@goggledocs.bsky.social
Docs/nurses/pharmacists from U.K. Talking CardioRenoMetabolic (#CaReMe) & more Catch us on YouTube http://youtube.com/c/GoggleDocs |Educate, Motivate, Activate!
๐ข TyG-BMI: a new vital sign in #MASLD?
๐น NHANES study: TyG-BMI โคด๏ธ = โคด๏ธ all-cause โ ๏ธ & ๐โ ๏ธ
๐ธ U-shaped risk curveโboth high & low TyG-BMI = โคด๏ธ risk
๐น HbA1c mediated most of the effect
๐ For MASLD, insulin resistance isnโt just presentโitโs predictiveโ๏ธ
๐ ggdocs.co/9cu63n
@pharmrj.pharmsky.app
๐ฆUpdated @medscape.com Primary Care #Hack
๐ฅInterpreting iron studies in primary care๐ฅ
๐ฏ What are iron studies?
๐ฏ Top tips & pitfalls to avoid
๐ฏ Managing โฌ๏ธ ferritin
๐ฏ Iron deficiency: once daily dosing help absorption
PDF download link in comments ๐๐พ
@goggledocs.bsky.social @pharmrj.pharmsky.app
๐ฆLatest @medscape.com Primary Care #hack is live!
๐ฅPaired #hacks covering the diagnosis & management of #HFrEF & #HFpEF in primary care
PDF download link in comments ๐๐พ
@pharmrj.pharmsky.app @goggledocs.bsky.social @hpillminster.pharmsky.app
๐ข Can LFTs track liver fat loss after weight loss in #T2Dโ
๐น DiRECT sub-study: 74% achieved MASLD remission with ~12kg wt loss
๐ธ โคต๏ธ ALT & GGT= predictors of liver fat โคต๏ธ (ALT >40 = PPV 100%)
๐น ALT change most closely linked to liver fat โคต๏ธ
๐LFTs = simple tool to track remission
๐ ggdocs.co/9g8ffo
Whoโs getting #GLP1 for #obesity ๐บ๐ธโ
๐น <3% of 39M eligible pts got Sema/tirz
๐ธ โซ๏ธโช๏ธ โ ๏ธ Px lower in โ๏ธ, โซ๏ธ/Asian/Hispanic pts, high SVI & rural area
๐น Uptake โคด๏ธ overall, but disparities persist
๐ธ Reflects system-level barriers
๐ #ObesityCare evolvingโequity must catch upโ๏ธ
๐ ggdocs.co/ao046p
๐ฅOur #CVRMUK paper is now published!
๐ก"Advancing Cardiovascular, Kidney, and Metabolic Medicine: A Narrative Review of Insights and Innovations for the Future"
๐ฏThis review advocates for an integrated #CKM framework
Open access link in comments ๐๐พ
@goggledocs.bsky.social @pharmrj.pharmsky.app
๐ข Danuglipron droppedโcan orforglipron still be the โoral GLP-1 that deliversโ?
๐น Pfizer halts danuglipron after liver signal
๐ธ Orforglipron P2=HbA1c โคต๏ธ2.1%, Wt โคต๏ธ14.7%, no liver signal
๐น P3 2025โwill it safely deliver?
๐ Small molecule GLP-1: blockbuster or cautionary tale?
๐ ggdocs.co/5qu8y3
Hot on heels of CVRMUK congress, @EimearDarcy
& I present our updated @medscape.com
Primary Care #Hack
๐ฅ#T2D #CVRM checklist๐ฅ
๐กA holistic, person-centred approach to supporting our patients living with #T2D
PDF download in comments below๐๐พ
@goggledocs.bsky.social @pharmrj.pharmsky.app
๐ฏ CVRMUK London conference tomorrow!
I'm covering
๐กA history lesson: the evolution of cardio-renal disease
๐กThe intersection of sleep & #CVRM
๐กEASL-EASD-EASO #MASLD guidance
๐ฅ Our Autumn CVRMUK conference is on 26/11/25
Register ๐๐พ
@goggledocs.bsky.social @pharmrj.pharmsky.app
๐ Our real-world paper shows GLP1s are associated with lower risk of MACE & less costs than DPP4s or insulin in T2DM at higher CV risk ๐
link.springer.com/article/10.1...
@pccs.bsky.social @goggledocs.bsky.social @sabouretcardio.bsky.social @astonuniversity.bsky.social @swbhnhs.bsky.social
๐ข #GLP1 โคต๏ธ kidney decline, CV events & mortality in CKDโ๏ธ
๐น Meta-analysis of 18K pts w/ eGFR <60:
โคต๏ธ eGFR decline โฅ50% (OR 0.72)
โคต๏ธ ๐ (OR 0.86)
โคต๏ธ โ ๏ธ (OR 0.77)
๐ธ โคต๏ธโคต๏ธ with human GLP-1 backbone
๐ฅEvidence across CKD stagesโnot just macroalbuminuria
๐ GLP-1 now a key ๐ฏ in CKD + #T2D
๐ ggdocs.co/tnqomz
Oral semaglutide cost-effective vs. liraglutideโeven at 50% โคต๏ธ price
๐น ๐ฌ๐ง modelled data: โคด๏ธ QALYs (+0.18) & โคต๏ธ comp.
๐ธ ๐ = โคต๏ธ Rx burden vs. daily ๐
๐น Results robust across sensitivity analyses
โ ๏ธ funded by NovoNordisk
๐ Challenges low-cost liraglutide, supports ๐ฏ oral GLP-1 use
๐ ggdocs.co/9h0bz1
๐ฏUpdated @medscape.com Primary Care #Hack
๐ฅ #DOAC dosing for stroke prevention in #NVAF & kidney impairment๐ฅ
๐จ #DOACs are not "fire & forget" drugs
๐ก Do not use #eGFR; #CrCl should be used for drug dosing
PDF download link in comments below ๐๐พ
@goggledocs.bsky.social @pharmrj.pharmsky.app
๐ข ACR in Obesity (Ob): Are we under Dx albuminuria?
๐น Ob โคด๏ธ creatinine excretion = ACR underestimates albuminuria
๐ธ Delay Rx in #CKD & #T2Dโesp. RASi, SGLT2i, nsMRA
๐น Bias = in โ & โคด๏ธ muscle
๐ธ Review callsโก๏ธโ๏ธโ๏ธ cutoffs or estimated AER (eAER)
๐ to rethink ACR thresholds in Obโ
๐ ggdocs.co/l1htvt
Albuminuria: The CKM biomarker weโre overlookingโ๏ธ
๐ฅ risk biomarker
๐น Even UACR <3.4 mg/mmol = โคด๏ธ #CVD, #CKD & โ ๏ธ risk
๐ธ Signals early endothelial dysfunc. in HTN, #T2D, #HF & #MASLD
๐น Yet ๐งscreening rates low
๐ธ Newer Rx (SGLT2i, #GLP1 , nsMRA) = ๐ฏ
โdetect, disclose & treatโ๏ธ
๐ ggdocs.co/hot30b
GLP-1 & blood cancer risk: Encouraging signal in cohort study
๐น #T2D patients on GLP-1 โคต๏ธ risk vs. insulin for hematological cancers (HR 0.46)
๐ธ โคต๏ธ risk of MDS, MPN, leukaemia, lymphoma & myeloma
๐น No benefit vs. met
๐ธ โ ๏ธ RWD = unresolved bias
๐ Supports ๐ฏ trials โคต๏ธcancer
๐ ggdocs.co/3yosuj
๐ก My latest Medical Mentor podcast is live!
๐ฅInterpretation & management of hypocalcaemia for PC ๐ฅ
On Spotify, Apple Podcasts & Medscape website (link๐๐พ)
+see my @medscape.com PC #Hack on hypercalcaemia and hypocalcaemia in PC (link๐๐พ)
@goggledocs.bsky.social @pharmrj.pharmsky.app
๐ข Are you a #UK #HealthcareProfessional managing patients with #KidneyDisease, #HighBloodPressure, #Diabetes or #Lupus?
๐ฉโโ๏ธ We want to hear what information/education you deliver about #kidneys, & anything that helped or hindered you.
๐ app.onlinesurveys.jisc.ac.uk/s/salford/ph...
๐ Thank you!
#Finerenone: CV & renal protection across all #T2D therapiesโ๏ธ
๐น Pooled analysis: 15,365 pts w/ T2D + CKD or CV
๐ธ Consistent benefit on ๐โ ๏ธ, ๐ฅ๐& kidney outcomes
๐น โคด๏ธK+ โคต๏ธ with SGLT2i use
๐ธ Benefit independent of SGLT2i/GLP-1 use
๐ Supports finerenone as a ๐ฏ in high-risk #T2Dโ๏ธ
๐ ggdocs.co/tx2a5r
๐ข #T1D Closed-Loop: MiniMedโข 780G in Real-World France
๐น TIR โคด๏ธ 11.8% (2.8h/day) at 6m, HbA1c โคต๏ธ 0.52%
๐ธ Hypoglycemia risk โคต๏ธ, zero severe hypos @ 12m
๐น Diabetes distress โคต๏ธ & QoL โคด๏ธ in adults & teens
๐ธ Fear of hypos โคต๏ธ in adults & children
๐ HCL the new standard in #DiabetesCareโ๏ธ
๐ ggdocs.co/pwpsiu
๐ข Mediterranean Diet: A Recipe for Cancer Prevention?
๐ฌ๐ง1 in 10 cancers - Obesity related (ORC)
๐น n450,111, 15y follow-up in EPIC study
๐ธ 6% โคต๏ธ risk ORC withMedDiet adherence (HR 0.94)
๐น Colorectal, liver, kidney cancer โคต๏ธ
๐ธ Not weightโno mediation via BMI/waist-to-hip ratio
๐ ggdocs.co/7larkw
MASLD: โElephant in the Roomโ of #CKM
๐น ๐ crisis: 1/3 adults affected, 65% in #T2D
๐ธ Liver fibrosis=predictor of โ ๏ธ & #CVD, #CKD,&HCC
๐น No approved Rx โ ๐ฏ lifestyle, โคต๏ธweight & multi-specialty care
๐ธ Future hope: GLP-1s, PPAR, THR-ฮฒ agonists
๐ Access the full paper via link
๐ ggdocs.co/dz0kai
๐ข #GLP1 & Safety: 82 Deaths Reported ๐ฌ๐ง
๐น 60 deaths linked to #T2D use, 22 to weight loss
๐ธ Mounjaro (18), Ozempic/Wegovy (29), Victoza/Saxenda (35)
โ ๏ธReports โ causation, but raises need for better patient education
๐MHRA warns against unregulated online sales & fake pens
๐ ggdocs.co/oapff4
"Computer says yes" to help pick the best glucose-lowering drug #T2D
๐น Machine-learning predicts optimal therapy (GLP1, SGLT2i, SU, DPP4i, or TZD)
๐ธ Model-concordant Rx = 5.3 mmol/mol โคต๏ธ HbA1c at 12m
๐น Better long-term outcomes: 38% โคต๏ธ glycaemic failure, 29% โคต๏ธ renal risk, 15% โคต๏ธ ๐
๐ ggdocs.co/9p2tgf
๐ข Beyond GLP-1: The next wave ...
๐น GIP/GLP-1 dual agonists (e.g., #Tirzepatide) โคด๏ธ wt loss vs. GLP-1
๐ธ 3x agonists (GIP/GLP-1/Glucagon) aim for >25% wt loss
๐น Emerging ๐๐: Amylin + GLP-1 combos, FGF21 analogs, oral non-peptides
๐ Will the next-gen ๐ โคด๏ธ wt loss beyond 30%โ
๐ ggdocs.co/hefyaj
Can resistance exercise reverse frailty in #T2D โ
๐น Frailty โคต๏ธ in 36% of intervention group vs. 17% usual care (OR 2.6, p=0.009)
๐ธ SPPB โคด๏ธ by 1+ point in 47.8% vs. 35.3% (p=0.034)
๐น Early intervention keyโ๏ธ
๐ Time to rethink exercise as standard Rx for frailty in #T2D
๐ ggdocs.co/zvm0cn
๐ข Cardiac, Renal & Metabolic (CRM) Overlap: A Public Health Crisis?
๐น CRM multimorbidity โคด๏ธ in 20 yrs (1 CRM: 21% โ 26%, all 3: 0.7% โ 1.5%)
๐ธ โซ๏ธ & low SES = โคด๏ธ risk but โคต๏ธtreatmentโ๏ธ
๐น Statins underused in 1/3 CRM pts, ACEi/ARB in 40-50%, SGLT2i/GLP1 <5%
๐ MDT + ๐ฏ therapy= keyโ๏ธ
๐ ggdocs.co/enhs7v
A โ a day helps keep the cirrhosis awayโ
๐น 78mg+ daily linked to โคต๏ธ liver fibrosis risk in #T2D, prediabetes & normoglycemia
๐ธ Effect independent of BMI, SES, etc...
๐น T2D strongest benefit
๐ธ No evidence that fancy oat milk lattes offer extra ๐
๐ โโ
@pharmrj.pharmsky.app
๐ ggdocs.co/vcwmxp
#SGLT2is are therapeutic titans but no drug is without harm
My #SGLT2i resources to ensure benefits outweigh harms:
๐ฏ Patientfacing YouTube videos
youtube.com/@drkevinfern...
๐ฏ @medscape.com Primary Care #Hacks
www.medscape.co.uk/viewarticle/...
@goggledocs.bsky.social @pharmrj.pharmsky.app
GLP-1RAs: Potential in Mental Health?
๐น Systematic Review
๐ธ Cognitive disorders: โคต๏ธ dementia risk in #T2D
๐น Substance use: โคต๏ธ alcohol & nicotine use via dopamine pathways
๐ธ Mood & psychotic disorders: No clear benefit,
๐ GLP-1RAs show promise but need RCTs in mental healthโ๏ธ
๐ ggdocs.co/b41wuf
