COORDINATE-DIABETES Trial Takeaways, Liver Disease & Diabetes, Colchicine for Cardiac Disease, Air Quality & Building Your Own HEPA Filter.
The Full Panel meets your TLDR (Too Long; Didn’t Read) needs by delivering the latest medicine & health news in a nutshell. 🥜
COORDINATE-DIABETES trial demonstrates that there is more to optimized health than just a prescription
Gist: The COORDINATE-DIABETES trial found that an integrated intervention (i.e., improved clinician prescribing practices via defined care pathways) approach significantly improved medication prescribing practices for patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD).
Nitty-Gritty: Clinics in the intervention group collaborated to formulate a clinic-specific analysis of barriers to care and defined a care pathway based on these barriers to care. Clinics also received tools for coordinating care among clinicians, clinician-oriented education and monthly conference calls, patient-oriented educational materials and feedback on quality metrics showing how their prescribing habits compared with other clinics. The primary researcher emphasized the importance of delivering existing therapies to patients, stating that the study proves significant improvements in prescribing practices, leading to better prevention of cardiovascular events.
Big Picture: With a targeted intervention involving better coordination, education, and feedback, the likelihood of patients being prescribed these beneficial medications increases more than fourfold (‼️). This can result in better disease management and possibly improved long-term health outcomes.
Original source: here.
ADA updates guidelines on NAFLD screenings for diabetic patients
Gist: The American Diabetes Association (ADA) has updated its screening guidelines for nonalcoholic fatty liver disease (NAFLD) in patients with diabetes or pre-diabetes, as part of an addendum to the Standards of Care in Diabetes published in December 2022. The update amends the "Comprehensive Medical Evaluation and Assessment of Comorbidities" section of the guidelines, emphasizing the need for timely diagnosis and treatment of NAFLD, which affects approximately 70% of type 2 diabetes (T2D) patients and can lead to cirrhosis, liver cancer, and increased cardiovascular disease risk. Type 2 diabetes and obesity represent the main risk factors for NAFLD.
Nitty-Gritty: Key changes include detailed recommendations for NAFLD screening in adults with T2D or pre-diabetes. Additionally, the ADA proposes that diabetic and pre-diabetic patients with elevated plasma aminotransferase levels (i.e., liver enzymes measured in your blood) and a low fibrosis (i.e., scarring and hardening of the liver) index should be assessed for NAFLD.
Big Picture: The updated guidelines underline the close connection between diabetes and liver disease and the importance of having current information for effective detection and management of the disease. TFP investigated whether the Canadian Diabetes guidelines reflected a similar change and could not find any updates at this time. However, that does not mean that Canadian health care providers aren't already assessing for this none the less. Guidelines are just that, a guide. They do not replace sound clinical judgement, individualized assessment and treatment plans of expert clinicians.
Original source: here.
First anti-inflammatory drug aimed at reducing cardiovascular events in adults with atherosclerotic cardiovascular disease (ASCVD)
Gist: The US Food and Drug Administration (FDA) has approved colchicine 0.5 mg (Lodoco) by Agepha Pharma, the first anti-inflammatory drug aimed at reducing cardiovascular events in adults with established atherosclerotic cardiovascular disease (ASCVD) or those at risk. This once-daily medication can be taken independently or alongside standard lipid-lowering drugs, with prescription availability expected later this year.
Nitty-Gritty: The LoDoCo2 trial involving over 5,000 patients provided key data for this approval. It demonstrated that the addition of colchicine led to reduced cardiovascular events compared to placebo during a median follow-up of 28.6 months.
The principal investigator emphasized that the approval marks a significant advance in managing patients with residual inflammation, asserting that lipid lowering and inflammation inhibition work synergistically. They suggest using colchicine in patients with elevated high-sensitivity inflammatory markers (C-reactive protein (CRP)) greater than 2 milligrams per liter (measured in the blood), indicating uncontrolled inflammation.
Big Picture: People should care about this development because it offers a new preventative measure for cardiovascular events, which are a major cause of mortality and morbidity worldwide. Additionally, this also validates the role of inflammation as a contributor to cardiovascular disease burden, not just cholesterol/lipid levels. Clinicians will need to determine its position within the spectrum of residual risk reduction approaches.
In late 2019, the Montreal Heart Institute's COLCOT clinical trial, led by Dr. Jean-Claude Tardif, demonstrated the benefits of colchicine in the same context.
Original source: here.
Concerned about air quality?
Gist: The death of a nine-year-old boy in B.C., whose asthma worsened due to wildfire smoke, underscores the lethal risk of poor air quality for those with respiratory and cardiac conditions. As Dr. Anne Hicks of the University of Alberta explains, wildfire smoke increases instances of asthma exacerbations, hospital visits due to lung conditions such as viral infections, pneumonia, and COPD, and incidents of heart attacks and strokes.
Nitty-Gritty: Hicks advises checking the Air Quality Health Index (AQHI) provided by Environment Canada to monitor air pollution levels. The index uses a scale of 1-3 (low risk), 4-6 (moderate risk), 7-10 (high risk), and above 10 (very high risk). However, individuals with asthma or other chronic conditions, infants, young children, pregnant people, and seniors can be more sensitive to lower levels of air pollution.
Big Picture: When air quality is bad, it's advised to stay indoors, keep windows closed, and use a HEPA or MERV13-rated air purifier. Heat risks should also be considered, as high temperatures can trigger asthma attacks and cause heat exhaustion or heat stroke. Wearing masks outdoors can help filter out pollutants, with N95 respirators offering the most protection.
It's crucial for people with asthma to have a steady supply of their daily "controller" medications and "reliever" medications ready for potential asthma exacerbations. Any worrisome signs should prompt an immediate hospital visit.
Original source: here.
Build a DIY HEPA filtration system:
TFP tested this, and we made the filter in the video below. We used IKEA air quality sensors with indicators of red, yellow or green (green being most ideal) to assess our home. We had a yellow reading prior to using our DIY filter. After turning on our DIY filter for a bit, we then had a green reading, meaning "good". From this crude experiment, we deduced that our DIY filter works well enough. That being said, we are not respirologists nor experts in this subject, therefore, be sure to do your own research when deciding what is best for you!
Interested in previous newsletters or other articles we’ve published? Check them out here at: thefullpanel.com
Got a question for us? Suggestions for content you’d like to see? Feedback? E-mail us at: hello@mail.thefullpanel.com