New Type 2 Diabetes Drugs and Their Cardiovascular Effects

New Type 2 Diabetes Drugs and Their Cardiovascular Effects – MM1703

Cardiovascular disease is the leading cause of death, morbidity and hospitalisation in people with type 2
diabetes. Several new classes of antidiabetic agents can improve various cardiovascular risk factors, including
weight, blood pressure and lipid profile, in addition to lowering blood glucose levels. Cardiovascular outcome
studies to date support the safety of three dipeptidyl peptidase-4 (DPP-4) inhibitors, one glucagon-like
peptide-1 (GLP-1) receptor agonist and one sodium–glucose cotransporter-2 (SGLT-2) inhibitor in people with
type 2 diabetes. Specific cardiovascular benefits of DPP-4 inhibitors and GLP-1 receptor agonists over standard
diabetes therapy have not yet been demonstrated.

Modern Medicine – March 2017

Diabetic Autonomic Neuropathy An Oft Neglected Entity

Diabetic Autonomic Neuropathy An Oft Neglected Entity – MM1703

Diabetic autonomic neuropathy (DAN) is common and important but generally under-recognised. DAN is not
a single entity, but an ‘umbrella term’ with broad clinical implications reflecting the diffuse and integral involvement
of the autonomic nervous system with major body organ systems. Cardiac autonomic neuropathy is a particularly
serious manifestation that may be associated with silent myocardial infarction and represents a major risk for
cardiovascular (CV) mortality. Simple inexpensive tests of cardiac autonomic function are markedly underused.
Gastric autonomic neuropathy is not only associated with upper gastrointestinal symptoms but also has impacts on
postprandial blood glucose control. Erectile dysfunction, another manifestation of autonomic neuropathy, is common
in men with diabetes and a marker of disordered CV function.

Modern Medicine – March 2017

What’s new in Asthma Treatment?

What’s new in Asthma Treatment? – MM1703

Large studies in patients with asthma have revealed different patterns of airway inflammation (asthma phenotypes) that
suggest the possibility of an individualised approach to asthma management. Doctors and patients now have a
wider choice of inhaled corticosteroid (ICS) plus longacting beta agonist (LABA) combinations and inhaler
devices. Evidence suggests that addition of the long-acting muscarinic antagonist tiotropium to ICS plus LABA therapy
may reduce asthma exacerbations while providing modest bronchodilatation. The monoclonal antibodies omalizumab
were recently introduced for the management of patients with severe allergic asthma and severe eosinophilic asthma, respectively.

Modern Medicine – March 2017

February 2017 edition

We welcome you to come and read through our latest, February, edition of Modern Medicine. It’s an ethics month, so we also include an interesting ethics-related article for you.

This month we focus on; Ophthalmology , Gastroenterology, Cardiology, Vaccines, Pain and Rheumetology.

We encourage all of our readers to complete the CPD questionnaire for this edition, this can be done on the answer-form included in the magazine, or on our website CPD system.

Modern Medicine, the journal that’s with you wherever you go.

Ankylosing Spondylitis: New Insights Into an old Disease

Ankylosing Spondylitis: New Insights Into an old Disease – MM1702

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease characterised by sacroiliitis and
extra-articular manifestations. Consider the diagnosis of AS in young patients with back pain and stiffness early
in the morning and after prolonged sitting. Appropriate initial investigations are a plain x-ray of the pelvis and
blood tests for HLA-B27, erythrocyte sedimentation rate and C-reactive protein level. MRI can identify early
inflammatory bony changes not seen on x-ray and is prudent in patients with a clinical history consistent with
AS but a normal x-ray appearance. The mainstay of treatment for patients with AS remains NSAIDs and
stretching exercises. Tumour necrosis factor inhibitors are effective therapy for patients who fail to respond to firstline

Modern Medicine – February 2017

Knee Osteoarthritis Management as a Chronic Disease

Knee Osteoarthritis Management as a Chronic Disease – MM1702

Comprehensive and multidisciplinary osteoarthritis (OA) management involves a combined approach of
nonpharmacological and pharmacological treatment to improve pain and function. All patients with OA should
engage in exercise and neuromuscular training. Weight reduction in overweight or obese patients can improve
physical function and pain by up to 50% in weight-bearing joints. Regular education/advice and monitoring are key
to patients’ long-term maintenance of physical activity and weight reduction. Choice of analgesia requires careful
consideration of risk versus benefit and proven efficacy. Arthroscopic surgery is not indicated for treating pain
associated with knee OA. Referral to an orthopaedic surgeon should be considered in patients with knee OA
who have severe symptoms and functional decline and have failed conservative management.

Modern Medicine – February 2017

Preventing Influenza and Pneumococcal Infections Reduces Adverse Outcomes

Preventing Influenza and Pneumococcal Infections Reduces Adverse Outcomes – MM1702

One of the strategic objectives of the 2011-2020 Global Vaccine Action Plan is for the benefits of immunisation
to be equitably extended to all people and encompasses special groups at increased risk of vaccine-preventable
diseases, such as preterm infants and pregnant women, as well as those with chronic and immune-compromising
medical conditions or at increased risk of disease due to immunosenescence. Despite demonstrations
of effectiveness and safety, vaccine uptake in these special groups is frequently lower than expected, even
in developed countries with vaccination strategies in place. For example, uptake of the influenza vaccine in
pregnancy rarely exceeds 50% in developed countries and, although data are scarce, it appears that only half
of preterm infants are up-to-date with routine paediatric vaccinations.

Modern Medicine – February 2017

Duration of Dual Antiplatelet Therapy After ACS A Moving Target

Duration of Dual Antiplatelet Therapy After ACS: A Moving Target – MM1702

Acute coronary syndrome (ACS) remains the major cause of morbidity and mortality worldwide.
Secondary prevention through lifestyle changes and pharmacotherapy remains pivotal to reduction. Aspirin
has improved outcomes in patients presenting with ACS. (CURE) trial was a landmark study showing improved
outcomes in an ACS cohort treated with aspirin and clopidogrel compared with aspirin alone. Inherent in
the use of more potent platelet inhibitors is a degree of obligate bleeding. Contemporary antiplatelet agents
probably provide maximal platelet inhibition with tolerable, safe bleeding in most patients for six to 12 months after

Modern Medicine – February 2017

The Gut Dysbiosis – Hypertension Link

The Gut Dysbiosis – Hypertension Link – MM1703

Recent studies have revealed that many health maladies are as a result of significant perturbation in core gut microbial communities and many parameters
such as host-microbe crosstalk which are intrinsically linked to the microbial ecology and gut functionality. The influence of gastro-intestinal microbiota
composition and their possible link to obesity, diabetes, neural disorders, brain development, insulin resistance and other metabolic disorders have been
well documented. However, recent data suggest that it may also play a role in the development and maintenance of cardiovascular disease.

Modern Medicine – February 2017