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Nivolumab is a programmed cell death receptor (PD-1) inhibitor that is increasingly used for various malignancies, both as a first line agent and as salvage therapy. Being a PD-1/PD-1 ligand checkpoint inhibitor, it is known to cause autoimmune inflammation of various organs and has been associated with thyroiditis, insulitis, colitis, hepatitis and encephalitis to name a few. There are increasing reports of nivolumab leading to acute onset fulminant type 1 diabetes and diabetic ketoacidosis (DKA). We present a case of a 68-year-old man who developed DKA after 2 doses of nivolumab for metastatic melanoma. He was found to have type 1 diabetes, but no diabetes related antibodies were positive. He recovered from diabetes and continues to use insulin 1 year after his diagnosis. This case and associated review illustrates the importance of educating and monitoring patients who start nivolumab therapy regarding this potentially life threatening complication. [ABSTRACT FROM AUTHOR]

Background: Use of menopausal hormonal therapy (MHT)-containing estrogen and a synthetic progestin is associated with an increased risk of breast cancer. It is unclear if progesterone in combination with estrogen carries a lower risk of breast cancer. Limited data suggest differences between progesterone and progestins on cardiovascular risk factors, including cholesterol and glucose metabolism. Whether this translates to differences in cardiovascular outcomes is uncertain. We conducted a systematic review and meta-analysis to synthesize the existing evidence about the effect of progesterone in comparison to synthetic progestins, each in combination with estrogens, on the risk of breast cancer and cardiovascular events. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus through 17 May 2016 for studies that enrolled postmenopausal women using progesterone vs. synthetic progestins and reported the outcomes of interest. Study selection and data extraction were performed by two independent reviewers. Meta-analysis was conducted using the random effects model. Results: We included two cohort studies and one population-based case-control study out of 3410 citations identified by the search. The included studies enrolled 86,881 postmenopausal women with mean age of 59 years and follow-up range from 3 to 20 years. The overall risk of bias of the included cohort studies in the meta-analysis was moderate. There was no data on cardiovascular events. Progesterone was associated with lower breast cancer risk compared to synthetic progestins when each is given in combination with estrogen, relative risk 0.67; 95 % confidence interval 0.55-0.81. Conclusions: Observational studies suggest that in menopausal women, estrogen and progesterone use may be associated with lower breast cancer risk compared to synthetic progestin. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcers and lower extremity amputations are common complications of diabetes mellitus that are associated with substantial morbidity, loss of quality of life, disability, and a high social and economic burden. The implementation of strategies to prevent these complications is a key aspect of diabetes care.Objectives: The objective of this article is to provide an overview of the available evidence on preventive diabetic foot care.Study Design: Literature review.Methods: Narrative review based on a thorough search of previous relevant studies, systematic reviews, and clinical guidelines on diabetic foot care published in English.Results: We describe diabetic foot care strategies that can be categorized within defined domains for the purpose of helping clinicians to remember them. We use the mnemonic "BE SMART" (Be aware of the risk factors, Educate patients and health providers, Structured clinical assessment, Metabolic evaluation and management, Assessment of Risk, and Team care) to organize these domains.Conclusion: Diabetic foot ulcers and lower extremity amputations are potentially preventable complications. Clinicians taking care of patients with diabetes should know, understand, and remember the multiple aspects of diabetic foot care.Clinical Relevance: This review can be used as a reference source for those interested in the care of diabetic foot. It highlights the importance of risk factor recognition, education, a structured clinical and metabolic evaluation, and also the importance of assigning patients a risk category that can help guiding multidisciplinary management efforts. [ABSTRACT FROM AUTHOR]

The author reflects on the safety issues related to the use of dipeptidyl peptidase-4 inhibitors (DPP4is) which reduces glycosylated hemoglobin (HbA1c) levels without causing weight gain. Topics discussed include avoidance of DPP4is in patients with risk factors for acute pancreatitis, SAVOR-TIM! 53 trials for examining increased risks for pancreatitis and evaluation of type 2 diabetes therapies for cardiovascular (CV) events. It suggests more use of drugs with greater glycemic effect.

The article offers information on a study based on effectiveness of dulaglutide noninferior to daily liraglutide for reducing hemoglobin (Hb) A1c levels in patients with uncontrolled type 2 diabetes who are receiving metformin therapy. It mentions that Glucagon-like peptide-1 (GLP-1) analogues can be considered as second- or third-line agents for patients with type 2 diabetes that is poorly controlled despite lifestyle modification and metformin therapy.

The article compares the efficacy of the drugs dulaglutide and liraglutide to metformin treated patients suffering from type-2 diabetes to reduce hemoglobin (Hb) A [1c] levels. It states the exclusion criteria of the study including pancreatitis, higher calcitonin level in serum and cardiovascular (CV) event. It concludes that weekly intake of dulaglutide did not show greater efficacy as compared to daily intake of liraglutide.

The article focuses on a study regarding the efficacy and safety of saxagliptin as with placebo for cardiovascular (CV) outcomes as with placebo for cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus. Topics discussed include the of CV death, nonfatal myocardial infarction, or nonfatal ischemic stroke as major outcomes, 17 percent relative risk reduction with saxagliptin compared with placebo and the assessment of the risk for pancreatic cancer.

The article focuses on a study regarding the prevalence of increased pancreatitis due to dipeptidyl peptidase-4 inhibitors (DPP4is) in type 2 diabetes. Topics discussed include the increase the risk for pancreatitis in patients with type 2 diabetes mellitus due to (DPP4is), pancreatitis, pancreatic cancer, and total treatment-emergent serious adverse events as major outcomes and the benefits of alternative antihyperglycemic agents.