Dulaglutide in Type 2 Diabetes: Do GLP-1 agonists delay progression of diabetic nephropathy?

By Connor Emdin
June 27, 2018

Forty percent of patients with type 2 diabetes go on to develop chronic kidney disease (CKD).1 These patients are at markedly elevated risk of death from cardiovascular disease.2 They also suffer from reduced quality of life, particularly when CKD progresses to end-stage renal disease and dialysis.3 Despite the substantial morbidity and mortality associated with diabetic kidney disease, therapies are limited. In the National Kidney Foundation Clinical Practice Guidelines for Diabetes and CKD from 2012, only angiotensin converting-enzyme-inhibitors (ACE-inhibitors) and angiotensin-receptor blockers were recommended for protection of renal function in patients with CKD and diabetes with albuminuria.4 Continue reading “Dulaglutide in Type 2 Diabetes: Do GLP-1 agonists delay progression of diabetic nephropathy?”

Type 1 Diabetes: Not Just a Disease of the Young

By Connor Emdin
January 30, 2018

Type 1 diabetes (T1D) is commonly thought of as a disease of children and young adults, with a peak age of diagnosis around 14 years.1 However, adults with T1D may be misdiagnosed as having type 2 diabetes (T2D) due to the much greater prevalence of T2D in older ages.2 Such misdiagnosis of T1D as T2D may have important clinical consequences. Individuals with undiagnosed T1D may be less likely to receive insulin therapy and may present with diabetic ketoacidosis, a life-threatening emergency characterized by elevated blood glucose and ketone levels.3 Continue reading “Type 1 Diabetes: Not Just a Disease of the Young”

Palliative Care in Advanced Heart Failure

By Connor Emdin
September 20, 2017

Heart failure (HF) is the leading cause of hospitalization for adults over the age of 65 in the United States and is associated with poor short-term survival, with an estimated median survival of 1.5-3 years after diagnosis.1,2 In addition to causing significant morbidity and mortality, HF is associated with reduced quality of life, spiritual distress, depression, and anxiety.3
Continue reading “Palliative Care in Advanced Heart Failure”

Quality of Life & Cost-Effectiveness of Intensive Blood Pressure Lowering

By Connor Emdin
September 6, 2017

In recent years, there has been considerable shift in treatment targets for blood pressure management. In 2014, the Eighth Joint National Commission (JNC 8) guidelines controversially up-revised blood pressure targets and recommended a target blood pressure of less than 140/80mm Hg in adults less than 60 years of age, increasing to less than 150/90mm Hg in those aged over 60 years. They argued that at the time, no randomized trial had demonstrated that lower blood pressure targets were associated with reduced risk of cardiovascular disease or death.1 These recommendations were a cause of heated debate and were inconsistent with recommendations from several other expert bodies, including American Heart Association and American College of Cardiology. Continue reading “Quality of Life & Cost-Effectiveness of Intensive Blood Pressure Lowering”

Declining Risk of Sudden Death in Heart Failure with Reduced Ejection Fraction

By Connor Emdin
August 1, 2017

Heart failure is the cause of more than one million hospital admissions in the United States annually1 and is a leading cause of death worldwide.2 Heart failure with reduced ejection fraction (HFrEF), characterized by EF typically <40%, is observed in approximately 50% of individuals with heart failure1 and is associated with an elevated risk of sudden cardiac death due to ventricular arrhythmia.3 While implantable cardioverter-defibrillators (ICD) can reduce the risk of sudden death, substantial risk remains and implantation itself is expensive and associated with risks including infection, and device misfiring.1,4 Therefore identifying the patient population who will gain most benefit from ICD implantation is of considerable interest. Continue reading “Declining Risk of Sudden Death in Heart Failure with Reduced Ejection Fraction”

Inclisiran: A Novel Therapeutic for Long-Term Lowering of LDL Cholesterol?

By Connor Emdin
May 18, 2017

Elevated low-density lipoprotein cholesterol (LDL cholesterol) is a leading cause of coronary heart disease and death worldwide.1 When LDL cholesterol particles become oxidized, they can invade the endothelium of blood vessels and attract macrophages, forming atherosclerotic plaques. Over a lifetime, high levels of LDL cholesterol can lead to the formation of numerous unstable atherosclerotic plaques, potentially leading to myocardial infarction, stroke, and death from cardiovascular disease (CVD).2 Continue reading “Inclisiran: A Novel Therapeutic for Long-Term Lowering of LDL Cholesterol?”