Dr. Alessandro Mantovani E-Mail
Assistant Professor, Section of Endocrinology and Metabolism, Department of Medicine, University of Verona, Verona, Italy
Research Keywords: type 2 diabetes and risk of cardiovascular complications; type 2 diabetes and risk of diabetic foot complications
Dr. Giovanni Targher E-Mail
Associate Professor, Section of Endocrinology and Metabolism, Department of Medicine, University of Verona, Verona, Italy
Research Keywords: type 2 diabetes and risk of chronic vascular complications of diabetes; role of nonalcoholic fatty liver disease in diabetes
Type 2 diabetes mellitus is a major public health problem that has reached epidemic proportions worldwide. Type 2 diabetes mellitus is also strongly associated with serious chronic complications, including ischemic heart disease, stroke, blindness, kidney disease and lower-extremity amputations leading to disability and early mortality. From 1980 to 2014, the number of people affected by type 2 diabetes mellitus almost quadrupled from 108 million to 422 million worldwide, showing a growth in the global prevalence from 4.7% to 8.5%. This growth trend is not estimated to slow in the near future. Indeed, according to the recent estimates from the International Diabetes Federation, the prevalence of the disease is expected to further increase to 9.9% by the year 2045 with an estimated population of around 640 million people with diabetes worldwide. This undoubtedly represents a potential future healthcare crisis for patients and providers alike. Areas of ongoing research include all aspects of type 2 diabetes mellitus, including epidemiology, physiopathology, risk factors, complications, management and treatment.
Keywords: type 2 diabetes; chronic complications; epidemiology; management; pharmacologic treatment; risk factors
Technology in diabetes is rapidly evolving, with the aim of helping affected people to safely optimize their blood glucose control. New technologies are now considered as an essential tool for managing glycemia predominantly in people with type 1 diabetes, and clinical trials have demonstrated that in these subjects the use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems are associated with improved glycemic control along with a better quality of life. Literature regarding technologies and type 2 diabetes is relatively lacking, but innovations may have an important role also in the management of these patients. Some studies in adults with type 2 diabetes have shown benefits with the use of CGM in terms of glycemic variability and improved therapeutic adjustments. Clinical trials about CSII and CGM use in type 2 diabetes may have some pitfalls and future studies are needed to assess how these advanced systems could improve clinical outcomes and also ensure cost-effectiveness in this population. In this narrative review, we aim to highlight the most relevant studies on this topic and to focus on the potential role of new technological devices in type 2 diabetes management.
Diabetes and cancer are widespread worldwide and the number of subjects presenting both diseases increased over the years. The management of cancer patients having diabetes represents a challenge not only because of the complexity and heterogeneity of these pathologies but also for the lack of standardised clinical guidelines. The diagnosis of cancer is traumatizing and monopolizes the attention of both patients and caregivers. Thus, pre-existent or new-onset diabetes can be overshadowed thus increasing the risk for short- and long-term adverse events. Moreover, drugs used for each disease can interfere with the clinical course of the concomitant disease, making challenging the management of these patients. Over the years, this issue has become more relevant because of the increased patients’ life expectancy due to the improved efficacy of diabetes and cancer therapies.
The purpose of this review is to highlight what is known and what should be taken into consideration to optimise the clinical management of patients with diabetes and cancer. Due to the complexity of these diseases, a multidisciplinary, shared approach, including all the protagonists involved, is necessary to improve patients’ quality of life and lifespan.
Recent randomized controlled trials (RCTs) have tested the efficacy of glucagon-like peptide-1 receptor agonists (GLP-1 RA) to specifically treat non-alcoholic fatty liver disease (NAFLD). We performed a meta-analysis of RCTs to investigate the efficacy of GLP-1 RAs for treatment of NAFLD or non-alcoholic steatohepatitis (NASH).
We systematically searched PubMed and ClinicalTrials.Gov databases utilizing specific terms to identify placebo-controlled or head-to-head RCTs (last research on March 1, 2020) involving NAFLD patients with the aim of evaluating the efficacy of GLP-1 RAs to treat NAFLD/NASH. Primary outcomes were changes in serum liver enzymes, liver fat content, or histologic resolution of NASH. Weighted mean differences (WMD) were used to test the differences between the treatment arms.
Overall, we found 7 placebo-controlled or head-to-head RCTs involving 472 middle-aged individuals (66% men; 77% with established diabetes) followed for a median of 16 weeks that have used liraglutide or exenatide to treat NAFLD on imaging (n = 6) or biopsy (n = 1). Compared to placebo or reference therapy, treatment with GLP-1 RAs decreased serum alanine aminotransferase [n = 7 studies; WMD: –8.77 IU/L, 95% confidence intervals (CI) –17.69 to 0.14 IU/L; I2 = 87.3%], gamma-glutamyltransferase levels (n = 4 studies; WMD: –10.17 IU/L, 95% CI –14.27 IU/L to –6.07 IU/L; I2 = 0%) and imaging-defined liver fat content (n = 4 studies; WMD: –6.23%, 95% CI –8.95% to –3.51%; I2 = 85.9%). In one RCT involving 55 patients with biopsy-proven NASH, a 48-week treatment with liraglutide also led to a greater histological resolution of NASH than placebo.
GLP-1 RAs (mostly liraglutide) seem to be a promising treatment option for NAFLD or NASH.