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Apr 14, 2021 12 tweets 9 min read Read on X
1/ #NYACP #Tweetorial
#MedTwitter, let’s start with a ❓

56 yo man with type 2 diabetes mellitus and CAD for 7 years has a A1C 8.0%, and albumin:creatinine ratio 300. Which add-on diabetes med will have a protective effect on his cardiac comorbidities?

@MedTweetorials
2/ That’s right- Canagliflozin!

In this tweetorial we address: Why are we optimistic about SGLT2 inhibitors?

♦️ The -flozins let glucose “flow out: of proximal convoluted tubules of nephrons
♦️ Half of filtered glucose is excreted- more than 💯g in T2DM patients
#flozinate PMID: 26137213
3/ Okay, they work for T2DM. But so do all7⃣of our first line agents! Why all the hype?

SGLTi also:

✅ ⬇️ risk of cardiovascular mortality in chronic and decompensated failure
✅ Slow progression of diabetic and non-diabetic kidney disease
✅ Induce weight loss ⚖️ PMID: 31290126
4/
Let’s take a look at the evidence: 🫀events in those with T2DM

🔹 🥉major trials- EMPA-REG OUTCOME, CANVAS, and DECLARE-TIMI 58 established a ⬇️ in risk of major adverse cardiovascular events (MACE)
🔹 MPA-REG OUTCOME: empagliflozin showed a 38% relative risk ⬇️in CV death EMPGA-REG OUTCOME:  PMID: 26378978CANVAS: PMID: 28605608DECLARE-TIMI: PMID: 30415602
5/ As of this January 2021, we know that this benefit extends even when GLT2i are started AFTER an episode of acute decompensated🫀 failure with reduced ejection fraction (HFrEF) PMID: 33200892
6/ Beyond 🫀 failure: SGLT2i slow diabetic kidney disease
CREDENCE (2019) showed that canagliflozin:
♦️ T2DM with eGFR 30-90
♦️ 34% ⬇️ risk of ESRD, doubling of creatinine, and death from renal cause
EMPA-KIDNEY is now investigating these effects in eGFR 20-45 and type 1 diabetes PMID: 30990260
7/ Last year, DAPA-CKD confirmed SGLTi work in those with non-diabetic kidney disease too
♦️ 14% patients had eGFR <30, and 33% had CKD without DMT2
♦️This is particularly impressive in the latter group, where ACE inhibitors are the ONLY medication that prevent kidney failure PMID: 32970396
8/ We need more clinical trials to study potential longterm adverse effects.

♦️ Most frequent: female mycotic infections, UTIs, ⬆️ urination
♦️ Hypoglycemia risk: low
♦️ Euglycemic ketoacidosis: low with adequate hydration and carb intake

Some SGLT2i carry specific warnings PMID: 31741440
9/ To recap, we know SGLT2i ⬇️

♦️ CKD progression, those with and without T2DM
♦️ MACE in T2DM, with history of CVD and after acute decompensated HFrEF
There’s still a lot to be discovered! The EMPEROR-preserved trial is investigating SGLT2i use in 🫀 failure with preserved EF PMID: 31584231
10/ Let’s end our SGLT2i discussion with some #histmed #historyofmedicine

SGLT2i have roots in the 1800s, when French chemists isolated Phlorizin from the bark of🍎🌳 and used it to treat🦠 🦟

It wasn't until the 1930s that🥼 discovered its effects on nephrons
12/
Thank you for this Tweetorial
@KShah0520!

Follow us for another #NYACP #Tweetorial in June!

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More from @NewYorkACP

Feb 1, 2023
1/
Hey #medtwitter @MedTweetorials , let's talk about #MPOX (formerly monkeypox)
✴️Mpox is caused by an orthopoxvirus (like smallpox)
✴️ Endemic to sub-Saharan Africa; recent outbreak in Europe and the Americas
✴️ On 8/4/22 the US declared the outbreak a public health emergency
@MedTweetorials 2/
We will be using the term “mpox” in place of the complete phrase “monkeypox” in line with the November WHO decision to change the term in recognition of racist and stigmatizing language used in association with this condition in 2022
@MedTweetorials 3/
Q: Which group has the highest number of #mpox cases in the US?
a)21-25
b)26-30
c)31-35
d)36-40
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