The comparative effects of metabolic surgery,SGLT2i,or GLP-1RA in patients with obesity and type 2 diabetes: a retrospective cohort study

BackgroundNew antidiabetic agents (sodium-glucose cotransporter-2 inhibitor [SGLT2i] and glucagon-like peptide-1 receptor agonist [GLP-1RA]) and metabolic surgery have protective effects on metabolic syndromes.ObjectivesTo compare the changes of metabolic parameters and costs among patients with obesity and type 2 diabetes undergoing metabolic surgery and initiating new antidiabetic agents over 12 months.SettingHong Kong Hospital Authority database from 2006–2017.MethodsThis is a population-wide retrospective cohort study consisting of 2616 patients (1810 SGLT2i, 528 GLP-1RA, 278 metabolic surgery). Inverse probability treatment weighting of propensity score was applied to balance baseline covariates of patients with obesity and type 2 diabetes who underwent metabolic surgery, or initiated SGLT2i or GLP-1RA. Metabolic parameters and direct medical costs were measured and compared from baseline to 12 months in metabolic surgery, SGLT2i, and GLP-1RA groups.ResultsPatients in all 3 groups had improved metabolic parameters over a 12-month period. Patients with metabolic surgery achieved significantly better outcomes in BMI (?5.39, ?.56, ?.40 kg/m², P < .001), % total weight loss (15.16%, 1.34%, 1.63%, P < .001), systolic (?2.21, ?.59, 1.28 mm Hg, P < .001) and diastolic (?1.16, .50, ?.13 mm Hg, P < .001) blood pressure, HbA1c (?1.80%, ?.77%, ?.80%, P < .001), triglycerides (?.64, ?.11, ?.09 mmol/L, P < .001), and estimated glomerular filtration rate (3.08, ?1.37, ?.41 mL/min/1.73m², P < .001) after 12 months compared with patients with SGLT2i and GLP1-RA. Although the metabolic surgery group incurred the greatest direct medical costs (US$33,551, US$10,945, US$10,627, P < .001), largely due to the surgery itself and related hospitalization, the total monthly direct medical expenditure of metabolic surgery group became lower than that of SGLT2i and GLP-1RA groups at 7 months.ConclusionBeneficial weight loss and metabolic outcomes at 12 months were observed in all 3 groups, among which the metabolic surgery group showed the most remarkable effects but incurred the greatest medical costs. However, studies with a longer follow-up period are warranted to show long-term outcomes.     

Bone and joint alterations in acromegaly

Growth hormone (GH) is fundamental for the maintenance of bone mass and metabolism both during childhood and in adulthood. This effect is due to a complex interaction between circulating GH and IGF-I produced peripherally. In vitro data and experimental animal models have clarified many of the regulatory mechanisms underlying the characteristic skeletal changes occurring in acromegaly. This review focuses on the effects of GH excess on bone metabolism and mass in acromegalic patients and, in particular, on the influence of factors such as hypogonadism, gender, age and therapy on bone metabolism and arthropathy.     

Toxicité des antirétroviraux chez les patients co-infectés par les virus VIH et VHC

The introduction of HAART (Highly Active Antiretroviral Therapy) has deeply modified the epidemiologic data on HIV infection. Consequently, chronic hepatotoxicities, particularly those related to HCV, became a leading cause of morbidity and mortality amongst co-infected HIV-HCV patients. They became a major factor to be considered before starting and conducting a HAART regimen. Due to the epidemiology of these two infections and referring to several huge randomised prospective clinical trials recently reported, understanding the antiretroviral toxicity is a true challenge in the follow-up of co-infected patients. It includes: i) understanding the intrinsec toxicities of each antiretroviral class, particularly drugs-related hepatotoxicities; then ii) the incidences of those treatments in co-infected patients, with or without anti-HCV bitherapy; and iii) the pathogenic reciprocal interactions between HIV and HCV and between anti-HIV and anti-HCV treatments. Four mechanisms of drug-related liver toxicity have been recognized: i) direct drug toxicity; ii) immune reconstitution; iii) hypersensitivity reactions with liver involvement; and iv) mitochondrial toxicity. The benefit-risk ratio notion must be strongly evaluated and the therapeutic strategy must include, for each patient, a strict monitoring of biochemichal (liver parameters, hemogram, amylasemia, lipasemia, evaluation of liver fibrosis index) and clinical (weight, lipodystrophy) parameters. A better pharmacological knowledge, a global view and the development of new drugs with less hepatotoxicity, like fusion inhibitors, would increase the quality of life of co-infected patients. Liver transplantation could be a hope for patients with severe hepatic failure.     

ALCOHOL DECREASES INSULIN SENSITIVITY IN HEALTHY SUBJECTS

To study the effect of alcohol on glucose and insulin metabolism,a simultaneous infusion of glucose and insulin was given for150 min to healthy volunteers, once during alcohol and onceduring calorie-free gingerale (control) ingestion. During alcoholintake, the average steady-state (between 100 and 150 min) glucoseof 5.44±0.39 mmol/1. and the average steady-state insulinof 6.3±1.1 ng/ml were significantly higher than those(4.0±0.39 mmol/1. of glucose and 4.4±0.6 ng/mlof insulin) observed during the control state. Despite the highersteady-state insulin concentrations, the glucose metabolismwas significantly less during alcohol ingestion. These findingssuggest alcohol-induced impairment in glucose metabolism iscaused by a decreased tissue sensitivity to insulin.