INTRODUCTIONDiabetes, hypertension, and cardiovascular disease share an interdependent background with respect to risk factors and vascular mechanisms, thus, making each a risk factor for the other. The co-existence of diabetes and hypertension, particularly, is a frequent and threatening occurrence given that both conditions carry the risk of development of cardiovascular complications and vice-versa. The article highlights vascular mechanisms and subsequent complications associated with these conditions. Insights are provided into current therapies for their management and certain new agents with vasoprotective therapeutic potential are discussed.MAIN RESULTS<ul><li class="ql-align-justify">Type 2 Diabetes Mellitus and Hypertension - The San Antonio Heart Study shows that 85% of those with type 2 diabetes had hypertension by the fifth decade of life, whereas 50% of those with hypertension experienced impaired glucose tolerance for type 2 diabetes. </li><li class="ql-align-justify">Mechanisms of Vascular Complications in Diabetes and the Impact of Hypertension</li><li class="ql-align-justify">AGE-RAGE axis - Hyperglycemia in type 2 diabetes accelerates formation of AGEs (Advanced Glycation End products), which accumulate in the extracellular matrix of vessels and contribute to vascular damage in diabetes. AGEs stimulate production of reactive oxygen species (ROS), which in turn further enhance AGE formation. Targetting AGE-RAGE (receptors for AGEs) as a therapeutic strategy has been undertaken to reduce cardiovascular disease incidence in diabetes. Some of these include DIAMOND (Distensibility Improvement and Remodeling in Diastolic Heart Failure), SAPPHIRE (Systolic and Pulse Pressure Hemodynamic Improvement By Restoring Elasticity), SILVER (Systolic Hypertension Interaction With Left Ventricular Remodeling), SPECTRA (Systolic Pressure Efficacy and Safety Trial of Alagebrium), BENEFICIAL (Evaluating the Efficacy and Safety of Alagebrium (ALT-711) in Patients with Chronic Heart Failure).</li><li class="ql-align-justify">Oxidative stress – Diabetes induced oxidative stress is caused by numerous processes, of which activation of Nox isoforms has most significance. Out of the total isoforms demonstrated, Nox 4 isoform is known to have the most implications in development of microvascular complications of type 2 diabetes. </li><li class="ql-align-justify">Inflammation and immune response </li></ul>				o&nbsp;&nbsp;Genetic evidence – GWAS (Genome Wide Association Studies) for insulin resistance indicates that classic immunometabolic genes including signalling pathways such as MAP3K1 (Mitogen-						Activated Protein Kinase 1), NF-kb regulators (nuclear factor kappa B), inflammasome activators (NRF3), and interferon-g receptor genes are associated with type 2 diabetes.				o&nbsp;&nbsp;Clinical evidence - Therapy with anti-TNF (tumor necrosis factor) agents supports an overall protective effect of anti-TNF therapies on lifetime risk of diabetes as well. Additionally, CANTOS 				(Canakinumab Anti-inflammatory Thrombosis Outcome Study) showed that anti-inflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab led to a 					significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering.				o&nbsp;&nbsp;Anti-inflammatory properties of antidiabetic therapies - Metformin has shown to reduce obesity-associated low-grade inflammation. Glicazide and troglitazone, as well as N-acetylcysteine, 					decrease inflammatory markers in patients with diabetic nephropathy and retinopathy. Epigenetics is another mechanism that may influence inflammation and immunometabolism in diabetes.<ul><li class="ql-align-justify">MiRNAs, Diabetes, and Vascular Complications </li></ul>MiRNAs are a group of noncoding RNAs that are multifunctional. They fine tune gene expression and have been implicated in various pathologic processes, including T2D and the development of diabetic vascular complications. Diabetic cardiovascular complications are associated with increased levels of miR-223, miR-320, miR-501, miR504 and miR1, and decreased levels of miR-16, miR-133, miR-492 and miR-373.<ul><li class="ql-align-justify">Novel therapies </li></ul>A.&nbsp;&nbsp;&nbsp;&nbsp;New therapeutic approaches targeting oxidative stress, inflammation, and fibrosis are currently being developed to treat diabetes-associated cardiovascular complications.B.&nbsp;&nbsp;&nbsp;&nbsp;Upcoming therapies for the treatment of cardiovascular complications of diabetes include pentoxifylline (methylxanthine derivative and nonspecific phosphodiesterase inhibitor with anti-inflammatory and antifibrotic effects), ruboxistaurin (selective protein kinase C-b inhibitor), pirfenidone (TGF-b inhibitor), bindarit (MCP-1/CCL2 inhibitor), sulodexide (an oral formulation composed of 2 glycosaminoglycans), AKB-9778 (Tie2 activator), baricitinib (JAK/STAT inhibitor), and Nox inhibitors. CONCLUSION &nbsp;Diabetes is associated with an increased risk of cardiovascular disease, which is exaggerated with coexistent hypertension. Many of the underlying molecular mechanisms, including oxidative stress, inflammation, and fibrosis cause microvascular and macrovascular complications of diabetes. Controlling comorbidities, especially hypertension, and targeting strategies to promote vascular health may be especially important in reducing the microvascular and macrovascular complications of diabetes. Note: Kindly access the full article with the below link: <a href="https://doi.org/10.1016/j.cjca.2017.12.005" rel="noopener noreferrer" target="_blank" style="color: rgb(91, 95, 199);">https://doi.org/10.1016/j.cjca.2017.12.005</a>

Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms

Inevitable Interdependence of Diabetes, Hypertension and Cardiovascular Disease resulting in Increased Morbidity

IntroductionHypoglycemia remains one of the highest feared barriers to achieving near normoglycemia. Impaired awareness of hypoglycemia (IAH) affects approximately 25% to 30% of all people with type 1 diabetes and eventually increases the risk of severe hypoglycemia. People experiencing repeated exposures to low glucose may develop a condition referred to as IAH. The management of individuals with IAH relies initially on its identification in the clinic through a detailed exploration of the frequency of hypoglycemia and an assessment of the individual’s ability to recognize these episodes. This review article highlights the clinical strategies that may help manage the patient with IAH, with or without problematic hypoglycemia. It focuses on identifying the patient and exploring different options to minimize the hypoglycemia risk. <ul><li class="ql-align-justify">A careful clinical history combined with validated objective questionnaires of hypoglycemia awareness such as those developed by Gold, Clarke, Pedersen-Bjergaard, and the HypoCOMPaSS study group, help establish a diagnosis of IAH.</li><li class="ql-align-justify">For individuals with IAH or who have experienced severe hypoglycemia, education remains the cornerstone of any therapeutic intervention.</li></ul>Education focusing on the clinical management of hypoglycemia- <ul><li class="ql-align-justify">In the United Kingdom, Dose Adjusted for Normal Eating (DAFNE) was developed as a structured education course based on the DTTP. Structured educational programs are now advocated for all people with type 1 diabetes (T1D), resulting in improved control without additional hypoglycemia risk.</li></ul>Education and psychological interventions focussing on improving awareness of hypoglycemia- <ul><li class="ql-align-justify">Various trials have employed educational intervention focused on the detection of hypoglycemia. These include The Recovery of Hypoglycemia Awareness in Longstanding T1D (HypoCOMPaSS) trial.</li><li class="ql-align-justify">Multiple programs are designed that focus on training sessions to improve an individual’s ability to focus on internal cues to detect, anticipate, avoid, and treat hyperglycemia and hypoglycemia and identify external signals that increase hypoglycemia risk. These include the Blood Glucose Awareness Training Program (BGAT), Hypoglycemia Anticipation, Awareness, and Treatment Training (HAATT), HyPOS (weekly 90-min group education sessions over 5 weeks), and DAFNE-Hypoglycemia Awareness Restoration Training (DAFNE-HART).</li><li class="ql-align-justify">There have been significant technological advancements in insulin delivery systems and glucose monitoring devices. These have shown considerable effect on managing people with T1D and IAH. These include CGM, Flash GM, closed-loop artificial pancreas, sensor-augmented pumps.&nbsp;</li><li class="ql-align-justify">For those individuals with severe disabling hypoglycemia, where education and technological interventions have proven unhelpful, pancreas transplantation either as whole pancreas or pancreatic islets is a therapeutic option.</li><li class="ql-align-justify">A few experimental therapies are considered, and more are emerging to improve hypoglycemia counter-regulation and awareness among individuals.</li></ul>ConclusionIAH remains a concern for many people with long-duration T1D and is a challenge to manage it. While there are an increasing number of technologies in place to aid the management of T1D, few have robustly demonstrated to restore hypoglycemia awareness. Therefore, management strategies should aim to individualize treatment targets and therapies based on individual abilities and preferences, and local resources, supporting the use of a structured education program or hypoglycemia-specific education program.Access the full article here: <a href="https://doi.org/10.1007/s13300-020-00958-z" rel="noopener noreferrer" target="_blank" style="color: rgb(0, 106, 204);">https://doi.org/10.1177/20420188211000248</a>

Clinical approaches to treat impaired awareness of hypoglycemia.

The clinical approach to managing IAH should be patient-centered and focused on the individuals’ requirements, considering the resources available.

IntroductionThis&nbsp;educational video&nbsp;summarizes&nbsp;one&nbsp;session&nbsp;from the&nbsp;IDF Virtual congress 2021&nbsp;that&nbsp;reviewed reaching the therapeutic goals in type 2 diabetes and what we have learned .&nbsp;The video&nbsp;is&nbsp;aimed at primary care physicians, family physicians, general practitioners, endocrinologists, diabetologists, cardiologists, and other physicians involved in the management of diabetes.The educational video consists&nbsp;of the following lecture:<ul><li>Reaching therapeutic goals in type 2 diabetes: what we have learned&nbsp;</li></ul>The video presentation will cover the following:<ul><li>How the evolution of insulin has improved our approach to preventing hypoglycemia in patients with diabetes.</li><li>The use of the fixed dose combinations, and some other strategies to managing type two diabetes.&nbsp;</li><li>The new ways of insulin delivering how we are closing the loop in patients with type two diabetes.</li></ul>Expert facultyProf. Eduard Montanya&nbsp;Senior Professor of Medicine at the University of Barcelona, Head of the Diabetes Section of Bellvitge University Hospital, Spain&nbsp;

Highlights from the IDF Virtual congress 2021

IntroductionThese educational videos present the revolutionary diabetes therapies and their impact on cardiovascular and renal outcomes, as presented during the 81st ADA Scientific Sessions. &nbsp;The educational videos consist of the following lectures:<ul><li class="ql-align-justify">Highlights from the 81st ADA Scientific Sessions:</li><li class="ql-align-justify">Joint ADA/EASD Symposium—Novel insights and old controversies around insulin and glucagon-like signaling (presented on 27 June 2021)</li><li class="ql-align-justify">Management of type 1 diabetes in adults—2021 draft ADA/EASD consensus report (presented on 28 June 28 2021)</li><li class="ql-align-justify">SGLT2is and GLP-1RAs – Are they worth it?</li><li>Intersection of diabetes, heart failure, and kidney disease – Challenges and new insights</li><li>Translating diabetes and heart failure clinical trial findings into clinical practice </li></ul>Expert facultyProf. Richard E. Pratley, MDMedical Director, AdventHealth Diabetes Institute, Senior Scientist and Diabetes Program Head, Advent Health Translational Research Institute Orlando, Florida Prof. Naveed Sattar, MDProfessor of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom

Highlights from the ADA 81st Scientific session

IntroductionThese educational videos highlight the importance of access to diabetes care in sub-Saharan Africa, considering the alarming rise in diabetes among the African population. The videos are aimed at primary care physicians, family physicians, general practitioners, endocrinologists, diabetologists, cardiologists, and other physicians involved in the management of diabetes.The educational videos consist of the following lectures:World diabetes day – November 14<ul><li class="ql-align-justify">Importance of multi-sectoral collaboration in improving access to care in sub-Saharan Africa.</li><li class="ql-align-justify">Diabetes Facts &amp; Figures.</li></ul>After watching these presentations, the viewers should be able to:<ul><li class="ql-align-justify">Understand the current facts &amp; figures for diabetes (as of 2021) globally and in Africa.</li><li class="ql-align-justify">Understand the impact of multi-sectoral collaboration in improving access to diabetes care in sub-Saharan Africa.</li><li class="ql-align-justify">Describe the call of action to help improve access to diabetes care.</li><li class="ql-align-justify">Get insight on the challenges in diabetes management in Africa.&nbsp;</li></ul>Expert facultyProfessor Jean Claude Mbanya MD, Ph.D., MRCP (UK), FRCP (London), FTWASProfessor of Medicine and Endocrinology, Faculty of Medicine and Biomedical Sciences University of Yaoundé 1, Yaoundé, Cameroon.

World diabetes day – November 14

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Super Module 1: Laying the Foundations

Join our celebration on World Diabetes Day

Insights from the International Diabetes Federation Atlas 10th Edition

IDF Diabetes Atlas

<h4>Introduction</h4>Beginning with the International Diabetes Federation (IDF) projections and statistics on diabetes prevalence in sub-Saharan Africa, this educational video discusses the prevalence of comorbidities and complications associated with diabetes and the risk factors specific to the sub-Saharan Africa region.&nbsp;This video is aimed at primary physicians, family physicians, general practitioners, endocrinologists, diabetologists, cardiologists, and other physicians involved in the management of diabetes. <h4>The educational video consists of the following lecture:</h4>Prevalence of diabetes in sub-Saharan Africa <h4>After watching the presentation, the viewers should be able to:</h4><ul><li>Understand the current and projected prevalence of diabetes in the IDF Africa region.</li><li>Explain the modifiable and non-modifiable risk factors for diabetes.</li><li>Discuss the prevalence of diabetes complications and comorbidities in sub-Saharan Africa as well as the multifactorial approach needed to improve outcomes.</li></ul><h4>Expert faculty</h4>Prof. Jean Claude Mbanya, MD, PhD, MRCP (UK), FRCP (London)Professor of Medicine and Endocrinology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon