Kidney Disease: Improving Global Outcomes Summit Recommendations on Implementation of Diabetes Management in CKD: From Primary to Data-Driven Collaborative Care.

Type 2 diabetes and chronic kidney disease (CKD) are preventable and treatable. Their silent and progressive clinical course calls for structured assessment with timely feedback to patients and care providers for activating decision-making. Apart from CKD, patients with diabetes can have complications affecting multiple organs, notably the cardiovascular system, eyes, and feet.

Adherence patterns to cardiovascular medications in people with type 2 diabetes mellitus: a retrospective cohort study using group-based trajectory analysis in primary care.

Aim: To assess adherence to glucose-, lipid-, and blood pressure-lowering medications in people with T2DM and identify predictors of non-persistent adherence behaviours.

Methods: We conducted a retrospective cohort study using primary care data from 2013 to 2023 for people diagnosed with T2DM. Medication adherence was assessed over 60 months, defined as receiving at least one prescription every six months.

Genomic risk prediction for type 2 diabetes in Australian individuals aged 70 years and older.

Aims: The utility of a polygenic score (PGS) for type 2 diabetes (T2D) has been demonstrated in the general adult population. However, while previous studies have included older adults within broader age ranges, the performance of PGS specifically in older individuals aged ≥70 years remains unclear. We aimed to evaluate the predictive utility of a PGS in an older cohort.

STAREE-HEART: A randomized placebo-controlled trial of atorvastatin effects on a marker of cardiac aging in older individuals without prior cardiovascular disease events: Protocol and baseline description of participants.

Background: Statins may prevent myocardial dysfunction associated with aging, and consequent atrial fibrillation (AF) and heart failure (HF). STAREE-HEART is a randomized, double-blind, placebo-controlled clinical trial assessing atorvastatin on markers of cardiovascular aging in a healthy older population. This ancillary study is nested in the STAtins in Reducing Events in the Elderly (STAREE) primary prevention trial.

Diabetes distress screening using PAID-5 and PAID-1 among adults attending a tertiary multidisciplinary type 1 diabetes clinic.

Aims: Living with type 1 diabetes can be challenging, and diabetes distress may be overlooked during time-constrained clinical assessments. Screening for diabetes distress with the one-item Problem Areas in Diabetes Scale (PAID)-1, in conjunction with the five-item PAID-5, may offer an efficient method to improve type 1 diabetes assessment. We aimed to evaluate the utility of this approach to identify possible diabetes distress and its clinically significant covariates.

Kidney Disease: The Forgotten Legacy of Type 1 Diabetes.

Type 1 diabetes is associated with a progressive decline in kidney function. With improved survival, more individuals with type 1 diabetes are reaching an age where irreversible loss of kidney function can impact health and clinical outcomes. Although current standard of care has markedly reduced the incidence of fast-progressing kidney disease characterized by heavy albuminuria, and improved patient survival, these same interventions have not slowed kidney decline in most patients.

Performance of the American Heart Association PREVENT Cardiovascular Risk Equations in Older Adults.

Background: The ability of the American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) calculator to accurately assign 10-year atherosclerotic cardiovascular disease (ASCVD) risk in older individuals, including those aged ≥80 years, is unknown. This study compares PREVENT with the 2013 Pooled Cohort Equation (PCE) calculator for predicting 10-year ASCVD risk in a large cohort of older adults.

Methods: This was a prospective cohort study of adults without CVD from Australia and the United States aged ≥70 years (≥65 years, if US minorities).

STatin TReatment for COVID-19 to Optimise NeuroloGical recovERy (STRONGER): study protocol for a randomised, open label clinical trial in patients with persistent neurological symptoms after COVID-19 infection.

Introduction: Increasing awareness of the high frequency, wide spectrum and disabling nature of symptoms that can persist following COVID-19 infection has prompted the investigation of management strategies. Our study aims to determine the effectiveness of atorvastatin on cognitive function, physical activity, mood, health-related quality of life and features of neurovascular impairment and neuroinflammation in adults with ongoing neurological symptoms after COVID-19 infection.

Methods And Analysis: The STatin TReatment for COVID-19 to Optimise NeuroloGical recovERy study is an ongoing international, investigator-initiated and conducted, multicentre, prospective, randomised, open label, blinded endpoint trial with fixed time points for outcome assessments.

The management of cardiovascular risk in people with diabetes: Insights from an audit of health services providing diabetes care.

Aims: To assess cardiovascular risk management among Australians with diabetes.

Methods: Retrospective analysis of clinical audit data collected from diabetes centres participating in the Australian National Diabetes Audit in 2022. Adults (≥18 years) with type 1 or type 2 were included.

Building a professionally recognised clinical trial workforce: Is it time for an education and accreditation strategy?

Evidence-based medicine relies heavily on well-conducted clinical trials. Australia lacks a discipline-specific education pathway to provide the specialist skills necessary to conduct clinical trials to the highest standards. Unlike allied health professionals, clinical trialists who currently possess the specialist skills to conduct clinical trials do not receive professional recognition.

Rethinking Cardiovascular Prevention: Cost-Effective Cholesterol Lowering for Statin-Intolerant Patients in Australia and the UK.

Background: Approximately 1 in 11 people are intolerant to statins. There have been no studies evaluating the cost-effectiveness of early intervention for primary prevention of cardiovascular disease (CVD) with three non-statin drugs (ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i; inclisiran and evolocumab), and bempedoic acid). We aimed to evaluate the cost-effectiveness of these therapies when initiated at age 40 years.

Beta-Blocker Therapy After Myocardial Infarction.

Historical data strongly supported the benefits of beta-blocker therapy following a myocardial infarction (MI) for its efficacy in reducing mortality and morbidity. However, in the context of the progressive evolution of treatment strategies for MI patients, the apparent benefit of beta-blocker therapy is becoming less clear. In particular, its effectiveness in patients with preserved left ventricular ejection fraction is currently being challenged.

Association of Year-to-Year Lipid Variability With Risk of Cognitive Decline and Dementia in Community-Dwelling Older Adults.

Background And Objectives: Lipid metabolism in older adults is affected by various factors including biological aging, functional decline, reduced physiologic reserve, and nutrient intake. The dysregulation of lipid metabolism could adversely affect brain health. This study investigated the association between year-to-year intraindividual lipid variability and subsequent risk of cognitive decline and dementia in community-dwelling older adults.

The growing range of complications of diabetes mellitus.

With the rising prevalence of type 2 diabetes mellitus (T2DM) and obesity, several previously under-recognised complications associated with T2DM are becoming more evident. The most common of these emerging complications are metabolic dysfunction-associated steatotic liver disease (MASLD), cancer, dementia, sarcopenia, and frailty, as well as other conditions involving the lung, heart, and intestinal tract. Likely causative factors are chronic inflammation and insulin resistance, whereas blood glucose levels appear to play a lesser role.

Cardiovascular effects of tirzepatide.

Tirzepatide is a first-in-class dual agonist at receptors for glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) for the treatment of T2D and obesity, with unprecedented efficacy for glycaemic control, reductions in body weight and improvements in blood pressure and lipid profile compared with placebo and GLP-1 receptor agonists. To date, clinical trials of tirzepatide have fulfilled the requirement by regulatory authorities of demonstrated cardiovascular safety in high-risk patients. Whether cardiovascular benefits will be found with dual GLP-1/GIP receptor agonists remains uncertain, and the contribution of GIP receptor activation to cardiovascular risk has not been established.

Effects of statins on kidney function in older adults.

Background: The effect of statin therapy on kidney function among older adults is unclear.

Objectives: To examine the association between statin use and changes in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), positive or negative, in an older adult cohort with versus without chronic kidney disease (CKD) at baseline.

Methods: This analysis included 18,056 participants aged ≥65 years with versus without CKD at baseline in a randomized trial of low-dose aspirin, who had no prior cardiovascular events, major physical disability, or dementia initially.

Intensive Glucose Lowering and Its Effects on Vascular Events and Death According to Age at Diagnosis and Duration of Diabetes: The ADVANCE Trial.

Objective: To compare the vascular effects of pursuing more versus less glucose lowering in patients with younger or older age at diabetes diagnosis, and with shorter or longer diabetes duration.

Research Design And Methods: We studied 11,138 participants from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial, classified into subgroups defined by age at diabetes diagnosis (≤50, >50-60, and >60 years) and diabetes duration (≤5, >5-10, and >10 years).

Results: Intensive glucose lowering significantly lowered the risk of the primary composite outcome of major macrovascular and microvascular events (hazard ratio 0.

Immediate Versus 5-Year Risk-Guided Initiation of Treatment for Primary Prevention of Cardiovascular Disease for Australians Aged 40 Years: A Health Economic Analysis.

Background And Objective: Current Australian cardiovascular disease (CVD) prevention guidelines calculate 5-year CVD risk and recommend treatment when risk crosses specific thresholds. This may leave risk factors untreated for people with a low short-term (i.e.

Baseline Characteristics of Participants in STAREE: A Randomized Trial for Primary Prevention of Cardiovascular Disease Events and Prolongation of Disability-Free Survival in Older People.

Background: The risk-benefit balance of statin use in healthy older people is uncertain. We describe the baseline characteristics of the STAREE (Statins in Reducing Events in the Elderly) trial, which is a randomized, double-blind, placebo-controlled trial among community-dwelling older people; the trial evaluated the effect of atorvastatin 40 mg for the prevention of major cardiovascular events (cardiovascular death, nonfatal myocardial infarction or stroke), and on disability-free survival (survival free of both dementia and persistent physical disability).

Methods And Results: STAREE enrolled people aged ≥70 years from 1583 general practices across Australia with no history of clinical cardiovascular disease, diabetes, or dementia.

Impact of Genetic Risk Information for Cardiovascular Disease on Behavioural, Psychological Responses, and Risk Factor Modification: A Systematic Review.

Aims: Cardiovascular disease (CVD) remains a significant public health concern, influenced by both genetic susceptibility and lifestyle factors. Integrating genetic risk information into clinical practice shows promise but has yielded mixed results regarding its impact on CVD prevention and management. This systematic review aimed to assess the impact of providing genetic CVD risk information on health behaviours, psychological outcomes, and risk factors.

Hypoglycaemia Prevention, Awareness of Symptoms, and Treatment (HypoPAST): protocol for a 24-week hybrid type 1 randomised controlled trial of a fully online psycho-educational programme for adults with type 1 diabetes.

Background: Management of type 1 diabetes (T1D) requires the use of insulin, which can cause hypoglycaemia (low blood glucose levels). While most hypoglycaemic episodes can be self-treated, all episodes can be sudden, inconvenient, challenging to prevent or manage, unpleasant and/or cause unwanted attention or embarrassment. Severe hypoglycaemic episodes, requiring assistance from others for recovery, are rare but potentially dangerous.

Do clinical decision support tools improve quality of care outcomes in the primary prevention of cardiovascular disease: A systematic review and meta-analysis.

Aim: To assess the effectiveness of Clinical Decision Support Tools (CDSTs) in enhancing the quality of care outcomes in primary cardiovascular disease (CVD) prevention.

Methods: A systematic review was undertaken in accordance with PRISMA guidelines, and included searches in Ovid Medline, Ovid Embase, CINAHL, and Scopus. Eligible studies were randomized controlled trials of CDSTs comprising digital notifications in electronic health systems (EHS/EHR) in various primary healthcare settings, published post-2013, in patients with CVD risks and without established CVD.