#ADA2021
1/6
✅Real world data from a 🇩🇪register of patients with ♂️#hypogonadism & #type2diabetes over 12 years!

❗️ ♂️ hypogonadism is common in T2D (≈ 50%)

⚠️@Bayer presented
⚠️ other data shown ⤴️ MACE
amjmed.com/article/S0002-…

So what did they find?
2/6

Baseline Characteristics.

🤔As you can see two very different cohorts of patients.

⚠️ High risk of unresolved bias
3/6

Changes in testosterone and glycaemic markers over time.

Testosterone therapy assoc with

⤴️ Testosterone
⤵️ HbA1c
4/6

Changes in weight and BP over time.

Testosterone therapy assoc with

⤵️ weight
⤵️ waist circumference
⤵️ BP
5/6

Testosterone therapy in this cohort assoc with

⤵️ All-cause mortality
⤵️ myocardial infarction
⤵️ stroke
⤵️ retinopathy
⤵️ polyneuropathy
My conclusions

Impressive data, particularly the 12 year follow up.

The two groups were quite different so impossible to eliminate residual bias.

We need an appropriately powered RCT to give us the information we need to counsel patients on the long-term effects.

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More from @drpatrickholmes

29 Jun
1/6
#ADA2021
Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)

Q. What next after metformin?

MET plus:
✅GLP-1ra (liraglutide)
✅Insulin(glargine)
✅SU (glimepiride)
✅DPP4i (sitagliptin)

But
😱 No SGLT2i
😱 No TZD

care.diabetesjournals.org/content/36/8/2… Image
2/6
Mean baseline characteristics

57 yr old
♀️36%
66%👴🏻, 20%👴🏿
BMI 34
HbA1c 7.5%
Duration of diabetes 4.2 yr

⚠️🇺🇸 only study
⚠️only 3.6% from 'Asian' descent
⚠️ So not representative to non-🇺🇸 #type2diabetes

care.diabetesjournals.org/content/42/11/…
3/6
Summary of glycaemic outcomes

🥳GLP-1ra & Basal Insulin did best

💩DPP4i did worse. In particular if baseline HbA1c>7.8%

Bottom line - I don't think DPP-4i is a good option if HbA1c >7.8% (62mmol/mol)

📷courtesy of Prof. Matthews Image
Read 6 tweets
28 Jun
AMPLITUDE-O Trial
1/5
Cardiovascular outcome trial for Efpeglenatide an investigational once weekly Exendin-4 based GLP-1ra.

What are the unanswered questions
Do Exendin-based GLP-1a ⤵️ MACE❓
Do GLP-1ra ⤵️ MACE in people taking SGLT2i❓
Does GLP-1ra ⤵️ renal decline❓

#ADA2021
2/5
Main results

Efpeglenatide
⤵️3-point MACE by 27%
⤵️expanded MACE by 21%
⤵️Renal composite by 32%
⤵️MACE or non-CV death by 27%

Best data yet to suggest adding GLP-1ra to SGLT2i ⤵️MACE

@DLBHATTMD
3/5
Renal outcomes

Efpeglenatide
⤵️Renal composite
⤵️Albuminuria
⤵️eGFR slope❗️
Read 6 tweets

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