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Medical Topics

Postoperative neuropathic pain is one of the most dreadful complications following lumbar spine surgeries. Owing to the similarities in the pathophysiological and biochemical mechanisms underlying epilepsy and neuropathic pain, many antiepileptic drugs (AEDs) like pregabalin and gabapentin are being used in the treatment of post-operative neuropathic pain.It is important to mention that Gabapentin 900mg/day led to the lowest VAS score (Pain score) and was the best in its opioid sparing effect followed by other concentrations&nbsp; of Gabapentin (1200mg, 600mg, and 300mg) &amp; Pregabalins (150mg &amp; 75mg), respectively with no significant differences in adverse events in spine Surgeries.
Reference:&nbsp; Garg RN, Vaje S, Patil H, Bajaj S. A prospective and observational study to assess the efficacy of pregabalin versus gabapentin in relieving early post operative neuropathic pain with respect to clinical and functional outcomes in patients undergoing open lumbar discectomy surgery. International Journal of Research in Orthopaedics. 2023;10(1):57–63. doi:10.18203/issn.2455-4510.intjresorthop20234039&nbsp;
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Management of Perioperative Pain Control After Spine Surgery

Postoperative pain is influenced by various factors, including the duration and site of the operation, the amount of manipulation involved, and the individualized perception of pain. More than two-thirds of patients who undergo total joint arthroplasty experience severe postoperative pain. Many patients suffer from extreme pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA), especially in the first 2 weeks. Enhanced pain control after arthroplasty is related to shorter rehabilitation time, decreased complications, and improved patient satisfaction. The number of joint arthroplasty surgeries have increased worldwide, with more than one million arthroplasties performed each year in the United States. Considering the increased number of arthroplasty cases, it seems necessary to identify the latest approaches for postoperative pain control. Duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SNRI), has been approved for treating depression,
anxiety, and post-traumatic stress disorders by the US Food and Drug Administration (FDA). It has also been
approved to treat diabetic neuropathic pain and fibromyalgia. Several studies has shown the role of duloxetine in reducing the pain caused by knee and hip osteoarthritis, two systematic reviews and meta-analyses have confirmed duloxetine’s analgesic and opioid-sparing role postoperatively. In conclusion, Duloxetine 30mg/60mg shows moderate opioid sparing effects and statistically significant reduction in pain scores with no significant difference in the prevalence of side effects versus Placebo.
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Reference: Azimi A, Hooshmand E, Mafi AA, Tabatabaei F-S. Effect of duloxetine on opioid consumption and pain after total knee and hip arthroplasty: A systematic review and meta-analysis of randomized clinical trials. Pain Medicine. 2023;24(9):1035–45. doi:10.1093/pm/pnad045&nbsp;
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Medicines and Opioids Consumption Effect on Post-operative Pain

Postoperative pain control is a critical component of comprehensive postsurgical patient care, as it affects patient satisfaction and operative outcomes and can result in pathophysiologic neural alterations that evolve into chronic pain syndromes. Tissue trauma resulting from surgery is thought to lead to both central and peripheral nerve sensitization, resulting in an activity-dependent increase in spinal neurons excitation and a decreased threshold of nociceptive afferents, respectively.&nbsp;
Historically, opioids have been the preferred drug of choice for the management of postoperative pain following joint arthroplasty. However, when used in excess, opioids can lead to deleterious side effects and have the potential for both addiction and abuse. These risks are particularly important in orthopaedics given that orthopaedic surgeons are highest prescribers amongst all surgeons.
Considering the concerns surrounding excessive opioid use, multimodal analgesic regimens utilizing a combination of opioid and nonopioid analgesic drugs targeting different sites within the central and peripheral nervous system have emerged as the new standard in managing postoperative pain. Among commonly used interventions, such as acetaminophen and nonsteroidal anti-inflammatory drugs, there is a growing body of evidence suggesting that duloxetine is used in the management of postoperative pain. The 60mg concentration of Duloxetine significantly reduced pain at rest and at movement as well as opioid consumption at 48 and 72hrs after Knee or Hip Replacement operations.
Reference: Jones IA, Talehakimi A, Murphy LS, Wang JC, Piple AS, Christ AB, et al. Duloxetine for postoperative pain control following knee or hip replacement: A systematic review and meta-analysis. Arthroplasty Today. 2023 Apr;20:101097. doi:10.1016/j.artd.2023.101097&nbsp;
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Post-operative Pain Control after Knee Replacement

Chronic sciatica (CS), like most neuropathic pain states, is often resistant to simple treatment regimens. Chronic sciatica is sciatica lasting longer than 3 months. Neuropathic pain states are typically managed by super-adding anticonvulsant drugs onto simple drug regimens. The drugs most used are gabapentin (GBP) or pregabalin (PGB). Chronic sciatica has therefore been increasingly treated with super-added GBP or PGB. GBP led to superior Visual analog pain intensity scale reduction with fewer and less sever adverse events than PGB. In addition to this, it is important to mention that GBP should be commenced before PGBs to permit optimal crossover of medicines.
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Reference:
Robertson K, Marshman L, Plummer D, Downs E. Effect of Gabapentin vs Pregabalin on Pain Intensity in Adults With Chronic Sciatica. JAMA Neurology. 2019;76(1):28.
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Trends in Pain Management of Chronic Sciatica

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Overview
The National Institute for Health and Care Excellence (NICE) has released updated guidance (NG226) on the diagnosis and management of osteoarthritis (OA) in individuals aged 16 and over. 
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&nbsp;Diagnosis: A Clinical Approach
NICE now recommends that imaging is not required to diagnose OA if the following features are present:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l3 level1 lfo1; tab-stops: list .5in;">Age ≥45 years</li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo1; tab-stops: list .5in;">Activity-related joint pain</li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo1; tab-stops: list .5in;">No morning joint stiffness or morning stiffness lasting ≤30 minutes</li>
</ul>
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Core Treatment Strategies
The guideline reinforces the importance of non-pharmacological interventions as the foundation of OA care:
<ol style="margin-top: 0in;" start="1" type="1">
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Patient Education Encourage understanding of OA </li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Exercise therapy For all people with osteoarthritis, offer therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness).</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Weight management For individuals with overweight or obesity, support weight loss to alleviate symptoms and improve function.</li>
</ol>
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Pharmacological Management
If Pharmacological treatments are needed to manage Osteoarthritis, use them:
*alongside non-pharmacological treatments and to support therapeutic exercise
*at the lowest effective dose for the shortest possible time.
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo3; tab-stops: list .5in;">Start with topical NSAIDs; if ineffective, consider an &nbsp;oral NSAID with a Proton pump inhibitor.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo3; tab-stops: list .5in;">Paracetamol and opioids are not routinely recommended due to limited efficacy and risk of harm.</li>
</ul>
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Intra-articular and Surgical Options
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l4 level1 lfo4; tab-stops: list .5in;">Corticosteroid injections when other pharmacological treatments are ineffective.</li>
<li class="MsoNormal" style="mso-list: l4 level1 lfo4; tab-stops: list .5in;">Referral for joint replacement surgery should be considered when conservative management fails, and &nbsp;when pain or functional limitations are impacting quality of Life.</li>
</ul>
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Interventions Not Recommended
The guideline advises against the use of:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l1 level1 lfo5; tab-stops: list .5in;">Glucosamine products</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo5; tab-stops: list .5in;">Acupuncture</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo5; tab-stops: list .5in;">Electrotherapy (e.g., TENS)</li>
</ul>
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Full guideline available at NICE: <a href="https://www.nice.org.uk/guidance/ng226">https://www.nice.org.uk/guidance/ng226</a>
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NICE Osteoarthritis Guideline (NG226) published on 19 October 2022

Post-spinal surgery pain remains a significant challenge despite advances in minimally invasive techniques. This pain, often severe and neuropathic, can lead to chronic pain and diminishees quality of life. While multimodal analgesia offers a comprehensive approach, limitations exist with current options like opioids. Duloxetine, an SNRI with demonstrated analgesic effect, may be an effective treatment option for postoperative pain following spine surgery. This systematic review evaluates the efficacy and safety of duloxetine in managing acute and chronic pain following spine surgery.
 Study Characteristics, Results, Discussion, and Conclusion
Study Characteristics
Seven studies (five RCTs, one pilot trial, and one retrospective observational study) comprising 487 participants were analyzed. All studies were published since 2015, with most after 2017. Duloxetine dosages ranged from 20-60mg, with varying administration schedules (single dose pre-operatively, pre- and post-operatively, or daily for three months). Various spinal surgery types were included. Numeric rating scale (NRS),Verbal numeric scale, brief pain inventory, visual analogue scale (VAS), Pain catastrophizing scale and McGill Pain Questionnaire (MPQ) were used to determine postoperative pain in included studies. Some of the studies included evaluated pain 48 hours and others studied&nbsp; 12 weeks after surgery.
Results
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal">RCTs: One RCT showed significantly lower pain scores with duloxetine/etoricoxib combination versus placebo, etoricoxib alone, and duloxetine alone. Another found similar pain score reductions with duloxetine and pregabalin, both superior to placebo. One study showed significantly lower pain scores with duloxetine/opioid versus placebo/opioid at 4- and 12-weeks post-surgery. Two RCTs found no significant difference between duloxetine and control (diazepam or placebo).</li>
<li class="MsoNormal">Pilot Study: Duloxetine significantly improved the affective component of pain as measured by the McGill Pain Questionnaire (MPQ).</li>
<li class="MsoNormal">Retrospective Study: 79.2% of patients (19/24) experienced a ≥2-point NRS pain score reduction with duloxetine. All patients (9/9) with postsurgical chronic pain responded positively. Mean NRS pain scores decreased significantly in responders (6.22 to 2.78).</li>
<li class="MsoNormal">Opioid Consumption: Studies concluded that there is a significant reduction in opioid consumption in patients receiving duloxetine.</li>
<li class="MsoNormal">Adverse Events: Studies concluded that Duloxetine was well tolerated without serious adverse events</li>
</ul>
Discussion
Results regarding duloxetine's efficacy for post-spinal surgery pain are mixed. While some studies demonstrated significant pain reduction, others did not. Thus, it is crucial to recognize the potential limitations within individual studies and the variability in methodologies.
&nbsp;To establish duloxetine’s efficacy and safety conclusively, future RCTs should systematically compare it with other oral medications such as nonsteroidal anti-inflammatory drugs, assess its long-term safety profile, and determine the optimal dosage regimen.
Conclusion
The findings suggest that duloxetine holds promise as an effective component and an alternative to opioids for postoperative pain management following spinal surgery.
 References: <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10793159/pdf/main.pdf">- The eﬀect of duloxetine on postoperative pain and opium consumption in</a>
<span style="font-size: 12.0pt; line-height: 115%; font-family: 'Aptos',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Aptos; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10793159/pdf/main.pdf">spine surgery: A systematic review -North American Pain society journal</a>

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The eﬀect of duloxetine on postoperative pain and opium consumption in spine surgery: A systematic review 

Osteoarthritis (OA) is a progressive joint disorder characterized by cartilage degradation, inflammation, and chronic pain, significantly impacting quality of life. In their paper, Farinelli et al. explore a wide range of pain management options—spanning from traditional to emerging therapies—while highlighting the limitations and future directions of OA treatment.
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Conventional Pharmacologic Treatments:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Commonly used to alleviate pain and inflammation, but can cause gastrointestinal, renal, and cardiovascular side effects.</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Acetaminophen: Often recommended for mild OA pain, although its efficacy is limited.</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Opioids: Used for severe pain, though associated with dependency and adverse effects, making them less favourable for long-term use.</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Topical agents: Such as capsaicin and diclofenac, may be useful for localized pain with fewer systemic effects.</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Intra-articular injections:</li>
<ul style="margin-top: 0in;" type="circle">
<li class="MsoNormal" style="mso-list: l2 level2 lfo1; tab-stops: list 1.0in;">Corticosteroids: Provide short-term relief, especially in inflammatory OA flares.</li>
<li class="MsoNormal" style="mso-list: l2 level2 lfo1; tab-stops: list 1.0in;">Hyaluronic acid: Offers lubrication and potential anti-inflammatory effects but with variable results in studies.</li>
</ul>
</ul>
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Non-Pharmacologic Approaches:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo2; tab-stops: list .5in;">Physical therapy and exercise: Recommended to improve joint function, muscle strength, and overall mobility.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2; tab-stops: list .5in;">Weight management: Particularly important for knee OA, as excess weight increases joint stress.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2; tab-stops: list .5in;">Patient education and self-management programs: Empower patients to take an active role in managing their condition.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2; tab-stops: list .5in;">: Alternative management: such as aquatic exercise, walking aids, and tibiofemoral bracing</li>
</ul>
&nbsp;
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Emerging and Future Therapies:
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Platelet-rich plasma (PRP): PRP holds promise in alleviating pain, enhancing knee functionality, and improving the quality of life.&nbsp; More favorable outcomes are observed in younger patients and cases of mild OA
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Mesenchymal Stem Cell Therapy: To date, bone marrow mesenchymal stem cells (BM-MSCs) are considered the gold standard of bone and cartilage tissue engineering. These cells can migrate from subchondral bone to damaged sites, differentiate into chondrocytes and osteoblasts, and integrate with new tissues and surrounding tissues.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Innovation in Osteoarthritis Therapy: Nanotechnology (including liposomes, micelles, and carbon nano allotropes) finds widespread application across diverse industries and in the field of medicine. Research has reported a crucial purpose of nanotechnology in treating OA through the development of drug delivery approaches. 
&nbsp;
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Personalized medicine: Future strategies may tailor pain management based on genetic, metabolic, and biomechanical factors.</li>
</ul>
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Conclusion: Despite the availability of multiple treatment strategies, no single approach fully addresses OA pain due to its complex and multifactorial nature. Multimodal and individualized strategies combining pharmacologic and non-pharmacologic interventions offer the best outcomes. Future research focused on molecular mechanisms and regenerative solutions is crucial for achieving more effective and personalized pain relief.
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For more information, click the link: <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC11048725/?utm_source=chatgpt.com">https://pmc.ncbi.nlm.nih.gov/articles/PMC11048725</a>

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Pain Management Strategies in Osteoarthritis

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Management of Osteoarthritis of the Hip:
Evidence-Based Clinical Practice Guideline
The American Academy of Orthopaedic Surgeons Board of Directors


Management of Osteoarthritis of the Hip: Evidence-Based Clinical Practice Guideline

Introduction:
Knee arthroscopy is a common orthopedic procedure, but surgical site infections (SSIs), though infrequent, can significantly impact patient outcomes. This newsletter summarizes the findings of a recent systematic review and meta-analysis that investigated risk factors for SSI following knee arthroscopy.
. The studies were published between 1992 and 2022 and conducted across three continents. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies.
Key Findings:
The meta-analysis identified several patient-related and surgery-related risk factors associated with increased risk of SSI after knee arthroscopy.
Patient-Related Risk Factors:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Obesity (BMI ≥30 kg/m ²): Obese patients had a 1.27-times higher risk of infection (95% CI, 1.08-1.49).</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Male Sex: Male patients demonstrated a 1.52-times greater infection risk (95% CI, 1.32-1.75).</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Diabetes: Patients with diabetes had a 1.71-times increased risk (95% CI, 1.36-2.14).</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Tobacco Use: Tobacco users experienced a 1.65-times elevated risk (95% CI, 1.38-1.97).</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo1; tab-stops: list .5in;">Preoperative Steroid Use: A history of steroid use significantly increased the risk of infection, with a 3.41-fold increase (95% CI, 2.10-5.54).</li>
</ul>
Surgery-Related Risk Factors:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list .5in;">High Procedure Complexity: Procedures requiring an auxiliary incision or extended operative time were associated with a 2.02-times higher risk (95% CI, 1.69-2.43).</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list .5in;">Autograft Use for Cruciate Ligament Reconstruction: The use of autografts was associated with a 2.66-times higher risk of infection compared to allografts (95% CI, 1.84-3.86).</li>
</ul>
Factors Not Significantly Associated with Infection:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo3; tab-stops: list .5in;">Age (&gt;50 years): No significant association was found between age and infection risk.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo3; tab-stops: list .5in;">Antibiotic Prophylaxis: The study found no significant association between antibiotic prophylaxis and infection.</li>
</ul>
Clinical Implications:
These findings provide valuable insights for orthopedic HCPs. Assessment of these risk factors can facilitate early identification of patients at increased risk of SSI following knee arthroscopy. This allows for optimization of perioperative strategies, enhanced postoperative care, and improved patient outcomes. However, it is important to remember that these are correlational findings, and further research is needed to establish causal relationships and explore the interplay of multiple risk factors.
References: <a href="https://www.journalofhospitalinfection.com/article/S0195-6701(24)00234-2/abstract">Risk factors for infection in patients undergoing knee arthroscopy: a systematic review and meta-analysis</a>
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Risk Factors for Infection After Knee Arthroscopy

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Time to Recovery in Patients with Acute Painful Musculoskeletal Conditions Treated with Extended-Release or Immediate-Release Cyclobenzaprine 

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Diagnosis and Treatment of Low Back Pain: ACP–APS Clinical Practice Guideline Summary (2007) 

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Choosing a Skeletal Muscle Relaxant 

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EFNS guidelines on the pharmacological treatment of neuropathic pain

EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision 

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Key Updates on Knee Osteoarthritis Management – AAOS 2021 

In patients with both chronic liver disease and type 2 diabetes who consistently followed their treatment regimen, GLP-1 agonists could lead to a reduced risk of major adverse liver outcomes (MALO). The impact of glucagon-like peptide-1 receptor (GLP1) agonists on hard clinical outcomes in patients with chronic liver diseases of any cause and concurrent type 2 diabetes is uncertain, despite their potential for resolving metabolic dysfunction-associated steatohepatitis. GLP1 agonists could potentially serve as a treatment option to lower the risk of MALO in patients with type 2 diabetes and any form of chronic liver disease who adhere to the treatment regimen over time. However, confirmation of these findings would require validation through randomized clinical trials.&nbsp;
&nbsp;
Reference: Wester A, Shang Y, Toresson Grip E, et alGlucagon-like peptide-1 receptor agonists and risk of major adverse liver outcomes in patients with chronic liver disease and type 2 diabetesGut Published Online First: 22 January 2024. doi: 10.1136/gutjnl-2023-330962.&nbsp;

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GLP-1 Agonists Reduce Risk for Severe Liver Disease

SGLT2 inhibitors were linked to a reduced likelihood of composite anemia outcomes, particularly instances of anemia events.&nbsp;
This retrospective cohort study, indicated that using SGLT2 inhibitors was associated with a 19% reduced risk of composite anemia outcomes compared to the use of GLP-1 RA.&nbsp;
The results remained consistent across various SGLT2 inhibitors, implying a class-wide effect of anemia benefits associated with SGLT2 inhibitors.&nbsp;
These main findings were supported by alterations in hematological laboratory parameters, revealing significant distinctions between the SGLT2 inhibitor and GLP-1 RA groups over the three-year monitoring period.&nbsp;
The similarity in glycemic control and kidney function changes observed in both the SGLT2 inhibitor and GLP-1 RA groups suggest that mechanisms possibly responsible for the decreased incidence of anemia with SGLT2 inhibitor use are likely independent of these factors.&nbsp;
SGLT2 inhibitors may be considered as an adjunct therapy to mitigate the occurrence of mitigate the occurrence of anemia in patients with type 2 diabetes and chronic kidney disease.&nbsp;
&nbsp;
Reference: Hu J, et al. Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients With Diabetes and CKD. JAMA Netw Open. 2024;7(3):e240946.&nbsp;

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Diabetes Treatment and Risk of Anemia in Patients with Diabetes and CKD 

Metformin for type 2 diabetes mellitus (T2DM) patients is linked to a decreased risk of experiencing severe diabetic nephropathy and major cardiovascular events.&nbsp;
For T2DM patients with compromised kidney functions, maintaining metformin therapy is connected to reduced risk of major kidney and cardiovascular events compared with non-metformin user or discontinued user.&nbsp;
Metformin usage among T2DM patients, regardless of their renal functions variation, consistently shows a lower risk of severe diabetic nephropathy (DN), major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE) compared with the control cohort.&nbsp;
&nbsp;
&nbsp;
&nbsp;
Reference: Yongjin Yi, et al. Impact of metformin on cardiovascular and kidney outcome based on kidney function status in type 2 diabetic patients: a multicentric, retrospective cohort study. Sci Rep 14, 2081 (2024).&nbsp;

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Impact of Metformin on Cardiovascular and Kidney Outcomes in Type 2 Diabetic Patients 

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ADA 2025 Guidelines: Navigating the New Diagnostic Algorithm for MASLD 

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ADA 2025 Guidelines- Management of MASLD:

ADA 2025 Guidelines- Management of MASLD

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Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) in People with Diabetes: The Need for Screening and Early Intervention. A Consensus Report of the American Diabetes Association 

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Dapagliflozin plus calorie restriction for remission of type 2 diabetes: multicentre, double blind, randomised, placebo-controlled trial

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Premium AI Image _ Pretty realistic heart illustration with isolated____.png

Impact of sodium‒glucose cotransporter‐2 inhibitors in patients with recent versus previous myocardial infarction: a systematic review and meta-analysis 

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Premium Photo _ Medicine in ampoules with insulin needles and.png

The Modern Role of Basal Insulin in Advancing Therapy in People With Type 2 Diabetes 

<div class="OutlineElement Ltr SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW218006624 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Higher A1c variability, assessed over a 4-year period, was associated with a substantially increased risk for subsequent mortality outcomes in patients with type 1 diabetes (T1D) and those with type 2 diabetes (T2D), regardless of average A1c levels <span class="EOP SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW218006624 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Variability measures were generally higher in T2D, with 38% of patients with T2D vs 33% of those with T1D having an A1c variability score ≥ 50.<span class="EOP SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW218006624 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Predictors of high A1c variability were younger age, obesity, comorbidities, and residence in deprived areas for both T1D and T2D, whereas non-White ethnicity was a predictor of high variability only in T1D.<span class="EOP SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW218006624 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">A higher vs lower A1c variability score (≥ 80 vs &lt; 20) was associated with nearly a threefold increase in mortality risk for patients with T1D and a twofold increased risk for those with T2D (hazard ratio [HR] for T1D, 2.78; 95% CI, 2.15-3.60; HR for T2D, 1.91; 95% CI, 1.83-1.99).<span class="EOP SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW218006624 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">The impact of average A1c levels on mortality was less pronounced than that of A1c variability, as evidenced by higher population attributable fractions for variability (A1c variability score ≥ 20) than for average A1c levels in both T1D and T2D.<span class="LineBreakBlob BlobObject DragDrop SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <span class="LineBreakBlob BlobObject DragDrop SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <a class="Hyperlink SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://www.sciencedirect.com/science/article/pii/S0168822725002438" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW218006624 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-weight: bold; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">HbA1c variability and all-cause mortality in type 1 and type 2 diabetes: A population-based cohort study using electronic health records - Diabetes Research and Clinical Practice</a><span class="EOP SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW218006624 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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thumbnail_A1C_ Questions from a Diabetes Practice _ ADW Diabetes.png

A1C_ Questions from a Diabetes Practice _ ADW Diabetes.png

HbA1c variability and all-cause mortality in type 1 and type 2 diabetes: A population-based cohort study using electronic health records

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Kidney - AI Generated Artwork - NightCafe Creator.jpg

The Association Between Hemoglobin A1c and Complications Among Individuals With Diabetes and Severe Chronic Kidney Disease 

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image (13) (1).png

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes | New England Journal of Medicine 

<div class="OutlineElement Ltr SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW201137233 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">In the first head-to-head trial of its kind produced significantly greater weight loss, and reduction in waist circumference, than <span class="NormalTextRun SpellingErrorV2Themed SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">semaglutide in adults with obesity but without type 2 diabetes over 72 weeks in the SURMOUNT-5 trial.&nbsp;<span class="EOP SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW201137233 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">The phase 3b <span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">open-label, randomized controlled trial showed that patients treated with <span class="NormalTextRun SpellingErrorV2Themed SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">tirzepatide vs <span class="NormalTextRun SpellingErrorV2Themed SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">semaglutide lost an average of 20.2% vs 13.7% of their baseline weight over the 72 weeks. Nearly twice as many participants achieved a target of ≥ 25% weight reduction on <span class="NormalTextRun SpellingErrorV2Themed SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">tirzepatide vs semifluid.<span class="EOP SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW201137233 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">For more information: <a class="Hyperlink SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://www.nejm.org/doi/full/10.1056/NEJMoa2416394" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW201137233 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-weight: bold; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">Tirzepatide as Compared with Semaglutide for the Treatment of Obesity - NEJM</a><span class="EOP SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW201137233 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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Tirzepatide as Compared with Semaglutide for the Treatment of Obesity 

<div class="OutlineElement Ltr SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW88859518 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">• Updated insulin treatment sections including new bolus and basal insulin formulations.<span class="EOP SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW88859518 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">• Updated recommendations on the principles of intensive insulin treatment regimens, including a more intensive form of multiple daily injections (MDIs) with new-generation faster-acting insulins and ultra-long-acting insulins, automated insulin delivery to achieve a high level of treatment personalization, better glycemia, and empowerment for people with diabetes.<span class="EOP SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW88859518 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">• Review of the roles and rationales for new insulin analogs, biosimilars, and diabetes technology devices for insulin therapy in pediatric diabetology<span class="EOP SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW88859518 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">• Summary of adjunctive medications used alongside insulin treatment that includes details on pramlintide, metformin, glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RA), and sodium-glucose cotransporter (SGLT) inhibitors.<span class="EOP SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW88859518 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">• Key considerations <span class="NormalTextRun AdvancedProofingIssueV2Themed SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">with regard to access to insulin and affordability specifically innovative, multi-faceted approaches involving governments, healthcare providers, pharmaceutical companies, and advocacy groups to ensure that all persons with diabetes who need insulin can obtain it without financial hardship<span class="EOP SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW88859518 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">For more information: <a class="Hyperlink SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://www.ispad.org/resources/ispad-clinical-practice-consensus-guidelines/2024-cpcg.html" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW88859518 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">ISPAD -2024 Clinical Practice Consensus Guidelines</a><span class="EOP SCXW88859518 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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ISPAD 2024 Clinical Practice Consensus Guidelines 

<div class="OutlineElement Ltr SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW148079439 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">New pilot study findings suggest that combining empagliflozin with metformin may significantly improve non-alcoholic fatty liver disease (NAFLD) progression in patients with type 2 diabetes (T2DM). This 6-month observational study of 63 metformin-treated T2DM patients with NAFLD demonstrated that the combination therapy group experienced significant reductions in BMI, glycated hemoglobin, ALT levels, controlled attenuation parameter (CAP), and steatosis degree compared to metformin monotherapy. The addition of empagliflozin led to a 9% reduction in the median CAP value. These promising preliminary results indicate that this combination therapy could offer substantial benefits for managing NAFLD in T2DM patients<span class="EOP SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW148079439 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">For more information: <a class="Hyperlink SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://www.mdpi.com/2227-9059/11/2/322" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW148079439 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">Effects of a Combination of Empagliflozin Plus Metformin vs. Metformin Monotherapy on NAFLD Progression in Type 2 Diabetes: The IMAGIN Pilot Study – Biomedicines.</a><span class="EOP SCXW148079439 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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Effects of a Combination of Empagliflozin Plus Metformin vs. Metformin Monotherapy on NAFLD Progression in Type 2 Diabetes: The IMAGIN Pilot Study 

<div class="OutlineElement Ltr SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW80458854 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">The ISPAD 2024 Clinical Practice Consensus Guidelines on Type 2 Diabetes (T2D) in Children and Adolescents provides an in-depth overview of the diagnosis, management, and complications associated with T2D in youth. Key updates from previous guidelines include refined diagnostic algorithms and new pharmacologic treatment recommendations for youth-onset T2D, such as the use of GLP-1 receptor agonists and insulin in certain cases.<span class="EOP SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW80458854 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">The document emphasizes the growing global concern over youth-onset T2D, noting that it is more common in certain ethnic groups, such as Native American and First Nations populations. The pathophysiology of youth-onset T2D closely mirrors that of adult T2D, driven by insulin resistance and impaired insulin secretion. The guidelines stress the importance of early diagnosis using criteria like HbA1c ≥6.5% or fasting plasma glucose ≥126 mg/dL, and they advocate for lifestyle interventions, including increased physical activity, diet changes, and weight management, as fundamental elements of care.<span class="EOP SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW80458854 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Furthermore, the report highlights the need for comprehensive research to address the social determinants of health, which play a significant role in the onset and progression of T2D in youth. It also underscores the importance of continuous monitoring, including the use of continuous glucose monitoring (CGM) devices, to manage blood glucose levels effectively.<span class="EOP SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW80458854 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Finally, the guidelines stress the critical need for personalized care and the development of interventions that address both clinical and psychosocial aspects of managing T2D in young <span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">people .<span class="EOP SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<p class="Paragraph SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW80458854 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">For more information: <a class="Hyperlink SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://karger.com/hrp/article/97/6/555/918111/ISPAD-Clinical-Practice-Consensus-Guidelines-2024" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW80458854 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-weight: bold; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">ISPAD Clinical Practice Consensus Guidelines 2024: Type 2 Diabetes in Children and Adolescents</a><span class="TextRun SCXW80458854 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-weight: bold;" xml:lang="EN-US" data-contrast="auto">&nbsp;<span class="EOP SCXW80458854 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}"> 
</div>

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Screenshot 2025-08-27 162932.png

ISPAD Clinical Practice Consensus Guidelines 2024: Type 2 Diabetes in Children and Adolescents 

<div class="OutlineElement Ltr SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW7509953 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Insulin treatment should commence as soon as possible after T1D diagnosis (within 6 h if ketonuria is present) to prevent metabolic decompensation and diabetic ketoacidosis (DKA).<span class="EOP SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW7509953 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">• Intensive insulin regimens delivered by combinations of MDIs or pump therapy with substitution of basal and prandial insulin aiming to have optimal glycemia are the gold standard for the treatment of T1D in children across all age groups.&nbsp;<span class="EOP SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW7509953 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">• Premix insulin regimen using NPH and regular soluble insulin should not be considered a best practice treatment for T1D.&nbsp;<span class="EOP SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW7509953 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">• All young people should have rapid-acting or regular insulin available and a means to inject this insulin for prevention and management of diabetes, hyperglycemia, and ketosis emergencies.<span class="EOP SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW7509953 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">For more information: <a class="Hyperlink SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://www.ispad.org/resources/ispad-clinical-practice-consensus-guidelines/2024-cpcg.html" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW7509953 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">ISPAD- 2024 Clinical Practice Consensus Guidelines</a><span class="EOP SCXW7509953 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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2025 ADA Standards of Care: What’s New in Diabetes Management? 

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Screenshot 2025-09-10 114044.png

  IDF Diabetes Atlas 2025 

<div class="OutlineElement Ltr SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW36245592 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Rates of cardiometabolic illnesses among American adults have reached an <a class="Hyperlink SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW36245592 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">astonishing 50%</a><span class="TextRun SCXW36245592 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">. For diabetes, cardiovascular disease, and related inflammatory conditions, the root cause often boils down to poor diet. Nearly <a class="Hyperlink SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://jamanetwork.com/journals/jama/fullarticle/2608221" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW36245592 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">45% of all deaths</a><span class="TextRun SCXW36245592 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto"> from cardiometabolic diseases are attributable to unhealthy eating. Clinicians know they should be giving diet advice, but some programs are taking it a step further, showing it works better to provide patients with the food itself.<span class="EOP SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW36245592 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Enter Food Is Medicine initiatives. These programs are based on the concept that improving access to healthy food is cheaper and more efficient than paying for the inevitable results of a lifelong poor diet. They target segments of the population struggling with purchasing and preparing healthy food due to social, economic, and other barriers.<span class="EOP SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; white-space-collapse: preserve; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW36245592 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">For more information: <a class="Hyperlink SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001343" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW36245592 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-weight: bold; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">A Systematic Review of “Food Is Medicine” Randomized Controlled Trials for Noncommunicable Disease in the United States: A Scientific Statement From the American Heart Association - Circulation</a><span class="EOP SCXW36245592 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>

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Screenshot 2025-09-10 114115.png

A Systematic Review of “Food Is Medicine” Randomized Controlled Trials for Noncommunicable Disease 

A Systematic Review of “Food Is Medicine” Randomized Controlled Trials for Noncommunicable Disease in the United States: A Scientific Statement From the American Heart Association 

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Screenshot 2025-09-10 114144.png

Early Introduction of SGLT-2 Inhibitors to Improve Chronic Kidney Disease Care in People with or without Diabetes

Early Introduction of SGLT-2 Inhibitors to Improve Chronic Kidney Disease Care in People with or without Diabetes—Consensus by Indian Nephrologists 

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Screenshot 2025-09-10 114220.png

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes 

<div class="OutlineElement Ltr SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW76023438 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Adherence to basal insulin in people with type 2 diabetes (T2D) is poorly understood. Yet, a comprehensive understanding is&nbsp;<span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">prerequisite&nbsp;for tailoring support strategies. This study assessed adherence using insulin injection data.&nbsp;&nbsp;<span class="EOP SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW76023438 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">&nbsp;Basal insulin data was provided from 165 participants in the randomized controlled&nbsp;<span class="NormalTextRun SpellingErrorV2Themed SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">DiaMonT-trial (NCT04981808).&nbsp;<span class="LineBreakBlob BlobObject DragDrop SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <span class="TextRun SCXW76023438 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Daily basal insulin injections recorded by connected insulin pens were compared to the recommended doses. Data&nbsp;was&nbsp;aggregated over 14-day periods.&nbsp;<span class="LineBreakBlob BlobObject DragDrop SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <span class="TextRun SCXW76023438 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">Adherence was quantified through&nbsp;<span class="LineBreakBlob BlobObject DragDrop SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <span class="TextRun SCXW76023438 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">(1) overall adherence, defined as the percentage of doses administered as recommended; (2) the distribution of correct, increased, reduced, and omitted doses; and&nbsp;<span class="LineBreakBlob BlobObject DragDrop SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <span class="TextRun SCXW76023438 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">(3) dose deviation, measured as the percentage deviation from the recommended dose.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; This study&nbsp;provided&nbsp;detailed insights into basal insulin adherence in people with T2D, crucial for improving adherence and glycemic control.<span class="LineBreakBlob BlobObject DragDrop SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <span class="LineBreakBlob BlobObject DragDrop SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <span class="TextRun SCXW76023438 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 12pt; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-US" data-contrast="auto">For more information:<span class="LineBreakBlob BlobObject DragDrop SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 12pt; line-height: 20.85px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <a class="Hyperlink SCXW76023438 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://diabetesjournals.org/diabetes/article/74/Supplement_1/1111-P/159312/1111-P-Data-Driven-Assessment-of-Basal-Insulin" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW76023438 BCX0" lang="EN-US" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 12pt; text-decoration-line: underline; line-height: 20.85px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US" data-contrast="none">https://diabetesjournals.org/diabetes/article/74/Supplement_1/1111-P/159312/1111-P-Data-Driven-Assessment-of-Basal-Insulin</a>
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Types of Diabetes_ Causes, Identification, and More.jpeg

Data-Driven Assessment of Basal Insulin Adherence in People with Type 2 Diabetes 

<div class="OutlineElement Ltr SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW52508060 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-GB" data-contrast="auto">This 2026 consensus report from the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) builds on the 2021 report to provide guidance for managing type 1 diabetes in adults.&nbsp;<span class="EOP SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW52508060 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-GB" data-contrast="auto">Reflecting the rapid advances in the field, all sections have been updated to account for novel therapies, interventions to delay disease onset, and the integration of&nbsp;new technologies.&nbsp;<span class="EOP SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW52508060 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-GB" data-contrast="auto">It also broadens its scope to screening for long-term diabetes complications, and the management of obesity and cardiovascular risk factors. Psychosocial care and diabetes&nbsp;self-management&nbsp;education and support (DSMES) remain key section elements<span class="EOP SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW52508060 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-GB" data-contrast="auto">For More Information:<span class="LineBreakBlob BlobObject DragDrop SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <a class="Hyperlink SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://professional.diabetes.org/sites/dpro/files/2025-09/2026-ADA-EASD-Management-of-Type-1-Diabetes-Consensus-Report-Draft-for-consultation.pdf" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW52508060 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 11pt; text-decoration-line: underline; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-GB" data-contrast="none">https://professional.diabetes.org/sites/dpro/files/2025-09/2026-ADA-EASD-Management-of-Type-1-Diabetes-Consensus-Report-Draft-for-consultation.pdf</a><span class="EOP SCXW52508060 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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Simple Steps to Preventing Diabetes • The Nutrition Source.jpeg

The management of type 1 diabetes in adults. The updated 2026 consensus report by the 3 American Diabetes Association (ADA) and the European Association for the Study of Diabetes 4 (EASD) 

<div class="OutlineElement Ltr SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW137019441 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-GB" data-contrast="auto">High insulin doses are required due to the rise in obesity and insulin resistance, in both type 1 and type 2 diabetes (T2DM). AT278 is a new ultra-rapid formulation of concentrated insulin aspart (500 IU/ml). <span class="EOP SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW137019441 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-GB" data-contrast="auto">In a randomised, double-blind, crossover, euglycemic clamp study, a single&nbsp;<span class="NormalTextRun SpellingErrorV2Themed SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">sc&nbsp;injection of 0.5 IU/kg of AT278 was compared to&nbsp;<span class="NormalTextRun SpellingErrorV2Themed SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">InsAsp, with an&nbsp;additional&nbsp;open comparison to&nbsp;<span class="NormalTextRun SpellingErrorV2Themed SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; border-bottom: 1px solid transparent;">HumIns&nbsp;in 41 adults with T2DM (BMI 25.0 - 38.7 kg/m2).<span class="EOP SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>
<div class="OutlineElement Ltr SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW137019441 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-GB" data-contrast="auto">Concentrated AT278 (500 IU/ml) offers ultra-fast characteristics independent of BMI and thus has the potential to improve quality of life for people with diabetes with high prandial insulin needs.<span class="EOP SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="EOP SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
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<div class="OutlineElement Ltr SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; clear: both; cursor: text; overflow: visible; position: relative; direction: ltr; font-family: 'Segoe UI', 'Segoe UI Web', Arial, Verdana, sans-serif; font-size: 12px; background-color: #ffffff;">
<p class="Paragraph SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px 0px 10.6667px; padding: 0px; user-select: text; overflow-wrap: break-word; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;"><span class="TextRun SCXW137019441 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-variant-ligatures: none !important; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" xml:lang="EN-GB" data-contrast="auto">For More Information:<span class="LineBreakBlob BlobObject DragDrop SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: WordVisiCarriageReturn_MSFontService, Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;">&nbsp; <a class="Hyperlink SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; text-decoration-line: none;" href="https://diabetesjournals.org/diabetes/article/74/Supplement_1/823-P/159768/823-P-AT278-a-Novel-Ultra-fast-Highly-Concentrated" target="_blank" rel="noreferrer noopener"><span class="TextRun Underlined SCXW137019441 BCX0" lang="EN-GB" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; color: #467886; font-size: 11pt; text-decoration-line: underline; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-GB" data-contrast="none">https://diabetesjournals.org/diabetes/article/74/Supplement_1/823-P/159768/823-P-AT278-a-Novel-Ultra-fast-Highly-Concentrated</a><span class="EOP SCXW137019441 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; font-size: 11pt; line-height: 19.425px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, sans-serif;" data-ccp-props="{}">&nbsp;
</div>

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Novel Ultra-fast Highly Concentrated Insulin Aspart (500 IU/ml), Shows Ultra-fast Properties Independent of BMI  

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Updated Vaccination Recommendations for People with Multiple Sclerosis

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MS
Multiple Sclerosis
CNS
Cognitive Impairment

A New Framework for Cognitive Impairment in MS: 5 Phenotypes Based on Severity and Domain

The evolving understanding of multiple sclerosis (MS) continues to reshape our approach to its diagnosis and management. A landmark article by Giovannoni and colleagues, published in Therapeutic Advances in Neurological Disorders, introduces the concept of "smouldering MS", positing it as the fundamental driver of disease progression. Below, we distill the key insights and clinical implications.
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Understanding Smouldering MS
Smouldering MS is characterized by persistent disease activity, independent of clinical relapses or visible MRI lesions. The authors propose that this chronic, underlying pathology may be the "real MS," responsible for long-term disability and progressive neurodegeneration.
Key Features Include:
<ul style="margin-top: 0in;" type="disc">
<li>Chronic Active Lesions: Also called "rim lesions," these slowly expanding lesions show sustained demyelination and axonal injury.</li>
<li>Diffuse Inflammation: Microglial and astrocytic activation in both gray and white matter drives progressive damage.</li>
<li>Cortical Demyelination: Subtle cortical damage, associated with cognitive and physical decline, is often missed on conventional MRI.</li>
<li>Accelerated Brain Atrophy: Smouldering MS is linked to faster brain volume loss, a key marker of neurodegeneration.</li>
</ul>
This paradigm challenges traditional notions that focus primarily on relapsing-remitting MS (RRMS) and emphasizes the importance of identifying smouldering disease activity early.
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Diagnostic and Monitoring Challenges
Traditional MRI metrics such as gadolinium-enhancing lesions and T2 lesion count may not adequately capture smouldering MS. Instead, the authors advocate for advanced imaging techniques and biomarkers to assess:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Chronic lesion activity: Better captured by techniques like susceptibility-weighted imaging (SWI).</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Diffuse neurodegeneration: Measured through cortical atrophy and brain volume loss.</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Microglial activation: Potentially detectable with PET imaging or other emerging modalities.</li>
</ul>
Neurologists should remain vigilant for subtle signs of progression that might not correlate with clinical relapses.
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Therapeutic Implications
Smouldering MS necessitates a paradigm shift in treatment approaches:
<ol style="margin-top: 0in;" start="1" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Early and Aggressive Intervention Delaying treatment risks missing the window to address the insidious damage associated with smouldering MS. Starting therapy early, even in clinically silent phases, may mitigate long-term disability.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Neuroprotective Strategies Therapies with potential neuroprotective effects, such as sphingosine-1-phosphate (S1P) receptor modulators (e.g., fingolimod), could play a critical role in targeting smouldering disease mechanisms.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Emerging Treatments Research into agents promoting remyelination, axonal repair, and microglial modulation is essential to address this unmet need.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Redefining Treatment Goals Beyond controlling inflammation, therapies should aim to reduce brain atrophy and slow neurodegeneration, which better reflect smouldering activity.</li>
</ol>
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Key Takeaways for Clinical Practice
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo4; tab-stops: list .5in;">Adopt a Broader Lens: Monitor for neurodegeneration and subtle signs of progression, even in the absence of clinical relapses.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo4; tab-stops: list .5in;">Refine Treatment Selection: Consider therapies with neuroprotective and disease-modifying potential to address smouldering MS.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo4; tab-stops: list .5in;">Communicate with Patients: Educate patients about the importance of long-term, proactive management to prevent silent progression.</li>
</ul>
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For the full article, visit: <a href="https://doi.org/10.1177/17562864211066751">Ther Adv Neurol Disord. 2022 Jan 25;15:17562864211066751</a>.

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Smouldering MS: The fundamental driver of disease progression

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Newsletter: Unveiling the Enigma of CD20-Positive CD8 T Cells 

Unveiling the Enigma of CD20-Positive CD8 T Cells 

<h3 class="MsoNormal" style="text-align: center;" align="center">Migraine: The Hidden Burden Across the Globe Insights from the OVERCOME (International) Study</h3>

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Migraine: The Hidden Burden Across the Globe
Insights from the OVERCOME (International) Study

Migraine: The Hidden Burden Across the Globe Insights from the OVERCOME (International) Study

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Sleep Under Siege: Understanding the Impact of Sleep Disturbances in Older Adults During and After the Pandemic 

The Impact of Trauma on Long-Term Mental Health: A Call for Follow-Up Care
Recent research sheds light on the significant and long-lasting mental health challenges faced by trauma patients.
A study by Lai Kin Yaw et al., published in JAMA Network Open, reveals that new mental health conditions often develop in patients after traumatic injuries, with these conditions being linked to increased risks of trauma readmissions, suicides, and all-cause mortality.
Key Findings:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Prevalence of Mental Health Conditions Post-Trauma: Among 29,191 adult trauma patients, 11.3% developed new mental health conditions after their trauma admission. The conditions primarily included drug dependence in 8.2%, neurotic disorders (including PTSD) in 5.4%, anxiety disorders, and mood disorders.  </li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Long-Term Impact: Developing a new mental health condition was associated with:</li>
<ul style="margin-top: 0in;" type="circle">
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Increased trauma readmissions: Patients with new-onset mental health conditions were 30% more likely to experience repeated trauma admissions.</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Higher risk of suicide: There was a 3.14-fold increase in the likelihood of suicide by hanging or drug overdose.</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Elevated all-cause mortality: These patients were 24% more likely to die from any cause, emphasizing the severe impact of mental health deterioration following trauma.</li>
</ul>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Vulnerable Subgroups: Certain factors were found to increase the risk of developing mental health issues after trauma, including:</li>
<ul style="margin-top: 0in;" type="circle">
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Younger age</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Unemployment</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Single or divorced status</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Indigenous ethnicity</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Lower socioeconomic status</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Traumatic brain injury</li>
</ul>
</ul>
Clinical Implications:
This study underscores the critical need for mental health follow-up in trauma patients, especially those from vulnerable subgroups. Given the high incidence of new mental health conditions following trauma and their association with adverse long-term outcomes, mental health care should be considered an essential component of trauma recovery.
Recommendations for Healthcare Providers:
<ol style="margin-top: 0in;" start="1" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list .5in;">Early Identification: Screen for emerging mental health conditions during hospital stays and post-discharge.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list .5in;">Targeted Interventions: Focus on high-risk groups such as younger patients, those with lower socioeconomic status, and individuals with traumatic brain injuries.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list .5in;">Long-Term Monitoring: Offer regular follow-ups for mental health assessments, considering the multiphasic trajectory of trauma recovery.</li>
</ol>
Takeaway for Practice:
Mental health conditions after trauma are not isolated to PTSD but also include drug dependence and mood disorders. Addressing these conditions promptly can improve long-term health outcomes and reduce the risk of further trauma, suicide, and premature death.
For optimal recovery, clinicians should integrate mental health care into the treatment plan for trauma patients.
For More Information:
We encourage you to review the full study for more insights on managing post-trauma mental health and its long-term effects: Yaw, L.K., Burrell, M., Ho, K.M. "Long-Term Outcomes and Determinants of New-Onset Mental Health Conditions After Trauma." JAMA Network Open, March 2025.
<a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831185">https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831185</a>

The Impact of Trauma on Long-Term Mental Health: A Call for Follow-Up Care

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