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(New recommendation)Evidence: moderate-qualityCCS/CHRS AF19We recommend that most patients should receive a DOAC (apixaban, dabigatran, edoxaban or rivaroxaban) in preference to warfarin when OAC therapy is indicated for patients with NVAF. An ARB can be used if the patient is intolerant of an ACEi.Recommendation: grade AAntihypertensive therapy is recommended for average SBP measurements of 140 mm Hg or DBP measurements of 90 mm Hg in pregnant patients with chronic hypertension, gestational hypertension or preeclampsia. It is recommended over ASA and dual antiplatelet therapy.ASA: evidence: level A Dual antiplatelet therapy: evidence: level BDementiaScreening and diagnostic strategiesDementia20An objective assessment of the patient's cognitive function could be achieved by using rapid psychometric screening tools such as the memory impairment screen and clock drawing test, the Mini-Cog, the AD8, the 4-item version of the MoCA (clock drawing, tap at letter A, orientation and delayed recall) and the GP Assessment of Cognition. [Extracted from the article]

Background: Physical activity (PA) is a cornerstone in the management of type 2 diabetes (T2DM). This pilot investigation explores the effects of a standard diabetes education program compared with a supplemental PA intervention on diabetes-related health outcomes. Methods: Using a prospective 2-armed design, 96 adults with T2DM were randomly assigned to either standard care (diabetes education program; n = 49) or standard care supplemented with an 8-week, individualized-counseling and community-based PA component (n = 47). Measurements were taken at baseline, 3,6, and 12 months. Primary outcomes were changes in PA (self-report) and HbAlc. Between group changes were compared using analysis of covariance (ANCOVA) and changes over time using repeated-measures ANOVA. Results: In comparison with standard care, the supplemental group demonstrated an increase in PA (Ps < 0.01) and cardiorespiratory fitness (Ps <0.05) from baseline to all follow-up time-points. HbAlc levels declined (P < .05) from baseline to all time points in the standard care group. Reduction in cholesterol-ratio (P < .01), increase in HDL (P < .05), and reductions in blood pressure, resting heart rate and BMI (approaching statistical significance Ps < 0.10) were also reported for both groups. Conclusions: PA counseling in addition to standard care is effective for promoting PA behavior change and positive health-related outcomes among individuals with T2DM. [ABSTRACT FROM AUTHOR]

The article discusses the 2018 update to the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE), a guideline which targets primary care health care practitioners. The 2018 update includes a total of 77 recommendations and 52 new recommendations, including multifaceted care for patients with cardiovascular risks. The guideline added a new category for hypertension for high-risk individuals and lists of risk factors of heart failure, hypertension and stroke.

Presents information on a study which investigated the effect of acarbose, an alpha-glucosidase inhibitor, on insulin release and insulin sensitivity in elderly patients with type 2 diabetes. Account of related studies; Research design and methods; Conclusions.

The JCR:LA-cp rat develops an extreme obese/insulin-resistant syndrome such that by 12 weeks of age, there is no longer any insulin-mediated glucose turnover. At 4 weeks of age, obese and lean rats have essentially identical basal and insulin-mediated glucose uptake in skeletal muscle. By 8 weeks of age, however, the obese rats no longer exhibit such intake. Plasma insulin concentrations in the normal fed state show only small increases up to 4 weeks, with a rapid rise to a marked hyperinsulinemia thereafter, with an age at half-development of 5.5 weeks. Plasma triacylglycerol concentrations in fed obese rats are elevated at 3 weeks and rise rapidly thereafter. The triacylglycerol content of skeletal muscle is significantly elevated in the obese rats at 4 weeks of age. Histological examination of Oil Red O-stained muscle tissue and transmission electron microscopy shows the presence of intracellular lipid droplets. Treatment with the potent triacylglycerol-lowering agent MEDICA 16 (beta,beta'-tetramethylhexadecanedioic acid) from 6 weeks of age reduces plasma lipids markedly, but it reduces body weight and insulin resistance only modestly. In contrast, treatment with MEDICA 16 from the time of weaning at 3 weeks of age results in the normalization of food intake and body weight to over 8 weeks of age. The development of hyperinsulinemia is also delayed until 8.5 weeks of age, and insulin levels remain strongly reduced. Plasma triacylglycerol concentrations remain at the same level as in lean rats, and neither an elevated muscle triacylglycerol content nor intracellular lipid droplets are found at 4 weeks of age. The results indicate that insulin resistance develops in the young animals and is not directly due to a genetically determined defect in insulin metabolism. The mechanism of induction instead appears to be related to an exaggerated triacylglycerol metabolism. [ABSTRACT FROM AUTHOR]