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1.
Diabet Med. 2019 Jan 6. doi: 10.1111/dme.13895. [Epub ahead of print]

Ethnicity and Type 2 diabetes in the UK.

Author information

1
Diabetes Research Group, Departments of Diabetes and Nutritional Sciences, King's College London, London, UK.

Abstract

Type 2 diabetes is a major UK public health priority. Among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher than in the white British population. Particularly striking is the earlier onset of Type 2 diabetes, which occurs some 10-12 years younger, with a significant proportion of cases being diagnosed before the age of 40 years. This review focuses on the UK context and Type 2 diabetes in adult populations, exploring the available evidence regarding the complex interplay of biological, lifestyle, social, clinical and healthcare system factors that are known to drive these disparities.

PMID:
30614072
DOI:
10.1111/dme.13895
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Publication type

Publication type

2.
Diabet Med. 2019 Jan 6. doi: 10.1111/dme.13894. [Epub ahead of print]

Time trends in diabetes mellitus in Jordan between 1994 and 2017.

Author information

1
National Centre (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), University of Jordan, Amman.
2
Department of Public Health and Community Medicine, Jordan University of Science and Technology (JUST), Irbid.
3
National Centre (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), University of Jordan, Amman, Jordan.
4
Jordan Ministry of Health, Amman, Jordan.

Abstract

AIM:

The prevalence of diabetes has been increasing over the past few decades. The objective of this study is to assess the time trends in diabetes between 1994 and 2017 in Jordan.

METHODS:

Surveys were conducted in 1994, 2004, 2009 and 2017 by the same investigators using generally similar methods. Fasting blood glucose was measured in all surveys. Variables were obtained using structured questionnaires designed specifically for the surveys. Crude and age-specific diabetes prevalence rates were derived for each sex, together with overall, crude and age-standardized prevalence rates.

RESULTS:

The prevalence of diabetes in men aged ≥ 25 years increased from 14.2% in 1994 to 18.3% in 2004, 26.8% in 2009 and 32.4% in 2017. The corresponding prevalence rates in women were 12.3%, 16.9%, 18.8%, and 18.1%, respectively. The overall age-standardized prevalence rate increased from 13.0% in 1994 to 17.1% in 2004, 22.2% in 2009 and 23.7% in 2017. Known diabetes in the 2017 survey accounted for 82.6% of people with diabetes. A HbA1c of < 59 mmol/mol (7.5%) was observed in 41.4% of participants with known diabetes.

CONCLUSION:

The results showed a high prevalence of diabetes in Jordan among people aged ≥ 25 years. Prevalence increased from 1994 to 2009, but slowed thereafter. The increase was greater in men than in women. Previously diagnosed diabetes accounted for a high percentage of people with diabetes in all surveys and was highest in 2017 survey, suggesting that the national strategy against diabetes has brought some benefits. Efforts should be made to improve glycaemic control in people with diabetes.

PMID:
30614070
DOI:
10.1111/dme.13894
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3.
Diabet Med. 2019 Jan 6. doi: 10.1111/dme.13896. [Epub ahead of print]

Management of people with Type 2 diabetes shared between a specialized outpatient clinic and primary health care is noninferior to management in a specialized outpatient clinic: a randomized, noninferiority trial.

Author information

1
Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, University of Copenhagen, Gentofte.
2
Institute of Nursing, University College Copenhagen, Copenhagen, Denmark.
3
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
4
Rudersdalklinikken, Holte.
5
Vangede Laegehus, Gentofte.
6
Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen.
7
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen.
8
Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.

Abstract

AIM:

To evaluate whether management of people with Type 2 diabetes shared between a specialized outpatient clinic and primary health care has noninferior HbA1c outcomes compared with mono-sectorial management in a specialized outpatient clinic.

METHODS:

A randomized controlled, noninferiority study. People with moderate hyperglycaemia, hypertension and/or incipient complications were eligible for the study. All participants had annual comprehensive check-ups at the outpatient clinic. Quarterly check-ups were conducted by general practitioners (GPs) for the shared care group and by endocrinologists at the outpatient clinic for the control group. The primary outcome was the mean difference in HbA1c from baseline to 12 months of follow-up. The noninferiority margin for HbA1c was 4.4 mmol/mol.

RESULTS:

A total of 140 people were randomized [age 65.0 ± 0.9 years, HbA1c 52 ± 0.8 mmol/mol (6.9 ± 0.1%), systolic BP 135.6 ± 1.1 mmHg; all mean ± sem]. Peripheral neuropathy was present in 68% of participants and microalbuminuria in 19%; 15% had history of a previous major cardiovascular event. Among study completers (n = 133), HbA1c increased by 2.3 mmol/mol (0.2%) in the shared care group and by 1.0 mmol/mol (0.1%) in the control group, with a between-group difference of 1.3 mmol/mol [90% confidence interval (CI) -1.3, 3.9] (0.1%, 90% CI -0.1, 0.4). Noninferiority was confirmed in both per protocol and intention to treat analyses.

CONCLUSION:

We found that our shared care programme was noninferior to specialized outpatient management in maintaining glycaemic control in this group of people with Type 2 diabetes. Shared care should be considered for the future diabetes management of Type 2 diabetes.

PMID:
30614066
DOI:
10.1111/dme.13896
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4.
Diabet Med. 2019 Jan 6. doi: 10.1111/dme.13893. [Epub ahead of print]

The cost of treating diabetic ketoacidosis in an adolescent population in the UK: a national survey of hospital resource use.

Author information

1
Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
2
Norwich Medical School, University of East Anglia, Norwich, UK.
3
Health Economics Consulting, Norwich Medical School, University of East Anglia, Norwich, UK.
4
Diabetes Department, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.

Abstract

AIMS:

Adolescents with Type 1 diabetes commonly experience episodes of ketoacidosis. In 2014, we conducted a nationwide survey on the management of diabetic ketoacidosis in young people. The survey reported how individual adolescents with diabetes were managed. However, the costs of treating diabetic ketoacidosis were not reported.

METHODS:

Using this mixed population sample of adolescents, we took a 'bottom-up' approach to cost analysis aiming to determine the total expense associated with treating diabetic ketoacidosis. The data were derived using the information from the national UK survey of 71 individuals, collected via questionnaires sent to specialist paediatric diabetes services in England and Wales.

RESULTS:

Several assumptions had to be made when analysing the data because the initial survey collection tool was not designed with a health economic model in mind. The mean time to resolution of diabetic ketoacidosis was 15.0 h [95% confidence interval (CI) 13.2, 16.8] and the mean total length of stay was 2.4 days (95% CI 1.9, 3.0). Based on data for individuals and using the British Society of Paediatric Endocrinology and Diabetes (BSPED) guidelines, the cost analysis shows that for this cohort, the average cost for an episode of diabetic ketoacidosis was £1387 (95% CI 1120, 1653). Regression analysis showed a significant cost saving of £762 (95% CI 140, 1574; P = 0.04) among those treated using BSPED guidelines.

CONCLUSION:

We have used a bottom-up approach to calculate the costs of an episode of diabetic ketoacidosis in adolescents. These data suggest that following treatment guidelines can significantly lower the costs for managing episodes of diabetic ketoacidosis.

PMID:
30614052
DOI:
10.1111/dme.13893
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5.
Diabetes. 2019 Mar;68(3):637-647. doi: 10.2337/db18-1064. Epub 2019 Jan 9.

The Role of Prostaglandins in Disrupted Gastric Motor Activity Associated With Type 2 Diabetes.

Author information

1
Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV.
2
Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV smward@med.unr.edu.

Abstract

Patients with diabetes often develop gastrointestinal motor problems, including gastroparesis. Previous studies have suggested this gastric motor disorder was a consequence of an enteric neuropathy. Disruptions in interstitial cells of Cajal (ICC) have also been reported. A thorough examination of functional changes in gastric motor activity during diabetes has not yet been performed. We comprehensively examined the gastric antrums of Lepob mice using functional, morphological, and molecular techniques to determine the pathophysiological consequences in this type 2 diabetic animal model. Video analysis and isometric force measurements revealed higher frequency and less robust antral contractions in Lepob mice compared with controls. Electrical pacemaker activity was reduced in amplitude and increased in frequency. Populations of enteric neurons, ICC, and platelet-derived growth factor receptor α+ cells were unchanged. Analysis of components of the prostaglandin pathway revealed upregulation of multiple enzymes and receptors. Prostaglandin-endoperoxide synthase-2 inhibition increased slow wave amplitudes and reduced frequency of diabetic antrums. In conclusion, gastric pacemaker and contractile activity is disordered in type 2 diabetic mice, and this appears to be a consequence of excessive prostaglandin signaling. Inhibition of prostaglandin synthesis may provide a novel treatment for diabetic gastric motility disorders.

PMID:
30626609
DOI:
10.2337/db18-1064
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6.
Diabetes. 2019 Jan 9. pii: db180501. doi: 10.2337/db18-0501. [Epub ahead of print]

Epitope Stealing as Mechanism of Dominant Protection by HLA-DQ6 in Type 1 Diabetes.

Author information

1
Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, the Netherlands, The Netherlands.
2
Laboratory of Biochemistry and Biophysics, Faculty of Agricultural Technology, Epirus Institute of Technology, Arta, Greece.
3
Department of Diabetes Immunology, Diabetes & Metabolism Research Institute at the Beckman Research Institute, City of Hope, Duarte, USA.
4
Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, the Netherlands, The Netherlands boroep@lumc.nl.
PMID:
30626607
DOI:
10.2337/db18-0501
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7.
Diabetes. 2019 Jan 7. pii: db180509. doi: 10.2337/db18-0509. [Epub ahead of print]

Structural and Functional Abnormalities of the Primary Somatosensory Cortex in Diabetic Peripheral Neuropathy: A Multimodal MRI Study.

Author information

1
Department of Human Metabolism, University of Sheffield, Sheffield, UK d.selvarajah@sheffield.ac.uk.
2
Academic Department of Magnetic Resonance Imaging, University of Sheffield, Sheffield, UK.
3
Department of Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
4
Department of Human Metabolism, University of Sheffield, Sheffield, UK.
5
Diabetes Research Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
6
FMRIB, Oxford University, Oxford, UK.

Abstract

Diabetic distal symmetrical peripheral polyneuropathy (DSP) results in decreased somatosensory cortical gray matter volume, indicating that the disease process may produce morphological changes in the brains of those affected. However, no study has examined whether changes in brain volume alters the functional organisation of the somatosensory cortex and how this relates to the different painful DSP clinical phenotypes. In this case-controlled, multimodal magnetic resonance brain imaging study of 44 carefully phenotyped subjects, we found significant anatomical and functional changes in the somatosensory cortex. Painful DSP insensate subjects have the lowest somatosensory cortical thickness with expansion of the area representing pain in the lower limb to include face and lip regions. Furthermore, there was a significant relationship between anatomical and functional changes within the somatosensory cortex and severity of the peripheral neuropathy. These data suggest a dynamic plasticity of the brain in DSP, driven by the neuropathic process. It demonstrates, for the first time, a pathophysiological relationship between a clinical painful DSP phenotype and alterations in the somatosensory cortex.

PMID:
30617218
DOI:
10.2337/db18-0509
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8.
Diabetes Care. 2019 Jan 7. pii: dc181126. doi: 10.2337/dc18-1126. [Epub ahead of print]

Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials.

Author information

1
Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.
2
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.
3
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Canada.
4
Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada.
5
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
6
Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, University of Zagreb School of Medicine, Zagreb, Croatia.
7
Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada v.vuksan@utoronto.ca.

Abstract

OBJECTIVE:

Evidence from randomized controlled trials (RCTs) suggests that viscous dietary fiber may offer beneficial effects on glycemic control and, thus, an improved cardiovascular disease risk profile. Our purpose was to conduct a systematic review and meta-analysis of RCTs to synthesize the therapeutic effect of viscous fiber supplementation on glycemic control in type 2 diabetes.

RESEARCH DESIGN AND METHODS:

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through 15 June 2018. We included RCTs ≥3 weeks in duration that assessed the effects of viscous fiber on markers of glycemic control in type 2 diabetes. Two independent reviewers extracted data. Data were pooled using the generic inverse variance method and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I 2 statistic). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the overall certainty of the evidence.

RESULTS:

We identified 28 eligible trial comparisons (n = 1,394). Viscous fiber at a median dose of ∼13.1 g/day significantly reduced HbA1c (MD -0.58% [95% CI -0.88, -0.28]; P = 0.0002), fasting blood glucose (MD -0.82 mmol/L [95% CI -1.32, -0.31]; P = 0.001), and HOMA-insulin resistance (IR) (MD -1.89 [95% CI -3.45, -0.33]; P = 0.02) compared with control and in addition to standard of care. The certainty of evidence was graded moderate for HbA1c, fasting glucose, fasting insulin, and HOMA-IR and low for fructosamine.

CONCLUSIONS:

Viscous fiber supplements improve conventional markers of glycemic control beyond usual care and should be considered in the management of type 2 diabetes.

PMID:
30617143
DOI:
10.2337/dc18-1126
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9.
J Clin Endocrinol Metab. 2019 Jan 9. doi: 10.1210/jc.2018-01468. [Epub ahead of print]

Predictors of long-term glycemic remission after 2-week intensive insulin treatment in newly diagnosed type 2 diabetes.

Author information

1
Department of Endocrinology, Fuwai Hospital & Chinese Academy of Medical Sciences, China.
2
Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China.
3
Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, China.
4
Department of Endocrinology, Dalian Municipal Central Hospital, China.
5
Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, China.
6
Department of Endocrinology, the Second Xiangya Hospital of Central South University, China.
7
Department of Endocrinology, Peking University Shenzhen Hospital, China.
8
Department of Endocrinology, West China Hospital, Sichuan University, China.
9
Department of Endocrinology, Shenzhen Second People's Hospital, China.
10
Department of Endocrinology, Peking Union Medical College Hospital, China.
11
Department of Endocrinology, the Second Affiliated Hospital of Chongqing Medical University, China.
12
Department of Endocrinology, Shengjing Hospital of China Medical University, China.
13
Statistics Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, China.
14
Department of Endocrinology, China-Japan Friendship Hospital, China.

Abstract

Context:

Although several studies suggest that improved β-cell function is a key determinant of glycemic remission in type 2 diabetes, other predictors remain unclear.

Objective:

The aim of this clamp-based study was to identify predictors of 2-year glycemic remission after short-term intensive insulin treatment.

Design:

A 2-year follow-up was planned in 124 drug-naïve type 2 diabetic patients who received continuous subcutaneous insulin infusion (CSII) for 2 weeks. Euglycemic-hyperinsulinemic clamps and intravenous glucose tolerance tests were performed to assess the insulin sensitivity (glucose infusion rate, GIR) and acute insulin response (AIR) pre- and post-CSII.

Results:

First-phase insulin secretion was restored, and the GIR was significantly improved (P<0.0001) after the 2-week CSII. Glycemic remission rates were 47.6% and 30.7% after 12 and 24 months of follow-up, respectively. Cox analysis revealed that a higher post-CSII glucose level (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.15-1.66, P=0.0005) and older age at diabetes diagnosis (HR 1.34, 95% CI 1.05-1.72, P=0.02) accounted for an increased risk of hyperglycemic relapse. A 1-SD increase in the AIR (HR 0.75, 95% CI 0.57-0.99, P=0.04), GIR (HR 0.67, 95% CI 0.48-0.93, P=0.016) post-CSII, and baseline GIR (HR 0.71, 95% CI 0.51-0.99, P=0.047), were inversely associated with this risk.

Conclusions:

Younger age at diabetes diagnosis, higher baseline insulin sensitivity and lower glucose levels after insulin treatment significantly favored a 2-year glycemic remission. This long-term remission was attributed to both improved insulin sensitivity and enhanced β-cell function after short-term intensive insulin treatment.

10.
J Clin Endocrinol Metab. 2019 Jan 9. doi: 10.1210/jc.2018-02321. [Epub ahead of print]

Youth and long-term dietary calcium intake with risk of impaired glucose metabolism and type 2 diabetes in adulthood.

Author information

1
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
2
Department of Medicine, University of Turku, Turku, Finland.
3
Division of Medicine, Turku University Hospital, Turku, Finland.
4
Murdoch Children's Research Institute, Parkville, Victoria, Australia.
5
Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku, Turku, Finland.
6
Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland.
7
Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
8
National Institute for Health and Welfare, Turku, Finland.
9
Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center - Tampere, Tampere University, Tampere, Finland.
10
Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland.
11
Department of Clinical Physiology, Tampere University Hospital and University of Tampere, Tampere, Finland.
12
Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
13
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.

Abstract

Context:

No previous studies have examined the role of youth calcium intake in the development of impaired glucose metabolism, particularly those with long-term high calcium intake.

Objectives:

To examine whether youth and long-term (between youth and adulthood) dietary calcium intake is associated with adult impaired glucose metabolism and T2D.

Design, Setting, and Participants:

The Cardiovascular Risk in Young Finns Study (YFS) is a 31-year prospective cohort study (n=1134, aged 3-18 years at baseline).

Exposures:

Dietary calcium intake was assessed at baseline (1980) and adult follow-ups (2001, 2007 and 2011). Long-term (mean between youth and adulthood) dietary calcium intake was calculated.

Main outcome measures:

Adult impaired fasting glucose (IFG) and T2D.

Results:

We found no evidence for non-linear associations between calcium intake with IFG or T2D among females and males (all p for non-linearity>0.05). Higher youth and long-term dietary calcium intake was not associated with the risk of IFG or T2D among females or males after adjustment for confounders including youth and adult BMI.

Conclusions:

Youth or long-term dietary calcium intake is not associated with adult risk of developing impaired glucose metabolism or T2D.

11.
J Clin Endocrinol Metab. 2019 Jan 3. doi: 10.1210/jc.2018-01402. [Epub ahead of print]

Proximal HbA1C Level and First Hypoglycemia Hospitalization in Adults with Incident Type 2 Diabetes.

Author information

1
From the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
2
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
3
Global Pharmacovigilance and Epidemiology, Sanofi, Bridgewater, NJ, USA.
4
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
5
Center for Health Metrics and Evaluation, the American Heart Association, Dallas, TX, USA.
6
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
7
Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
8
Farr Institute for Health Informatics Research, University of Manchester, Manchester, UK.

Abstract

Context:

HbA1C is an important predictor of severe hypoglycemia.

Objective:

To determine the association of proximal HbA1C level with first hypoglycemia requiring hospitalization (HH) in adults with incident type 2 diabetes (T2D).

Design, Setting, and Participants:

A nested case-control study was designed using linked data from the Clinical Practice Research Datalink and Hospital Episode Statistics in England in 1997-2014. The first hypoglycemia as primary diagnosis for hospitalization after T2D diagnosis was identified. Proximal HbA1C was measured within 90 days prior to the first HH.

Main Outcome Measure:

Odds ratio (OR) for developing HH.

Results:

The association of proximal HbA1C level with first HH was similar between HbA1C of 6.0% (OR 1.54; 95% CI 1.12-2.11) and 9.0% (1.48 [1.01-2.17]), compared to the reference HbA1C level of 7.0%. For proximal HbA1C level of 4.0-6.5%, every additional 0.5% increase in HbA1C was associated with lower first HH risk with OR (95% CI) ranging between 0.37 (0.20-0.67) and 0.86 (0.76-0.98). For proximal HbA1C level of 8.0-11.5%, every additional 0.5% increase in HbA1C was associated with higher first HH risk with OR (95% CI) ranging between 1.16 (1.04-1.29) and 1.34 (1.18-1.52). The U-shaped association between proximal HbA1C level and first HH did not exist among current sulfonylureas users but persisted among current insulin users (Pinteraction=0.002). Among current non-insulin non-sulfonylureas users who had first HH, 78% took insulin or sulfonylureas prior to HH.

Conclusions:

Having either poor or near-normal HbA1C was associated with higher risk of first HH in T2D within three months.

12.
Lancet. 2019 Jan 5;393(10166):3-5. doi: 10.1016/S0140-6736(18)32824-1. Epub 2018 Nov 10.

Pump, pipes, and filter: do SGLT2 inhibitors cover it all?

Author information

1
Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto M5B 1W8, ON, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada. Electronic address: vermasu@smh.ca.
2
Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.
PMID:
30424891
DOI:
10.1016/S0140-6736(18)32824-1
[Indexed for MEDLINE]
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