TYPE-2-DIABETES

DIABETES

Treatment simplification of complex insulin regimens in T2D

An educational video to discuss the challenges associated with commonly-used insulin advancement options and the need for treatment simplification for many adults with T2D. The video reviews data supporting the use of BI + GLP-1 RA FRCs versus commonly-used insulin regimens in adults with T2D.

<h2>Low number of people with diabetes, using insulin, are achieving glycemic control</h2>

*Target HbA1c &lt;7%; The IDMPS (N=1936) was a large, observational study program, collating data in seven individual waves from 2005 to 2017. The data from wave 7 (2016–2017) describing real-world acheivement of glycemic targets was reported in this study HCPs, Healthcare practitioners; OADs, oral antidiabetic drugs; T2DM, type 2 diabetes mellitus

References

<h2>Once basal insulin has been initiated,&nbsp;titration inertia&nbsp;can become a predominant issue for people with diabetes</h2>

Real-world evidence indicates that the structured and monitored titration algorithms that are applied in randomized controlled trials are not reflective of behavior in practice

Reference

<h2>Fear of hypoglycemia&nbsp;is a major barrier to insulin initiation and optimal insulin titration</h2>
Careful titration of insulin therapy can achieve glycemic control without a significant risk of hypoglycemia1; however, in clinical practice,&nbsp;fear of hypoglycemia is a common barrier&nbsp;to optimal titration, concordance and achieving glycemic targets with insulin1–3

<h2>Titration is a critical phase for basal insulin, and imperative for success of therapy</h2>
Difference in dose usage controlled Clinical Studies reality vs Real Life 45-75% of Basal&nbsp;T2 patients are uncontrolled and below optimal BI dose by as much as 30%.

Contact frequency determines outcome of basal insulin initiation trials.

Titration Inertia; A Predominant Issue for People with Diabetes

INTEGRATED-DIABETES-CARE

Time-In-Range (TIR): How to interpret it and how it is associated with outcomes

Watch the Interview with Dr. Richard Bergenstal, International Diabetes Center, Minneapolis, USA following the ATTD 2021 Congress. Dr. Richard Bergenstal explains on how to interpret TIR and how it is associated with outcomes.

<h2>Peak esophageal intraepithelial eosinophil counts</h2>
Most studies use&nbsp;peak esophageal intraepithelial eosinophil counts&nbsp;(eosinophils per high-power field, or EOS/HPF) to determine histologic outcome, using both percent change in peak EOS/HPF as well as proportion of patients achieving a treatment response, as shown below.4

<h3>How treatment responses are classified4</h3>
<ul>
 <li>&lt;1 EOS/HPF
 <ul>
 <li>(Normal biopsy)&nbsp;Considered a&nbsp;complete histological remission</li>
 </ul></li>
 <li>≥1 to &lt;15 EOS/HPF
 <ul>
 <li>(Reduced eosinophilia)&nbsp;Considered the&nbsp;histologic response threshold</li>
 </ul></li>
 <li>≥15 EOS/HPF
 <ul>
 <li>(Persistent eosinophilia)&nbsp;Considered a&nbsp;non-response</li>
 </ul></li>
</ul>

<h2>Peak EOS/HPF is the most common histologic measure of disease severity4</h2>
&lt;1 complete normalization
<h3>Normalized enrichment score</h3>
The&nbsp;Normalized Enrichment Score (NES)&nbsp;is an additional assessment to confirm the diagnosis using gene expression of interest in eosinophilic esophagitis compared with healthy controls.5
<h3>How NES is assessed</h3>
The EoE diagnostic panel, or EDP (shown below), is a molecular diagnostic test that differentiates patients with eosinophilic esophagitis from normal controls based on 94 EoE genes; a heatmap shows which gene transcripts are upregulated (red) relative to normal controls (blue).5

<h2>EoE Diagnostic panel heatmap5</h2>
<ul>
 <li>Patients with EoE&nbsp;</li>
 <li>Normal controls&nbsp;</li>
</ul>

<h2>NES scores appear to normalize in EoE patients after successful treatment6</h2>

<h3>EoE-HSS Composite score</h3>
The&nbsp;Eosinophilic Esophagitis Histologic Scoring System (EoE-HSS)&nbsp;is a scoring system that measures histologic changes in the esophagus beyond eosinophil count, including barrier function and remodeling, grading 8 features of eosinophilic esophagitis to quantify frequency, severity, and extent of abnormalities.7
<h3>How NES is assessed</h3>
Pathologists score histological degree of abnormality (grade) and histological extent of pathologic severity (stage) using a 4-point scale for each feature (0=normal; 3=most severe or extensive). The maximum possible grade or stage score for each biopsy is 24.7

<h3>EoE-HSS Composite scores are more predictive of treatment response than eosinophil count alone4,7</h3>
<ul>
 <li>0 (normal)</li>
 <li>24 (most severe or extensive)</li>
</ul>

Measures of Disease Severity in Eosinophilic Esophagitis (EoE)

EOSINOPHILIC-ESOPHAGITIS-EOE

GASTROENTEROLOGY

In this episode, Paivi Hamalainen, Finnish neuropsychologist at Masku Neurological Rehabilitation Centre in Finland talks about the treatment of cognitive impairments of a chronic disease, and what neurologists can learn in order to provide a more holistic approach to treating patients with MS disease.

MULTIPLE-SCLEROSIS

NEUROLOGY

Cognitive training – A curse or a blessing?

What happens when our cognitive&nbsp; functioning is challenged – which is the case for many people living with MS? To shed some light on the impact of cognitive decline and the future perspectives for cognitive rehabilitation in MS, we have the pleasure of having Hanneke Hulst, assistant professor from the MS center in Amsterdam, (Amsterdam UMC – VUmc), in the studio for this episode.&nbsp;October 2020.

Cognitive decline – The invisible burden of MS?

Biomarkers are important in MS, as they can potentially help with diagnosing patients, inform about disease prognosis, and help monitor disease activity and progression. Neurofilament light chain (NfL) is one of the most promising biomarkers in MS, but is it ready for clinical practice? In this episode, Professor of Neurology Finn Sellebjerg will tell us about the potential and limitations of this exciting biomarker.&nbsp;

A promising biomarker in MS: Neurofilament light chain

<h2>WHY IS IT IMPORTANT TO ASSESS MULTIPLE DISEASE DOMAINS IN EoE?</h2>

Outcomes from different disease domains may be discordant with one another14
<ul>
 <li>Symptoms may persist and fibrotic changes may still occur despite histologic remission 9,15,16</li>
 <li>Symptoms may not be present despite endoscopic and histologic evidence of inflammation3</li>
 <li>Subtle esophageal findings of EoE may not be recognized by the less-experienced endoscopist and routine endoscopic findings alone may not detect sections of reduced luminal diameter and microscopic inflammation, thereby requiring additional histologic assessments 9,14,15,17,18</li>
 <li>EoE specific QoL assessments may not correlate with mild forms of endoscopic features of EoE and basal layer hyperplasia, thus requiring confirmation from endoscopic and histologic findings 3</li>
</ul>

black

<table border="1" cellpadding="1" cellspacing="1" style="width: 100%;">
 <tbody>
 <tr>
 <td style="text-align: center; background-color: rgb(91, 37, 148);">&nbsp; Comprehensive assessment using symptoms and QoL, histology, and endoscopy, enables an individualized, patient-centric approach to the management of EoE7,9,11,15</td>
 </tr>
 </tbody>
</table>

Importance of assessing key disease domains in EOE

<ul>
 <li>
 Median diagnostic delay of EoE is&nbsp;1-2 years&nbsp;in children, and increases with age1</li>
 <li>
 Every year of symptoms before diagnosis Increases the chance of fibrostenosis by&nbsp;5%2*</li>
</ul>
Early diagnosis and intervention may improve QoL of children with EoE and reduce progression of disease&nbsp;3-5

Unmasking the Hidden Symptoms!&nbsp;Gain critical insights into the often-overlooked signs of eosinophilic esophagitis (EoE) in children, understand the underlying pathophysiology, and explore cutting-edge diagnostic and treatment options.

This must-read content will equip you with the knowledge to better identify and manage EoE, ensuring improved outcomes for your pediatric patients.

EOE Pediatric - Unmasking the Hidden Symptoms

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The ADCT gives a measure of how controlled the eczema is. Answer these 6 simple questions with your patient to find the ADCT score. It will indicate proper course of action.

Atopic dermatitis, a type of eczema, may be affecting your Patient's life in more ways than you know.

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