diabetes 4.     Tirzepatide Associated With Reduced Albuminuria in Participants With Type 2 Diabetes 5.     Use of SGLT2i Versus DPP-4i as an Add-On Therapy and the Risk of PAD-Related Surgical Events (Amputation, Stent Placement, or Vascular Surgery)   For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

On this podcast episode of the top 200 drugs, I'm covering liraglutide, folic acid, clotrimazole, empagliflozin, and semaglutide. Liraglutide is a GLP-1 agonist that can be used for weight loss as well as diabetes. The most common adverse effect of this medication is nausea. Folic acid is a commonly used supplement in pregnancy as well as in those patients taking methotrexate. Deficiency of folic acid can lead to anemia. Clotrimazole is an antifungal agent. It is mostly used for topical purposes such as athlete's foot and vaginal yeast infections. Empagliflozin was originally developed as a diabetes medication but can be helpful in patients with heart failure and CKD. I discuss this in greater detail in the podcast. Semaglutide is another GLP-1 agonist that is used for diabetes care as well as weight loss. The formulation used for diabetes is Ozempic while the weight loss product is Wegovy.

Welcome to the 45th episode of my drug pronunciation series! As we continue through the alphabet from A-Z, we're on the letter “E” for empagliflozin. Also check out episode 228 for ezetimibe and episode 134 for eszopiclone.   In this episode, I break down empagliflozin and Jardiance into syllables, tell you which syllables to emphasize, and share my sources.     The written pronunciations are helpful. They are below

Despite advances in the management of acute myocardial infarction (MI), up to 38% of patients will experience signs of heart failure (HF) and many have a reduced left ventricular ejection fraction (LVEF). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have well-documented cardiovascular benefits. However, data are limited regarding their use after an acute MI. Guest Authors: Amy Hu, PharmD and Kathleen Pincus, PharmD, BCPS, BCACP, CDCES Music by Good Talk

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.     Insulin Efsitora versus Degludec in Type 2 Diabetes without Previous Insulin Treatment   2.     Semaglutide and Opioid Overdose Risk in Patients With Type 2 Diabetes and Opioid Use Disorder 3.     Associations of Diabetes and Prediabetes with Mortality and Life Expectancy in China: A National Study 4.     GLP-1 Medication Use for Type 2 Diabetes in the US 5.     Healthcare Utilization and Cost Associated with Empagliflozin in Older Adults with Type 2 Diabetes   For more information about each of ADA's science and medical journals, please visitwww.diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health

In this CCO Nephrology podcast episode, hear from nephrologists Pietro Canetta, MD, MS, and Andy Bomback, MD, PhD, experts in clinical management and research on glomerular diseases as they discuss key updates in managing IgAN. Faculty highlight the importance of a comprehensive supportive care regimen to protect patients' kidneys and prevent progression of disease. In addition, they review the merits and place in therapy of novel and emerging therapies.  Topics include:Supportive care as the foundation of IgAN managementPlace in therapy for new and emerging agentsTargeted-release formulation of budesonideEndothelin receptor antagonists (eg, sparsentan)Factor B inhibitors (eg, iptacopan)The role of clinical trial involvementLearn more about IgA nephropathy with educational activities and resources here:  CME-certified text module with animated pathophysiology video and patient voice audio clipClinicalThought commentariesResources on IgAN from the American Kidney Fund

N Engl J Med 2024;390:1455-1466BackgroundDespite advances in the care of patients after myocardial infarction, there remains residual risk of heart failure and death. The amount of risk parallels the degree of left ventricular systolic dysfunction. Previous studies have shown that the drug class of sodium–glucose cotransporter 2 (SGLT2) inhibitors reduce cardiovascular risk (especially recurrent heart failure) in multiple clinical situations.The goal of the placebo-controlled Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction (EMPACT-MI) trial was to determine whether empagliflozin reduced the risk of heart failure or death in patients with acute MI and either a new reduction in LV function or signs of congestion, or both.PatientsAdult patients who had been hospitalized with MI within 14 days before randomization. There had to be a new LVEF 65 (50%), Type 2 DM (32%) and 3-vessel CAD (31%). Slightly more than 70% of patients had more than one enrichment factor.Approximately 20% of patients had an LVEF > 45%. Slightly more than half of patients had an LVEF between 35% and 45%. Trial ProceduresRandomization was 1:1 to empagliflozin 10mg daily or matching placebo. The trial was conducted between 2020-2023 at 451 sites in 22 countries. The median time from admission to randomization was 5 days. The trial had a streamlined design, with the collection of essential data only, including information about specific safety events, and mainly remote follow-up of patients (by means of a Web-based application or a telephone call) with only a few face-to-face visits; the trial assessed investigator-reported end-point events rather than centrally adjudicated end-point events. Specifically, follow up included a remote visit at 2 weeks, a face-to-face visit at 6 months, and remote visits every 6 months thereafter until the end of the trial, when a final telephone call was performed.EndpointsThe primary end point was a composite of hospitalization for heart failure or death from any cause as assessed in a time-to-first-event analysis.The key secondary end points in the prespecified hierarchical testing strategy were the total number of hospitalizations for heart failure or death from any cause, the total number of nonelective cardiovascular hospitalizations or death from any cause, the total number of nonelective hospitalizations for any cause or death from any cause, and the total number of hospitalizations for myocardial infarction or death from any cause. Trial authors estimated that 532 patients with a primary end-point event would provide the trial with 85% power to detect a 23% lower risk of an event in the empagliflozin group than in the placebo group, with a two-sided type I error of 0.05. However, the trial originally planned to enroll about 3300 patients, with the option to enroll 5000 patients. But then the trial was further increased to 6500 patients.Key secondary endpoints were assessed using a prespecified hierarchical testing procedure. This began with the primary endpoint.ResultsAn interesting aspect of this trial, and more recent post-MI trials is that the ratio of screened to enrolled patients is almost 1:1. Whereas older trials screened many more patients than were enrolled, in EMPACT, only 88 of 6600 screened patients were excluded. In total, approximately 3200 patients were randomized in both arm.After a median follow-up of 18 months, a primary end-point event — a first hospitalization for heart failure or death from any cause — occurred in 8.2% in the empagliflozin group and in 9.1% in the placebo group, with incidence rates of 5.9 and 6.6 events, respectively, per 100 patient-years (hazard ratio, 0.90; 95% confidence interval [CI], 0.76 to 1.06; P=0.21). A look at the two components showed that there were fewer heart failure hospitalizations in the empagliflozin group (3.6% vs 4.7%; HR 0.77 (0.60–0.98)) Overall death were similar in both groups. As for secondary endpoints, total heart failure hospitalizations was 2.4 vs 3.6 events, respectively, per 100 patient-years (rate ratio, 0.67; 95% CI, 0.51 to 0.89). The composite of total heart failure hospitalizations or death were not significantly different (HR 0.87 0.68-1.10). CV death was 4% in both groups. There were no obvious subgroup effects nor differences in safety. Conclusions The addition of empagliflozin did not significantly reduce a composite endpoint of heart failure admissions and death. Even the reduction in heart failure admissions was modest. Given the medication burden of the typical patient after myocardial infarction, coupled with the high cost of this drug class, we see no strong evidence for routine use of SGLT2i in EMPACT-MI-type patients. The null results of this trial and PARADISE-MI speak to the beneficial effects of modern post-MI care—including mostly rapid revascularization with PCI. It is difficult to improve on baseline care of the MI patient in 2024. Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Welcome back Rounds Table Listeners!We are back today with our Classic Rapid Fire Podcast!This week, Drs. Mike and John Fralick discuss two recent papers exploring the role of ticagrelor with aspirin versus ticagrelor alone after percutaneous coronary intervention in acute MI and the efficacy of empagliflozin after acute MI. Two papers, here we go!Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT) (0:00 – 9:22). Empagliflozin after Acute Myocardial Infarction (9:22 – 16:00).And for the Good Stuff:Impact of presentation at conference with timed release of academic publication (16:00 – 17:32).Top spot in the PWHL and attendance record at stake in latest Montreal-Toronto showdown (17:32 – 19:59).Questions? Comments? Feedback? We'd love to hear from you! @roundstable

Commentary by Dr. Valentin Fuster

This week, please join author Adrian Hernandez as he discusses the article "Effect of Empagliflozin on Heart Failure Outcomes After Acute Myocardial Infarction: Insights From the EMPACT-MI Trial." For the episode transcript, visit:  https://www.ahajournals.org/do/10.1161/podcast.20240515.717282

ACC.24: EMPACT-AMI trial

ACC Recap #1: DanGer Shock (plus a sobering JAMA research letter on Impella use), REDUCE-AMI, PREVENT, and EMPACT-MI are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. DanGer-Shock Trial Impella CP Improves Survival in STEMI, Cardiogenic Shock https://www.medscape.com/viewarticle/impella-cp-improves-survival-stemi-cardiogenic-shock-2024a10006kz Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659 Published DanGer Shock Study  https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 JAMA Research letter https://jamanetwork.com/journals/jama/article-abstract/2817457 II. REDUCE-AMI Trial New Data Question Beta-Blockers Post-MI With Preserved EF https://www.medscape.com/viewarticle/new-data-question-beta-blockers-post-mi-preserved-ef-2024a10006y8 Beta-Blockers Post-MI Past Their Expiration Date: REDUCE-AMI https://www.medscape.com/viewarticle/1000663 REDUCE-AMI paper https://www.nejm.org/doi/full/10.1056/NEJMoa2401479 Meta-analysis: Beta Blockers for MI https://doi.org/10.1016/j.amjmed.2014.05.032 III. PREVENT Trial Preventive PCI for Vulnerable Plaques Reduces Cardiac Events https://www.medscape.com/viewarticle/preventive-pci-vulnerable-plaques-reduces-cardiac-events-2024a10006tc Preventive Coronary Stents: Not There Yet https://www.medscape.com/viewarticle/preventive-coronary-stents-not-there-yet-2024a10006yr PREVENT https://doi.org/10.1016/S0140-6736(24)00413-6 IV. EMPACT MI trial of Empagliflozin in the Post-MI setting Empagliflozin Fails to Reduce Events After Acute MI https://www.medscape.com/viewarticle/empagliflozin-fails-reduce-events-after-acute-mi-2024a10006kn EMPACT-MI: Another SGLT2 Inhibitor Miss in Post-MI Care  https://www.medscape.com/viewarticle/1000684 EMPACT MI https://www.nejm.org/doi/10.1056/NEJMoa2314051 DAPA MI https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300286 PARADISE MI https://www.nejm.org/doi/full/10.1056/NEJMoa2104508 Kaul thread https://x.com/kaulcsmc/status/1776611935842165029 Kaul paper https://www.ahajournals.org/doi/full/10.1161/circulationaha.116.022537 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Before we head off to SHM CONVERGE this weekend, here are a few articles that may be of use in your practice. A random assortment from end-of-life care to ketamine in pain control, hopefully its something for everyone. | 00.05 - Intro | | 00.48 - CONVERGE - come visit me on Saturday in Hall F! Or email boostershots@ucsd.edu if you want to discuss at other times! | | 01.42 - Empagliflozin delays CKD progression in diabetic or glomerular disease, but not necessarily hypertensive or renovascular disease [ACP Journal Club 2024 (subscription required), Lancet D&E 2024] | 03.14 - Antibiotics and end of life care - I recommend you look at the paper [CID 2024] | | 06.33 - Low dose ketamine for pain control vs. morphine → Shorter onset, but shorter duration [AJEMEN 2024] | 08.00 - Using Deep Learning models to estimate CV risk using CXR only [AIM 2024] references for the groups' other studies using Deep Learning: Long-term mortality from CXR [JAMA 2019], Identifying high risk smokers for lung cancer CT screening [AIM 2020] | 09.53 - 43s Summary (yes I lied, it wasn't 30s), disclaimers, credits, etc. | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

In the sequel to last week's episode, we are back with Dr. Jonathan Davis, Director of the Heart Failure program from San Francisco General. We continue our tour of GDMT for HF, by covering SGLT2-i, MRAs, as well as some AKI and outpatient considerations. This is part 1 of 2 parts which will cover an overview of GDMT medications, and dive into Beta-blockers and ARNIs. Part 2 to come out next week! | 00.33 - Previously on Booster Shots | | 01.31 - Chapter 3: SGLT2-i | The now famous EMPA-REG OUTCOME trial [NEJM 2015] Empagliflozin in HFpEF (not discussed in this episode [NEJM 2021] | 04.24 - Chapter 4: MRAs | RALES trial demonstrating benefit in Morbidity/Mortality [NEJM 1999] | 10.04 - Organizing follow up | | 11.51 - Issues with AKI | | 15.10 - Some fun questions about Fun questions | | 16.54 - Summary of All The Things! | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.] Music by Amit Apte. Medical Heart Vectors by Vecteezy

Welcome back Rounds Table Listeners! In this throwback episode, Drs. John and Mike Fralick discuss two papers – one, exploring the use of SGLT2 inhibitors in CKD, and the second investigating the effect of RAS inhibitor discontinuation on the progression of CKD. Empagliflozin in Patients with Chronic Kidney Disease (0:00 – 9:00). Renin-Angiotensin System Inhibition in ... The post TBT – Chronic Kidney Disease first appeared on Healthy Debate. The post TBT – Chronic Kidney Disease appeared first on Healthy Debate.

Welcome back Rounds Table Listeners! In this throwback episode, Drs. John and Mike Fralick discuss two papers – one, exploring the use of SGLT2 inhibitors in CKD, and the second investigating the effect of RAS inhibitor discontinuation on the progression of CKD. Empagliflozin in Patients with Chronic Kidney Disease (0:00 – 9:00). Renin-Angiotensin System Inhibition in ...The post TBT – Chronic Kidney Disease appeared first on Healthy Debate.

Welcome back Rounds Table Listeners! As we approach the end of 2023, let's revisit five important research studies from 2022: The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (0:00 – 2:56) Tirzepatide Once Weekly for the Treatment of Obesity (2:56 – 6:00) Empagliflozin in Patients with Chronic Kidney Disease (6:00 – ...The post TBT – The Top Papers of 2022 appeared first on Healthy Debate.

Welcome back Rounds Table Listeners! As we approach the end of 2023, let’s revisit five important research studies from 2022: The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (0:00 – 2:56) Tirzepatide Once Weekly for the Treatment of Obesity (2:56 – 6:00) Empagliflozin in Patients with Chronic Kidney Disease (6:00 – ... The post TBT – The Top Papers of 2022 first appeared on Healthy Debate. The post TBT – The Top Papers of 2022 appeared first on Healthy Debate.