Research in brief

Abstract

Two multicentre, double-blind, randomised, placebo-controlled studies report that the DPP4 inhibitors alogliptin (n=5380) and saxagliptin (n=16 492) are effective anti-diabetes drugs and do not increase the risk of cardiovascular events in patients with type 2 diabetes. After a median follow-up of 18 months in the alogliptin study and 2·1 years in the saxagliptin study, the occurrence of the primary endpoint—a composite of cardiovascular death, myocardial infarction, or ischaemic stroke—was not increased by the drug treatment compared with placebo in either study. Moreover, the drug-treated patients had better glycaemic control than did those given placebo. These data provide important insights into the safety and efficacy of these drugs for patients with type 2 diabetes who have a high cardiovascular risk. The richness of gut microbiota could be associated with metabolic disease and might predict responsiveness to dietary interventions in patients with obesity, suggest two new studies. In one study, low microbial richness in the gut (<480 000 bacterial genes) was associated with increased adiposity, insulin resistance, dyslipidaemia, and inflammation in 292 Danish individuals, 169 of whom had obesity. Patients with obesity and low microbial richness were prone to metabolic disease and tended to gain more weight than those with obesity and high microbial richness. In the second study, an association was found between low richness of gut microbiome (<480 000 bacterial genes) and response to dietary interventions in 38 obese and 11 overweight individuals. 6-week diet-induced weight loss followed by 6-week weight-maintenance improved microbial richness, adiposity, and circulating cholesterol concentrations in patients with low microbial richness at baseline. However, diet was less effective at improving inflammation in these patients. Altogether, these data highlight the importance of a healthy gut microbiome for metabolic health, and indicate that the level of microbial richness could be a predictive marker for treatment of patients with obesity and related complications. Adherence to long-term medical treatment is a major challenge for patients with cardiovascular disease. A fixed-dose combination drug of aspirin, a statin, and two blood pressure-lowering drugs has now been reported to increase long-term treatment adherence and to improve cardiovascular benefits compared with standard care. 2004 patients in India and Europe were randomly assigned to the combination treatment or to standard care for a median of 15 months. At the end of the study, 86·3% of those receiving the combination were adherent to treatment vs 64·7% of those on standard care. Combination treatment also resulted in greater improvement of systolic blood pressure and low-density cholesterol concentration than did standard care; these differences were small, albeit statistically significant. These results are encouraging and further research will help elucidate the effect of combination treatment on cardiovascular outcomes. Researchers now suggest that assessment of the risk of thyroid cancer based on ultrasound imaging could reduce the number of unnecessary biopsies for patients with a low risk of cancer. In a retrospective case-control study, 8806 patients underwent ultrasound imaging between 2000 and 2005 at the University of California, San Francisco (CA, USA). During this time, 105 patients were diagnosed with thyroid cancer. Thyroid nodules were found in 96·9% of patients with thyroid cancer and in 56·4% of those not diagnosed with cancer, indicating that nodules were common in most patients who were screened. Interestingly, the nodules associated with thyroid cancer had only three ultrasound characteristics in common (microcalcifications, an entirely solid composition, and size of more than 2 cm). The investigators state that if one ultrasound feature is used to prompt biopsy, 56 biopsies would be done per cancer diagnosed, whereas, if two characteristics were required, this number would be reduced to 16 and the risk of cancer would be very low in those for whom biopsy is deferred. New research shows that children and adolescents with type 1 diabetes could have an increased risk of multiple sclerosis). In a cohort study, data from 5653 patients with type 1 diabetes collected from January 1995, to October 2012, in 248 German and Austrian centres were analysed for multiple sclerosis. Regression analyses showed that the prevalence of multiple sclerosis was higher in paediatric and adolescent patients with type 1 diabetes compared with published data for German and mid-European prevalence. Additional risk factors for multiple sclerosis included thyroid antibodies (in men only), and being born in spring or summer. The role of environmental factors in the risk for co-occurrence of multiple sclerosis and type 1 diabetes should be further investigated.