Assessment of Glycemic Control in Veterans With Chronic Obstructive Pulmonary Disease and Type 2 Diabetes Mellitus on Inhaled Corticosteroid Therapy.

OBJECTIVE: To determine if the use of inhaled corticosteroid (ICS) therapy affects glycemic control in patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM). BACKGROUND: Studies have shown mixed evidence on the association between ICS use and worsening glycemic control in patients with preexisting diabetes. METHODS: Data were recorded from electronic medical records of veteran patients aged 18 to 80 with COPD and T2DM on at least 2 oral antiglycemic medications from January 1, 2000, to December 31, 2017, at the Veterans Affairs (VA) North Texas Health Care System (VANTHCS). The primary outcome was the rate of A1c progression >10% at 12 months and 5 years. RESULTS: This study included 127 (64 in the ICS group and 63 in the non-ICS group) patients; baseline characteristics between groups were similar with the exception of age and tobacco use. No statistically significant difference was found between groups with regard to the primary outcome. More patients in the non-ICS group had antiglycemic medications initiated at 12 months (P = .009) and 5 years (P = .003) compared to the ICS group. CONCLUSION: Inhaled corticosteroids did not negatively impact glycemic control among veterans with comorbid COPD and T2DM.

Adverse Effects Associated With Newer Diabetes Therapies.

The increasing number of newer type 2 diabetes therapies has allowed providers an increased armamentarium for the optimal management of patients with diabetes. In fact, these newer agents have unique benefits in the management of type 2 diabetes. However, they are also associated with certain adverse effects. This review article aims to describe the notable adverse effects of these newer antidiabetic therapies including the glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and the sodium-glucose cotransporter 2 inhibitors. The adverse effects reviewed herein include pancreatitis, medullary thyroid carcinoma, heart failure, gastrointestinal disturbances, renal impairment, and genitourinary infections. More clinical data are necessary to solidify the association of some of these adverse effects with the newer diabetes agents. However, it is important for health care practitioners to be well informed and prepared to properly monitor patients for these adverse effects.

HIV-1 genital shedding is suppressed in the setting of high genital antiretroviral drug concentrations throughout the menstrual cycle.

BACKGROUND: It is not known if fluctuations in genital tract antiretroviral drug concentrations correlate with genital virus shedding in human immunodeficiency virus (HIV)-infected women on antiretroviral therapy (ART). METHODS: Among 20 HIV-infected women on ART (tenofovir [TFV], emtricitabine [FTC], and ritonavir-boosted atazanavir [ATV]) with suppressed plasma virus loads, blood and cervicovaginal samples collected twice weekly for 3 weeks were tested for antiretroviral concentrations, HIV-1 RNA, and proviral DNA. RESULTS: Cervicovaginal:plasma antiretroviral concentration ratios were highest for FTC (11.9, 95% confidence interval [CI], 8.66-16.3), then TFV (3.52, 95% CI, 2.27-5.48), and ATV (2.39, 95% CI, 1.69-3.38). Within- and between-person variations in plasma and genital antiretroviral concentrations were observed. Low amounts of genital HIV-1 RNA (<50 copies/mL) were detected in 45% of women at 16% of visits. Genital HIV-1 DNA was detected in 70% of women at 35% of visits. Genital virus detection was associated with higher concentrations of mucosal leukocytes but not with genital antiretroviral concentrations, menstrual cycle phase, bacterial vaginosis, genital bleeding, or plasma virus detection. CONCLUSIONS: Standard doses of ART achieved higher genital than plasma concentrations across the menstrual cycle. Therapeutic ART suppresses genital virus shedding throughout the menstrual cycle, even in the presence of factors reported to increase virus shedding.