SGL2 Inhibitors in 2020

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In 2020, the American Diabetes Association is making two paradigm-shifting recommendations in the treatment of type 2 diabetes.

  1. Prescribe Sodium glucose co-transporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists to patients at high risk for atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease in addition to patients with already established disease, as previously recommended.
  2. Consideration for use of those drugs to be independent of the patients baseline A1c or individualized A1c target. Previously, additional pharmacologic agents were recommended only when A1c was above target despite using first-line metformin and lifestyle interventions.

In case of Atherosclerotic CV Disease; add Empagliflozin

Heart Failure: Empagliflozin, canagliflozin or dapagliflozin.

For heart failure patients with reduced ejection fraction (HFrEF) who have persistent symptoms and an elevated serum natriuretic peptide level on optimal pharmacologic and device therapy, add dapagliflozin.

CKD:  Canagliflozin in patients with diabetes and proteinuria. In patients with type 2 diabetes who have nephropathy (urine albumin excretion >300 mg per day) and eGFR >30 mL/min per 1.73 m2, add Canagliflozin (CREDENCE trial).

In addition, SGLT2 inhibitors in general may have a role as a third agent in those who cannot or will not take insulin, when full doses of metformin and a sulfonylurea have not produced satisfactory metabolic control, or in patients in whom risk of hypoglycemia is high (frail, older adults) or in whom avoidance of weight gain is a priority.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Enjoy coffee this winter: Caffeine offsets some health risks of diets high in fat, sugar

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A new study, published in Science Daily, in rats, suggests that caffeine offsets negative effects of an obesogenic diet by reducing the storage of lipids in fat cells and limiting weight gain and the production of triglycerides. In the study, rats that consumed caffeine extracted from mate tea gained 16% less weight and accumulated 22% less body fat than rats that consumed decaffeinated mate tea. The study by scientists at the University of Illinois also found that the effects were similar with synthetic caffeine and that extracted from coffee.

The amount of caffeine per serving in mate tea ranges from 65-130 milligrams, compared with 30-300 milligrams of caffeine in a cup of brewed coffee. For four weeks, the rats in the study ate a diet that contained 40% fat, 45% carbohydrate and 15% protein. They also ingested one of the forms of caffeine in an amount equivalent to that of a human who drinks four cups of coffee daily.

Considering the findings, mate tea and caffeine can be considered anti-obesity agents.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Discrepancies in Ayushman Bharat and Rashtriya Arogya Nidhi Schemes

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I saw a report of Rema Nagarajan in TOI that a 12-year-old Sameer from Bihar’s Muzaffarpur, suffering from aplastic anemia, needs Rs 12 lakh for a bone marrow transplant but in spite of being entitled under both Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Rashtriya Arogya Nidhi (RAN), he is getting no relief.

The hurdles are that Ayushman Bharat does not cover bone marrow transplant and an office order says that he cannot be covered under Rashtriya Arogya Nidhi (which provides up to Rs 15 lakh coverage for serious illnesses) because he is covered under Ayushman.

The job of the government is to help and not find the loopholes. Government orders cannot supersede the spirit behind the schemes. It’s like that the rules cannot supersede the act.

I have another patient, Mithilesh Kumar from Bokaro, Jharkhand. He is a contract worker. He was operated for implantation of CRTD St. Jude Device pacemaker at CMC, Vellore in 2014. At that time, he managed to arrange the amount for operation by selling his property. Now, battery of the pacemaker is to be replaced. He has Ayushman Bharat card, but it does not cover the expenses of battery replacement. He has written to PM, Narendra Modi for help.

Not covering the battery replacement does not make sense. If you have decided to cover a pacemaker, it is understood that the battery would last 5-15 years depending on the type of device and second or third replacement needs to be covered.

Where should a poor man go for the clarifications. Courts are already overloaded with cases. Everyone cannot afford the courts also. Such powers should be given to district magistrate or the CMO to handle and interpret the government orders in the right spirit.

I am marking an email to Dr Harsh Vardhan Ji, PM Office and Dr Vinod Paul for positive interventions.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

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