Comparative Efficacy of Lobeglitazone Versus Pioglitazone on Albuminuria in Patients with Type 2 Diabetes Mellitus
DIABETES THERAPY
Authors: Kim, Kyung-Soo; Hong, Sangmo; Ahn, Hong-Yup; Park, Cheol-Young
Abstract
Introduction The aim of this analysis was to evaluate the efficacy of lobeglitazone on albuminuria at 24 weeks of follow-up in patients with type 2 diabetes mellitus (T2DM) compared with pioglitazone using data from a randomized, double-blinded phase III trial. Methods In the phase III trial, patients who were inadequately controlled with metformin received 0.5 mg of lobeglitazone or 15 mg of pioglitazone for 24 weeks. Post hoc, exploratory analysis was used to investigate mean changes from baseline in the urine albumin-creatinine ratio (UACR) between the lobeglitazone (N = 104) and pioglitazone (N = 101) treatment groups. Results After 24 weeks of treatment, UACR was slightly decreased in the lobeglitazone group (- 4.3 mg/g creatinine [Cr]) compared to baseline and slightly increased in the pioglitazone group (5.2 mg/g Cr), with no change in the estimated glomerular filtration rate in either group; this difference was not statistically significant (P = 0.476). The incidence of new-onset microalbuminuria (2.4%) and the progression of albuminuria by > 1 stage (2.9%) in the lobeglitazone group were lower than the respective values in the pioglitazone group (6.8 and 6.1%, respectively). Of the patients in the lobeglitazone group, 50% exhibited regression to normoalbuminuria, compared to 39.3% of the patients in the pioglitazone. In subjects in the lobeglitazone group with micro- and macroalbuminuria, UACR tended to be more decreased and HbA1c was more reduced compared to those with normoalbuminuria (P = 0.014). Conclusion Lobeglitazone had a tendency to improve albuminuria in patients with T2DM and had comparable effects on albuminuria as pioglitazone which has demonstrated beneficial effects.
The effect of ejection fraction on mortality in Coronary Artery Bypass Grafting (CABG) patients
PAKISTAN JOURNAL OF MEDICAL SCIENCES
Authors: Awan, Nabil Iftikhar; Jan, Azam; Rehman, Mujeeb Ur; Ayaz, Narmeen
Abstract
Background and Objectives: Patients with low ejection fraction undergoing isolated CABG surgery are at a higher risk for postoperative complications and mortality. This study was conducted to evaluate the impact of ejection fraction on the outcome of isolated Coronary Artery Bypass Grafting (CABG). Methods: Between July, 2017 to May, 2019 total 1214 patients underwent isolated CABG. Patients were divided into three groups based on their pre-operative Ejection Fraction (EF). Group-I included 625 patients with EF >50% [Normal EF], Group-II included 484 patients with EF 35-50% [Mild to Moderately Reduced EF], and Group 3 included 105 patients with EF<35% [Severely Reduced EF]. Results: The mean age of Group-I was 57.58 +/- 9.206, Group-II was 58.38 +/- 9.124 and Group-III was 58.81 +/- 8.663.The male gender was the predominant gender in all three groups: 194(41.1%) in Group-I, 201(52.6%) in Gp2, 52 (61.9%) in Group-III. 231(36.9) patients in Group-I, 234(48.3)in Group-II and 59(56.2) in GroupIII had raised creatinine pre operatively. 5(0.8%) patients in Group-I, 2(0.4%) in Group-II and 3(2.9%) in Group-III had history of CVA. Hypertension was present in approximately 60% of all our patients. In the peroperative period 20(3.2%) patients in Group-I required an IABP as compared to 73(15.1%) in Group-II and 41(39.0%) in Group-III. The mean post-operative mortality in Group-I was 19 (3%), Group-II was 24(5.0%) and low EF group was 9(8.6%). Conclusions: The results clearly indicate that worsening pre-operative ejection fraction is associated with a higher mortality post-operatively in patients undergoing isolated CABG. In addition, use of IABP increases as pre-operative LVEF decreases.