Discover and read the best of Twitter Threads about #metformin

@boulware_dr

Another confirmatory trial of beneficial effect of #fluvoxamine 100mg BID with Budesonide inhaler in a highly vaccinated population for #COVID19

Dose matters. 50mg 2x/d is not 100mg 2x/d. FLV 50mg 2x/d did not have benefit in two trials

https://twitter.com/ABsteward/status/1648074491573026817

As a combo blinded trial (FLV + inhaler), which one had benefit? Hard to know. In activ-6, we did not observe a benefit of inhaled fluticasone in a double blind RCT, yet UK Principle did see a benefit in open label trial with budesonide.

Importantly the #fluvoxamine dose studied here was 100mg 2x/day.

Covid-out and activ-6 both confirmed a lack of benefit of 50mg 2x/day dose.

If I gave someone 1/2 the effective dose of an HIV med & it didn't work, does that mean the med doesn't work? Or just dose was wrong?

Read 14 tweets

David Boulware, MD MPH

@boulware_dr

#Paxlovid effect on reducing #COVID19 hospitalizations in vaccinated population finally revealed to the public by FDA. #IDTwitter
0.9% (3/317) paxlovid vs. 2.2% (7/314) placebo
fda.gov/media/166197/d…

The relative risk reduction (RRR) of #covid19-related hospitalization was 57.5% (95%CI, -63% to 89%) with #Paxlovid in vaccinated high risk population.

Will point out that the the Hazard Ratio is also 58% for $1 of #metformin.

If one combines the EPIC-SR vaccinated + EPIC-HR seropositive groups together, then risk of #covid19 hospitalization was:
▪️ 0.5% (4/807) with #paxlovid
▪️ 1.9% (15/791) with placebo
Relative RIsk Reduction = 74% (95%CI, 22%-91%)
Number Needed to Treat = 71 (95%CI, 40-300)

Read 27 tweets

Marie-Aude VISINE

@AudeVisine

#covid19 : nouveau point de situation personnel, mais sourcé d'@EricTopol
Pour lui
🔹passage en phase #endémique malgré le risque toujours présent et estimé < 30 % de survenue dans les 2 ans de l'émergence d'un variant + dangereux et/ou plus contagieux.
1/

https://twitter.com/EricTopol/status/1633639863701630976

Le schéma ⤵️ résume les 4 facteurs qui mènent à l'émergence de nouveaux variants (pers. immuno-compromises chez qui le virus évolue ; absence de mesures de prévention au niveau mondial pour contenir les contaminations ; réservoirs animaux avec les pblématiques de co-infection
2/

🔹des espoirs concernant la prévention du #covidlong suite à la publication de la récente étude randomisée sur le bénéfice de la prise de #metformin pendant 15 jours (même si un essai randomisé en double aveugle avec #Paxlovid et #metformin est souhaitable).
🔹toujours rien
3/

Read 6 tweets

Nicole Laurent, LMHC

@KetoCounselor

Microcytic anemias, which affect all cell lines, can have adverse effects on brain and nervous system health. Iron deficiency #anemia, the most common type of microcytic anemia, can cause #cognitive impairment. 🧵(1/18)

Iron is crucial for #brain function, and its #deficiency can reduce #oxygen delivery to the brain, affecting #cognitive processes like #attention, #memory, and learning. (2/18)

#B12 deficiency, another common cause of microcytic anemia, can also damage the nervous system. (3/18)

Read 18 tweets

David Boulware, MD MPH

@boulware_dr

Does #metformin reduce hospitalization or not? In a double-blind placebo controlled trial, 28-day data:

NIH guidelines cite the 14-day mITT data where there was not a statistical reduction.
The 14-day and 28-day ITT data also had a statistical reduction in hospitalization.

These numerical complete case data were published in NEJM.
"Through day 28, hospitalization or death occurred in 8 of 596 patients (1.3%) receiving metformin and in 19 of 601 controls (3.2%)"
(2.9% & 1.2% above are by Kaplan-Meier methodology).
nejm.org/doi/full/10.10…

While the authors were not allowed to highlight these data or put a p-value in, apparently there are a lot of poeple who can't run a chi-square or fisher's exact test -- as I keep hearing that metformin didn't reduce hospitalization in the COVID-Out trial.

Read 4 tweets

@CKD_ce

@ckd_ce

1) Welcome to our #accredited #tweetorial on clinical trial results and emerging data for treatment of Diabetes and CKD #DM in #CKD. I am Brian Rifkin MD, @brian_rifkin, from the Hattiesburg Clinic. #Nephtwitter #Medtwitter #FOAMed

2) This #accredited #tweetorial series on #kidneydisease #CKD is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance. It is not intended for US- or UK-based HCPs. Accreditation statement & faculty disclosures at ckd-ce.com/disclosures/.

3) This activity is accredited for #physicians #physicianassociates #nurses #NPs #pharmacists. Prior programs in this series, still eligible for CE/#CME, can be accessed at ckd-ce.com. FOLLOW US to learn from expert faculty!

Read 41 tweets

WesElyMD

@WesElyMD

1/🧵Can a Diabetes drug prevent Long COVID?

Most solid data yet of a medication preventing #LongCOVID from quadruple blinded, non-pharma sponsored COVID-OUT trial N=1,125.

A 42% relative ⬇️ in clinician diagnosed LC was seen (10.6% down to 6.3%).

bit.ly/3jvvKj4

2/ Metformin’s success (1 LC prevented for every 23 pts treated) could save millions from suffering.

<$1 per course = very cost effective.

Too good to be true? Maybe but very solid science.

Let me unpack a bit more…

bit.ly/3jvvKj4

3/ This trial had 6 groups of patients because 3 meds (metformin/fluvoxamine/ivermectin) were randomized vs. placebo.

The other drugs showed no benefit toward Long COVID reduction.

Metformin also looked good for Acute COVID.

Read 9 tweets

David Boulware, MD MPH

@boulware_dr

COVID-Out double-blind randomized trial tested #metformin, ivermectin, or fluvoxamine for outpatient #COVID19. Secondary endpoint was incidence of Long Covid (PASC).
Volunteers were followed monthly to 10 mo.
Metformin 42% reduction in Long Covid.
medrxiv.org/content/10.110…

Incidence of Healthcare provider diagnosed long covid (PASC) was 42% less among those randomized to #metformin vs. matched placebo.

Hazard Ratio for Long Covid in the metformin group versus control was 0.58 (95% CI 0.38 to 0.88, P=0.009);

There was no benefit for those randomized to #ivermectin vs. matched placebo for reducing long covid and low-dose #fluvoxamine was not beneficial either for decreasing #longcovid.

Read 16 tweets

@CKD_ce

@ckd_ce

1) Welcome to a new #accredited (0.75h CE/#CME) #tweetorial on challenging case presentations for pts with #cardiometabolic disease, #CaReMe #FOAMed.
Our expert author is Claire Davies. @claireyrivs is a specialist diabetes & endocrinology #pharmacist working in Gateshead in 🇬🇧.

2) She is a member of UKCPA Diabetes & Endocrinology committee @UKCPADiabetes & works across #diabetes, #endocrinology, & emergency/acute care in Secondary Care. She is currently involved in development of regional guidelines & education to support medicines optimisation for PLWD

3a) This program is intended for healthcare professionals and is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company.

Read 36 tweets

@CKD_ce

@ckd_ce

1) Welcome to our new #accredited #tweetorial which is Part 1 of a 2-part "highlights" program on new #SGLT2i & #DKD data presented at @ERAkidney #ERA22. #Physicians #nurses #pharmacists #PAs and #NPs can all earn 0.5h CE/#CME by following this thread!

2) @ERAkidney #ERA22 is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #Nephrology. It was held in May. Our expert author is Dr. Sheila Bermejo (@shbermejo) from @vallhebron in Barcelona, Spain.

3) This program is #accredited for CE/#CME & is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance. It is not intended for US- or UK-based based HCPs. Accreditation statement & faculty disclosures at ckd-ce.com/disclosures/.

Read 43 tweets

cardio-met

@cardiomet_CE

1) Welcome to an #accredited #tweetorial on optimizing the use of #SGLT2i in the management of #T2D. This program is accredited for 0.50 🆓credits for #physicians #nurses #physicianassociates #nursepratcitioners #pharmacists by @academiccme! I am @tmodarressi of @HeartDoctorNJ.

@AndrewJSauer @DrMichaelShapir @MichaelJBlaha @dramitkhera @pnatarajanmd @PamTaubMD @DrMarthaGulati @DrRaniKhatib @AAgarwalaMD @RpratleyMD @drricardocorrea @AliceYYCheng @SantosGallegoMD @SABOURETCardio @hvanspall @DLBHATTMD @cpcannon

2) This program is intended for healthcare professionals and is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company. See archived programs, all by expert authors, still available for credit at cardiometabolic-ce.com.

Read 47 tweets

@CKD_ce

@ckd_ce

1) Welcome to our new #tweetorial on optimizing #interprofessional & #multidisciplinary care & medical therapy for patients with #DKD. I am Sophia Ambruso DO, @Sophia_kidney, from @CU_kidney.

2) This #accredited #tweetorial series on #kidneydisease #DKD through the lens of #T2D is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers. Faculty disclosures are at ckd-ce.com/disclosures/.

3) This activity is accredited for 0.75h credit for #physicians #physicianassociates #nurses #NPs #pharmacists. Past programs still eligible for credit can be found at ckd-ce.com. FOLLOW US for more programs by expert faculty!

Read 41 tweets

@CKD_ce

@ckd_ce

1) Welcome to our new #accredited #tweetorial on #mechanismofaction & impact of meds commonly used in patients with or at risk for #DKD progression: #MRAs, #GLP-1 receptor agonists & #DPP-4 inhibitors. I am Sophia Ambruso DO, @sophia_kidney, from @CU_Kidney.

3) This activity is accredited for #physicians #physicianassociates #nurses #NPs #pharmacists. Past programs still eligible for credit can be found at ckd-ce.com. Faculty disclosures are at ckd-ce.com/disclosures/. FOLLOW US for regular programs by expert faculty!

Read 62 tweets

Andrew J Scott

@ProfAndrewScott

Delighted to see my paper “The Economic Value of Targeting Aging” -written with @NuCampEconomics and @davidasinclair – published in @NatureAging nature.com/articles/s4358…
Here is a thread explaining the main results-

#aging #longevity 1/12

Life expectancy has increased dramatically over last 150 years - most US children born today are expected to live into their mid-80s #longevity. This has shifted the disease burden towards chronic Non-Communicable diseases #aging and an increase in years spent in poor health 2/12

How should we value these past and future life expectancy gains? Is a compression of morbidity more valuable? What is the value of treatments that delay #aging? How does that compare with treating single diseases? 3/12

Read 12 tweets

Medical Science and Technology #earlytreatments

@MedicalScitech

A metal ion orients SARS-CoV-2 mRNA to ensure accurate 2′-O methylation of its first nucleotide
» doi.org/10.1038/s41467…
The #SARSCoV2 #coronavirus is able to utilize the changes in metal ion concentrations to disguise itself in the human host body thus evading immune responses.

Efficacy of #clarithromycin on #COVID19 pneumonia without oxygen administration; protocol for multicenter, open-label, randomized-controlled, 3-armed parallel group comparison, exploratory trial #CAMECOVID
» doi.org/10.1101/2021.0…
Japan Registry of Clinical Trials jRCTs071210011

The influence of #HLA genotype on the severity of #COVID19 infection
» doi.org/10.1111/tan.14…
A genetic link has been discovered explaining why some people catch #Covid but don't get sick. The gene is found three times as often in people who are #asymptomatic.

Read 199 tweets

Medical Science and Technology #earlytreatments

@MedicalScitech

🔝5 Concerns about #SARSCoV2 #Biology: A Call to Pause, Deliberate, and Revise Policy─This review is intended both as a basic resource and to initiate an open and critical dialog about SARS-CoV-2 biology for an independent and public call to action. jjcouey.medium.com/5-concerns-abo…

Structural basis of ribosomal #frameshifting during translation of the #SARSCoV2 #RNA #genome
» doi.org/10.1126/scienc…
A unique feature of the SARS-CoV-2 genome controls protein synthesis and presents an "Achilles heel" of the virus.

Brainstem neuropathology in two cases of #COVID19: #SARSCoV2 trafficking between #brain and #lung
» doi.org/10.1007/s00415…
Neuropathologic evidence strongly suggests that the pathophysiology of COVID-19 related respiratory failure includes a neurogenic component.

Read 213 tweets

Medical Science and Technology #earlytreatments

@MedicalScitech

Reducing #COVID19 #Airborne #Transmission Risks on #PublicTransportation Buses
» doi.org/10.1101/2021.0…
Wearing of #facemasks reduced the overall particle count released into the bus by an average of 50%, the dispersion distance by several feet and #aerosol particles by 84.36%.

🔝#SARSCoV2 Infects Human Engineered Heart Tissues and Models COVID-19 Myocarditis
» doi.org/10.1016/j.jacb…
#COVID19 can kill heart muscle cells, interfere with contraction. Details of how #coronavirus infects #heart: models of tissue damage may help develop potential therapies.

High-content screening of coronavirus genes for innate immune suppression reveals enhanced potency of SARS-CoV-2 proteins
» doi.org/10.1101/2021.0…
196 protein products of seven coronaviruses: the genes encoded by #SARSCoV2 are generally more potent immune suppressors than others

Read 236 tweets

Medical Science and Technology #earlytreatments

@MedicalScitech

⚠️#Ocular #MRI Findings in Patients with Severe #COVID19: A Retrospective Multicenter Observational Study
» doi.org/10.1148/radiol…
All patients had nodules in the macular region, 8/9 (89%) had bilateral nodules, 2/9 (22%) had nodules outside the macular region. Screening needed.

⚠️🔝New-Onset #IgG #Autoantibodies in Hospitalized Patients with #COVID19
» doi.org/10.1101/2021.0…
An international team of researchers studying COVID-19 has made a startling and pivotal discovery: The virus appears to cause the body to make weapons to attack its own tissues.

⚠️🔝Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance
» academic.oup.com/eurheartj/adva…
Damage to the heart found in more than half of #COVID19 patients discharged from hospital who show raised levels of troponin.

Read 235 tweets

Willemijn Coene

@MinaCoen

1/12 👩🏼‍🔬 Nieuw onderzoek (preprint): "#Metformin use is associated with reduced mortality in a diverse population with COVID-19 and diabetes"

Is dit dan 'n middel tegen COVID-19? Het mag goed klinken maar ik denk 't niet 👇🏻

(CW ziekteangst, ongelijkheid)

medrxiv.org/content/10.110…

2/12 Achtergrond: type 2 diabetes mellitus (T2DM) is een vorm van suikerziekte waarbij het lichaam niet meer goed op insuline reageert (insulineresistentie).

Dit in tegenstelling tot type 1 (T1DM) waarbij het lichaam wel goed op insuline reageert maar het niet meer zelf maakt.

3/12 Om schadelijke gevolgen van een hoge bloedsuikerspiegel bij T2DM te voorkomen krijgen mensen medicatie om deze te verlagen. Metformine wordt veel gebruikt.

Het is een bijzonder middel: we weten niet zo heel goed hoe 't werkt.

Daarover later meer; eerst naar 't onderzoek.

Read 13 tweets

Lu Chen

@houndcl

(1/) An update of analysis of Dr. Raoult’s #hydroxychloroquine #azithromycin trial on 1061 patients.
mediterranee-infection.com/pre-prints-ihu/
(warning: it’ more like conspiracy theory)

(2/) Actually the preprints have two versions.

“Version 2”
mediterranee-infection.com/wp-content/upl…

Final version
mediterranee-infection.com/wp-content/upl…

There're minor changes in the final version compared to v2. Most are Ct values and HCQ serum concentrations. Other baseline characteristics are the same.

(3/) Another difference is the way that NEWS scores were presented.

Version 2. Mean-Sd-median-range.

Final version. Low-medium-high brackets.

Read 12 tweets

Shashikiran Umakanth, MD

@shashikiranu

Insulin is NOT a first choice medicine in type 2 diabetes mellitus (T2DM).

Exceptions:
- Short-term use in #T2DM:
(1) ketosis
(2) sepsis
(3) extremely high blood glucose
- Long-term use in #T2DM:
(4) secondary oral medication failure (also called ß-cell failure)
@sambit_dash

1.

https://twitter.com/sambit_dash/status/1187334173050068992

The guideline chart attached above is very clear - lifestyle modifications should be the first choice ± #metformin. Metformin is cheap.
I am least influenced by industry, and use long-term insulin in <5% T2DM, mostly for reason (4), usually after exhausting other options.

2.

Those <5% are at a secondary level care hospital, and not at primary care. In primary care, that number will be even lower.

For those who NEED, both biphasic insulin and glargine are available in @pmbjpbppi #JanAushadhi kendras too. Insulin is quite inexpensive there.

3.

Read 7 tweets

Discover and read the best of Twitter Threads about #metformin

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Discover and read the best of Twitter Threads about #metformin

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