Taking Empagliflozin With Metformin
There are 4 different strengths of Synjardy. Each tablet contains 5mg or 12.5mg of empagliflozin and 850mg or 1g of metformin. Your doctor will prescribe the right strength of tablet for you.
The usual dose is 1 tablet, taken twice a day. It’s a good idea to take your medicine with a meal. This means the metformin is less likely to upset your stomach.
Cardiovascular Risk Reduction And Glucose Reduction
Three major classes of medications for the treatment of diabetes were approved after the 2008 U.S. Food and Drug Administration guidance and thus had their cardiovascular impact evaluated in large cardiovascular outcome trials. The dipeptidyl peptidase-4 inhibitors did not show cardiovascular benefit, and though cardiovascular safety has generally been confirmed, saxagliptin showed evidence of an increased risk of hospitalization for heart failure . In contrast, a number of drugs from the glucagon-like peptide 1 receptor agonist class and sodium-glucose cotransporter 2 inhibitor class were shown not only to have acceptable cardiovascular safety profiles in primary analyses but subsequently also to reduce major adverse cardiovascular events independent of their effects on glycemia. These drugs are leading a paradigm shift in the care for patients with diabetes, providing cardiologists and other clinicians with the opportunity not only to lower blood glucose but in fact to reduce hard cardiovascular outcomes.
What Is The Best Diabetes Medication One That Can Protect Your Heart Health
With Deepashree Gupta, MD, and Matthew Freeby, MD
Which medicine should you be taking to control your diabetes? That’s a question that needs to be answered after your doctor takes into account several important factors, such as your personal medical history, including your heart health and your risk of kidney disease. As your doctor has no doubt told you, just having type 2 diabetes puts you at increased risk of having heart disease and so both conditions should be tackled simultaneously.
Thankfully, in the last few years that have the ability to control your blood sugar and reduce the risks associated with heart disease, says Deepashree Gupta, MD, assistant professor of endocrinology at the University of California at Los Angeles David Geffen School of Medicine and an endocrinologist at UCLA Health Westlake Village.
Having type 2 diabetes increases your risk of heart disease so you may need two medications to protect your health. Photo: 123rf
Dr. Gupta spoke about “So Many New Medications: Are They Better Than the Old Ones?” at the 5th annual Healthy Living with Diabetes Conference sponsored by UCLA.¹
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Acupuncture To Relieve Neuropathy Pain
A growing number of people are using acupuncture to treat neuropathy pain linked with diabetes and other health-related problems.
What is acupuncture? It is a practice in which fine needles are inserted into the skin to stimulate specific points in the body. Traditional Chinese medicine is based on the theory that energy flows through the body along certain pathways, called Ã¢â¬ËchiÃ¢â¬â¢. Illness or pain results when that energy is blocked or out of balance. The Chinese theory holds that acupuncture unblocks or balances that flow of energy.
Many Western researchers say acupuncture may alter brain chemicals that affect the body and mind. Translated into the language of Western medicine, the healing power of acupuncture may come from its effect on the nervous system, on hormones, and on “feel good” brain chemicals called endorphins.
One landmark study found that patients have reduced pain and improved movement with acupuncture. The National Institutes of Health and World Health Organization have both approved certain uses of acupuncture related to pain.
Sickness Is Not Inevitable
The journal Medical Science Educator offers an interesting take from Dr. Hanno Pijl, an internist-endocrinologist in the Netherlands, on the need for lifestyle. Pijl says today’s health care system has not adapted to “chronic ‘age-associated’ non-communicable disease,” and still very much reflects a model centered on infectious disease and fractures, treated by antibiotics and anesthesia-enabled surgeries.
His argument suggests that there is no scientific basis for the notion that sickness is inevitable in old age, pointing to behavior- and environmentally-based noxious stimuli as a culprit for disease. Pijl specifically cites “wrong food, prolonged stress, lack of physical exercise, bad sleep and smoking” among the most prevalent self-imposed causes. He points to these behaviors as the “root causes” of chronic disease and asserts that lifestyle modifications, not drugs, is the answer.
His prescription? A model in which patients share responsibility for their health, rather than placing 100% of the burden on their physicians, coupled with a diagnostic process that includes “the socio-economic, mental, spiritual and behavioral aspects of a patient’s life in addition to biological markers of health and disease.”
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Relaxation Techniques To Relieve Neuropathy Pain
Stress can make neuropathy pain worse, so it is important to learn to relax. Your breathing pattern is often affected by changes in emotions. That’s why managing your breathing is an important tool for relaxation. By becoming familiar with your own breathing patterns, you can learn to control your breathing, stress level, and pain as well.
First, find a quiet location, a comfortable body position, and a good state of mind. Try to block out worries and distracting thoughts.
Relaxation techniques to help with diabetes nerve pain include:
Beat The Heart Attack Gene: The Revolutionary Plan To Prevent Heart Disease Stroke And Diabetes
Chapter 96: Why a Personalized Treatment Plan Is Important
Why a Personalized Treatment Plan Is Important
Although Alysia was delighted to see her cholesterol numbers improve, she wondered if following a prevention plan wed specifically designed for her husband was the best way to manage her cardiovascular risks. As it turned out, when she finally came to our clinic for a comprehensive evaluation, she had three disorders that dont affect Patrick:
Insulin resistance , the root cause of type 2 diabetes and 70 percent of heart attacks. In this chapter and the next one, well look at treatments for this extremely common condition, including the best workouts, a delicious spice thats probably already in your kitchen, and if necessary, medication. We also advise all of our patients with IR to eat like a diabetic so you never become one, by watching carbs and limiting or avoiding sugary foods.
An inherited cholesterol disorder. An advanced lipid profile test revealed that Alysia had high levels of lipoprotein , the mass murderer that triples heart attack risk. As discussed in earlier chapters, elevated levels of this cholesterol have been shown to cause heart attacks and strokes, often at an unusually young age. That meant Alysias self-treatment was only addressing part of her cholesterol problem. Later in this chapter, youll discover which inexpensive vitamin can be helpful for a lipoprotein problem and other cholesterol issues.
Meditation To Relieve Diabetes Nerve Pain
Meditation is a therapy offered in many pain treatment centers for diabetes and other painful disorders. Research shows that meditation can lower blood pressure and improve heart rate, breathing, and brain waves. Tension and tightness seep from muscles as the body receives a quiet message to relax.
The soothing power of repetition is at the heart of meditation. Focusing on the breath, ignoring thoughts, and repeating a word or phrase — a mantra — makes the body relax. People describe feeling warmth, calm, even a sense of heaviness while they meditate.
While you can learn meditation on your own, it helps to take a class. A teacher can guide you — and help you reach that deeper, more relaxed state.
Diabetes And Heart Disease: What Is The Connection
Research suggests a strong link between diabetes and heart disease. The conditions share many of the same risk factors, including obesity, high blood pressure, and high cholesterol.
Research has also discovered specific biological mechanisms associated with diabetes that increase the risk of heart disease.
Heart disease and stroke are the leading causes of death in people with diabetes, according to the
more likely to die from heart disease than adults without diabetes. High blood sugar levels in people with diabetes may damage blood vessels, increase inflammation, and disrupt the normal blood flow in the heart.
Therefore, it is important for people with diabetes to reduce heart disease risk by managing their blood sugar, blood pressure, and cholesterol levels, eating a healthy diet, getting regular exercise, and taking medications as prescribed.
The most common type of heart disease is coronary artery disease. It develops over time as the arteries that supply blood to the heart fill with plaque, which is made up of cholesterol and other substances.
Plaque causes the arteries to harden and narrow. This is known as atherosclerosis.
Narrowing of the arteries reduces blood supply to the heart, starving it of oxygen and nutrients. This causes the heart muscle to weaken over time, increasing a persons risk of heart failure, heart attack, and other heart issues.
more likely to die from heart disease than those without diabetes.
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Cautions With Other Medicines
There are some medicines that may increase the effects of empagliflozin.
This can make you more likely to get side effects.
Tell your doctor if you are taking any of these medicines:
- medicines that make you pee more , like furosemide â these can increase your risk of dehydration and lower your blood pressure
- high blood pressure medicines
- other medicines that can lower your blood pressure â including some antidepressants, nitrates , baclofen , tamsulosin , or co-careldopa or levodopa
- medicines that cause low blood sugar, such as insulin or gliclazide â your doctor may lower your dose of these other medicines to prevent hypos
Putative Mechanisms Of Cardiovascular Benefit
GLP-1RA therapy appears to significantly reduce atherothrombotic cardiovascular events. Hypothesized mechanisms of cardiovascular benefits of GLP-1RAs include both their impact on cardiovascular risk factors, such as blood pressure, as well as direct effects via atherogenesis, inflammatory pathways, and endothelial function . In fact, the primary cardiovascular benefits of GLP-1RAs appear to be largely independent of established atherosclerotic risk factors .
GLP-1RA treatment has demonstrated a consistent reduction in weight and blood pressure . In the above cardiovascular outcomes trials, GLP-1RA treatment resulted in a small but significant impact on weight loss, ranging from 0.7 kg with lixisenatide to as much as 4.3 kg with semaglutide SC. Similarly, systolic blood pressure was reduced across the board, ranging from 1 mmHg with abiglutide to 3 mmHg with oral semaglutide .
In addition to relatively modest but favorable effects on classical cardiovascular risk factors, GLP-1 receptor expression has been identified in cardiovascular tissues, and GLP-1 peptides have been linked to reduction in reactive oxygen species in endothelial cells and cardiomyocytes . Infusion of GLP-1 and GLP-1RA in human subjects has resulted in improvements in left ventricular function, hemodynamics, and reduction in ischemic injury .
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The Role Of Newer Anti
Cardiovascular disease is the leading cause of death in patients with diabetes mellitus,1 but not all patients with diabetes have the same risk of developing CVD. CV risk increases with diabetes duration and is affected by other comorbidities like hypertension, dyslipidemia, metabolic syndrome, and chronic kidney disease.2 Diabetic patients with existing CVD, as a function of pre-selection, have the highest risk of a subsequent CV events. Thus, secondary prevention of CV events may not be synonymous with cardio-protection in diabetes in general and evidence for the efficacy of anti-diabetic therapies should be evaluated in this light. Until recently there was a paucity of large prospective randomized clinical trials in diabetic patients with CVD. However, based on the 2008 Food and Drug Administration mandate to demonstrate safety of all newer hypoglycemic agents prior to seeking approval, the scenario has changed. As a result, several new hypoglycemic medications have recently undergone randomized placebo-controlled CV outcome trials focused on patients with preexisting CVD or are at high risk of developing CVD. The following review is a concise synthesis of these new trial data for the clinical cardiologist.
Table 1: Study Characteristics of Cardiovascular Outcome Trials of Newer Hypoglycemic Agents
Lessons Learned and Future Direction
Diabetes Medications That Treat Heart Disease Too
If you have diabetes, you are more likely to develop heart disease. Overtime, high blood sugar can damage your blood vessels and heart, putting youat a greater risk of having a heart attack or stroke the most commoncauses of death for adults with diabetes.
The good news is that there are diabetes drugs that have the happy side effect of also treating heart disease. While these medications arent new, the discovery that certain diabetes drugs can thwart heart disease is a recent development.
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How To Cope With Side Effects
What to do about:
- thrush â ask your pharmacist to recommend an antifungal treatment for thrush. Speak to your doctor if it does not work within a week or you get thrush often. There are also things you can do to prevent thrush returning.
- pain or a burning feeling when you pee â these can be signs of a urinary tract infection . Take paracetamol, and rest and drink plenty of fluids â fluids help your body flush out the bacteria. Speak to your doctor if symptoms are not better in 2 or 3 days, or if they get worse at any time.
- peeing more than normal â this is a sign that your medicine is working and you’re peeing out more sugar in your urine. Drink lots of water, and other sugar-free fluids, to avoid dehydration. If this side effect bothers you, talk to your doctor or pharmacist.
- mild skin rash or itchy skin â it may help to take an antihistamine. Check with a pharmacist to see what type is suitable for you. Speak to your doctor if the rash or itching does not go away or gets worse.
The Future Of Sglt2 Inhibitors For Heart Failure
Several clinical trials are in design or launching to determine whether SGLT2 inhibitors offer other potential cardiac benefits, such as improving the heart muscle function. Additional trials include measuring the effects on broader populations with kidney disease and assessing SGLT2 inhibitor effects after a heart attack in patients who do not have diabetes.
Future research will help cardiologists determine which patients might benefit most from SGLT2 inhibitors and at what point in the disease process.
Over the course of my career, Ive witnessed the development of numerous classes of diabetes drugs that have now been proven to have cardiovascular safety, such as the thiazolidinediones, various forms of long-acting insulin, and dipeptidyl peptidase 4 inhibitors, as well as two classes with proven cardiovascular benefits the SGLT2 inhibitors and the glucagon-like peptide 1 receptor agonists.
Since regulatory agencies in the U.S. and Europe began requiring cardiovascular safety assessment in 2008, I have had the privilege of being involved in the clinical trials assessment of most of the diabetes drugs developed in that time.
To visit with a specialist about heart failure treatment options, call orrequest an appointment online.
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Even Prediabetes May Hurt Your Heart
The culprit in diabetes toll on the heart was long thought to be a lone offender: elevated blood sugar levels. Over time, high blood sugar can damage blood vessels and lead to hardening of the arteries, which in turn leads to heart disease. But, as it turns out, there’s more at play. People with diabetes are also more likely to have other conditions that raise the risk for heart disease and stroke, including too much LDL cholesterol, not enough HDL cholesterol and high triglycerides . That triad known as diabetic dyslipidemia is a deadly combination that puts people with diabetes at risk for cardiovascular disease. Even more concerning: These conditions can develop even before diabetes is diagnosed.
Mounting research suggests the damage may begin at the prediabetes stage. A large review of studies published in a July 2020 issue of BMJ gives credence to what research scientists have suspected for a while: People with prediabetes meaning their blood sugar levels are higher than normal, but not high enough to be considered diabetes are at substantial risk of developing cardiovascular disease. In reviewing the 129 studies, which involved more than 10 million people, researchers found that prediabetes was associated with a 15 percent increased risk of cardiovascular disease.
Diabetes Drug Can Treat And Reverse Heart Failure And Reduce Hospitalizations
- The Mount Sinai Hospital / Mount Sinai School of Medicine
- Empagliflozin, a recently developed diabetes drug, can effectively treat and reverse heart failure in both diabetic and non-diabetic patients, according to new research.
Empagliflozin, a recently developed diabetes drug, can effectively treat and reverse heart failure in both diabetic and non-diabetic patients, according to researchers at the Icahn School of Medicine at Mount Sinai.
Their clinical trial showed that this medication can improve the heart’s size, shape, and function, leading to better exercise capacity and quality of life, which will reduce hospitalizations for heart failure patients. The results were presented on Friday, November 13, at the American Heart Association Scientific Sessions 2020 and simultaneously published in the Journal of the American College of Cardiology.
“Our clinical trial’s promising results show this diabetes drug can ameliorate lives of heart failure patients with reduced ejection fraction, enhance their exercise capacity, and improve their quality of life with little to no side effects. We expect this work will help lead to U.S. Food and Drug Administration approval of empagliflozin for this patient population in the coming months,” said first author Carlos Santos-Gallego, MD, postdoctoral fellow at the Icahn School of Medicine at Mount Sinai.
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