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Aim: Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti‐hypertensive and lipid‐lowering medications in people with Type 2 diabetes from 2006 and 2015. Methods: Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual‐level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti‐hypertensive medication (angiotensin‐converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs. Results: From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: −0.5 to −0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti‐hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin‐converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged. Conclusions: Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin‐converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels. What's new?: Mean total cholesterol levels in people with diabetes decreased with a simultaneous increase in statin use.The percentage of people with blood pressure (BP) > 140/90 mmHg increased, which may reflect the change in BP targets from ≤ 130/80 to ≤ 140/90 mmHg that occurred between 2006 and 2015.Anti‐hypertensive treatment approaches shifted towards using more angiotensin II receptor blockers with a simultaneous decline in the use of angiotensin‐converting enzyme inhibitors.Although improved control of high cholesterol in people with diabetes was encouraging, further efforts are required to improve hypertension management in people with diabetes. [ABSTRACT FROM AUTHOR]

Summary Aims: To compare the incidence of symptomatic hypoglycaemia in fasting Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan. Methods: Patients with type 2 diabetes (age ≥ 18 years) who were treated with a stable dose of a sulphonylurea with or without metformin for at least 3 months prior to screening, who had an HbA1c < 10% and who expressed their intention to daytime fast during Ramadan were eligible for this open-label study. Patients were randomised in a 1 : 1 ratio to either switch to sitagliptin 100 mg qd or to remain on their prestudy sulphonylurea. Patients completed daily diary cards to document information on hypoglycaemic symptoms and complications. The primary end-point was the overall incidence of symptomatic hypoglycaemia recorded during Ramadan. Results: Of the 1066 patients randomised, 1021 ( n = 507 for sitagliptin and n = 514 for sulphonylurea) returned at least one completed diary card and were included in the analysis. The proportion of patients who recorded one or more symptomatic hypoglycaemic events during Ramadan was lower in the sitagliptin group (6.7%) compared with the sulphonylurea group (13.2%). The risk of symptomatic hypoglycaemia was significantly decreased with sitagliptin relative to sulphonylurea treatment (Mantel-Haenszel relative risk ratio [95% CI] = 0.51 [0.34, 0.75]; p < 0.001). There were no reported events that required medical assistance (i.e. visits to physician or emergency room or hospitalisations) or were considered severe (i.e. events that caused loss of consciousness, seizure, coma or physical injury) during Ramadan. Conclusions: In Muslim patients with type 2 diabetes who observed the fast during Ramadan, switching to a sitagliptin-based regimen decreased the risk of hypoglycaemia compared with remaining on a sulphonylurea-based regimen. The incidence of hypoglycaemia was lower with gliclazide relative to the other sulphonylurea agents and similar to that observed with sitagliptin. [ABSTRACT FROM AUTHOR]

Our objective was to assess the pattern of type-2 diabetes-associated androgen alteration in patients with erectile dysfunction (ED). A total of 127 diabetic male patients with ED were enrolled in this study. Erectile function was assessed using the International Index of Erectile Function (IIEF). At the time of assessment, patients were also interviewed and assessed for socio-demographic and medical history that includes duration and severity of diabetes mellitus (DM). Patients underwent routine laboratory investigations, in addition to total testosterone (T), dehydroepiandrosterone sulphate (DHEA-S) and insulin assessment. The mean age ± SD was 53.8 ± 9.3 years. Of patients 25.2% ( n = 32/127), 6.3% ( n = 8/127) and 31.5% ( n = 40/127) had low total T, low DHEA-S and hyperinsulinaemia respectively. There were significant association between the increase in age and body mass index and the presence of low T level. Of the patients 37.5% ( n = 12/32) with low T level had glycosylated haemoglobin (HbA1c) >7% while, 22.1% ( n = 21/95) of the patients with normal T level had HbA1c >7% ( p < 0.05). There were significant associations between the number of patients with low level of total T or DHEA-S and poor control of DM. Patients with low T level were two times more likely (56.3%, n = 18/32) to have severe ED than patients with normal T level (27.4%, n = 26/95) ( p < 0.01). There were significant differences between the mean levels of total T or DHEA-S and poor control of DM. No significant associations were detected between hyperinsulinaemia and the level of fasting blood sugar, duration of DM, metabolic control of DM or ED severity. Patients with low T level were three times as likely to have hyperinsulinaemia as those patients with normal T level ( p < 0.05). The current study clearly demonstrated that there were significant associations between low level of total T or DHEA-S and poor control of DM. [ABSTRACT FROM AUTHOR]

Background: Human genetically inherited cardiac diseases have been studied mainly in heterologous systems or animal models, independent of patients' genetic backgrounds. Because sources of human cardiomyocytes (CMs) are extremely limited, the use of urine samples to generate induced pluripotent stem cell-derived CMs would be a noninvasive method to identify cardiac dysfunctions that lead to pathologies within patients' specific genetic backgrounds. The objective was to validate the use of CMs differentiated from urine-derived human induced pluripotent stem (UhiPS) cells as a new cellular model for studying patients' specific arrhythmia mechanisms., Methods and Results: Cells obtained from urine samples of a patient with long QT syndrome who harbored the HERG A561P gene mutation and his asymptomatic noncarrier mother were reprogrammed using the episomal-based method. UhiPS cells were then differentiated into CMs using the matrix sandwich method.UhiPS-CMs showed proper expression of atrial and ventricular myofilament proteins and ion channels. They were electrically functional, with nodal-, atrial- and ventricular-like action potentials recorded using high-throughput optical and patch-clamp techniques. Comparison of HERG expression from the patient's UhiPS-CMs to the mother's UhiPS-CMs showed that the mutation led to a trafficking defect that resulted in reduced delayed rectifier K(+) current (IKr). This phenotype gave rise to action potential prolongation and arrhythmias., Conclusions: UhiPS cells from patients carrying ion channel mutations can be used as novel tools to differentiate functional CMs that recapitulate cardiac arrhythmia phenotypes., (© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)