thedasd82

Nicole Kidman vs. Lauren Sanchez is the perfect metaphor for 𝕏 You do your best to genuinely get some attention and then the big account enters the room 🤣

🧵 New 2026 NICE Update on Initial Drug Therapy in Type 2 Diabetes Detailed Thread 1️⃣ Big Shift in Philosophy This is no longer just about lowering HbA1c. The new guidance prioritises: • Cardiovascular protection • Renal protection • Individualised treatment • Early combination therapy Glucose control is important but outcomes matter more. 2️⃣ First-Line Therapy (No Major Comorbidities) For most adults: ✅ Modified-release metformin PLUS ✅ An SGLT-2 inhibitor If metformin cannot be used → start SGLT-2 inhibitor alone. ➡️ This is a major shift from traditional “metformin first, add later.” 3️⃣ Why SGLT-2 So Early? Because evidence now strongly supports: • Reduction in heart failure hospitalization • Slowing CKD progression • Cardiovascular mortality benefit • Weight reduction • Low hypoglycaemia risk This class is now foundational therapy. 4️⃣ If the Patient Has Heart Failure Start immediately: ✅ Metformin ✅ SGLT-2 inhibitor If metformin contraindicated → SGLT-2 alone. HF benefit drives this decision independent of HbA1c. 5️⃣ If Atherosclerotic CVD Is Present Initial therapy can include: ✅ Metformin ✅ SGLT-2 inhibitor ✅ Subcutaneous semaglutide (GLP-1 RA) If Yes 👉🏻 GLP-1 RA can now be started upfront in ASCVD. This reflects strong CV outcome trial data. 6️⃣ Early-Onset Type 2 Diabetes (Younger patients, aggressive phenotype) Start: ✅ Metformin ✅ SGLT-2 inhibitor Consider adding: • GLP-1 receptor agonist • Tirzepatide This group often needs earlier intensification. 7️⃣ Obesity + Type 2 Diabetes Initial therapy: ✅ Metformin ✅ SGLT-2 inhibitor Weight-neutral or weight-reducing strategies are preferred. Avoid agents that promote weight gain unless necessary. 8️⃣ Chronic Kidney Disease (CKD) Treatment depends on eGFR: 🔹 eGFR >30 → Metformin + SGLT-2 🔹 eGFR 20–30 → Dapagliflozin or Empagliflozin + DPP-4 inhibitor 🔹 eGFR <20 → Consider DPP-4 inhibitor If DPP-4 not suitable → consider pioglitazone or insulin. Renal protection is central in this update. 9️⃣ Frailty Be cautious. Offer: ✅ Metformin Consider SGLT-2 only if risk of: • Hypotension • Dehydration • Falls If risk is high → DPP-4 inhibitor may be safer. Individualisation is critical here. 🔟 What’s Clearly De-emphasised? Sulfonylureas are no longer early go-to drugs. Reasons: • Hypoglycaemia risk • Weight gain • No cardiovascular benefit They are now secondary options. 1️⃣1️⃣ Key Takeaway The 2026 update moves us from: “Glucose-centric diabetes care” ➡️ to “Cardio-renal-metabolic protection from day one.” Early combination therapy is now the norm, not the exception. 1️⃣2️⃣ Practical Clinical Message When starting treatment in Type 2 Diabetes, now ask: • Does this patient have HF? • ASCVD? • CKD? • Obesity? • Frailty? The comorbidity determines the drug choice not just HbA1c. nice.org.uk/guidance/ng28/… #MedTwitter #MedX

@VertigoWarrior @grok is it true?

6. This is how drainage water looks in Japan. 🇯🇵

Japan is a different world altogether 🇯🇵 Open the Thread and Be Amazed🧵 1. Unreal but true

Checotah, Oklahoma’s own Carrie Underwood demonstrated grace under pressure today and her incredible talent. Thank you for honoring our beautiful nation.

@mmamas1973 Hope to see you there, after 5 years

Great to be back in sunny Amsterdam for the #ESC2023 meeting with my vienna umbrella 😜 can't wait to see everyone

Retinoids are the ONLY 'miracle' skincare ingredient. They treat acne, pigmentation, scarring, fine lines/ wrinkles, and even have anti-cancer effect. But most people use them wrong, end up with irritated skin, and stop. Here's the RIGHT way to use them in your routine... 👇 1/

New Study Demonstrates How Inflammation🔥pulls LDL into the Artery Wall - 🧵 for the lay-reader (upon request) LDL particles play a role in the pathway of atherosclerosis. To do this, they must enter the artery wall by passing through the endothelium, a thin membrane that lines the walls of blood vessels But how? Do LDL particles just passively flow through the endothelium like grains of rice thrown at a chicken-wire fence? Well, the diameter of an LDL is on the order of 20-30 nm, whereas the gaps between endothelial cells is ~3-6nm... so, instead, LDL must be transported, actively, into the artery wall. Inflammation plays a role here. This new study shows that inflammatory transcriptional regulators and cytokines (signaling molecules) increase the expression of proteins involved in the formation of pockets of membrane,"caveole," that 'suck up' LDL particles. Specifically, the inflammatory cytokines include TNFalpha and IL-1Beta, which activate NLRP3 inflammasome, which causes increased expression of proteins that compose caveole and contribute to LDL transcytosis (active transport through the endothelium) Earlier studies also showed the elevated glucose promotes this transcytosis process In summary, inflammation and elevated glucose are 2 factors that cause LDL to be taken into artery walls and promote atherosclerosis. Questions that remain (for me) are: - what is the relative impact of high LDL alone is the ABSENCE of chronic pathological inflammation and/or elevated glucose? - what therapeutic approaches could prevent cardiovascular disease by targeting these pathways (by extension, what cardioprotective role might ketosis play via beta hydroxybutyrate, which inhibits NLRP3)? - what are other pathways involved in transcytosis (including the undiscovered and understudied), and might there be a more bidirectional and dynamic process, in the context of a healthy metabolism, than we previously thought? pubmed.ncbi.nlm.nih.gov/37100720/ pubmed.ncbi.nlm.nih.gov/36935311/

If you like this thread, please retweet the first tweet 😀 twitter.com/ATRightMovies/…

@MyOther50249040 Life can be cruel..

His mother asked me to go out somewhere with him... so happy... but i cant do that, coz i know he will feel awkward when go out with me. So I said "oh this is August, and the street will be so crowded. maybe next time mam.." so sad.. TT I really want to go out with him actually.

Lions fight while eating a water buffalo, then it casually walks off

@DoctorTro Would support low-carb diet as a cardiologist who treat a lot of patients with metabolic syndrome. Unfortunately, almost all refuse to comply.

@IAmSteveHarvey All I ask - by Adele

Songs you don't play at a wedding…

I started smoking cigarettes at age 12 and became a daily drinker at age 17 At age 58 I'm 20 years sober, an Ultramarathon runner and Ironman Triathlete You can reinvent yourself at anytime

Diagnosis? #CardioTwitter

@astriferdiana Wowww nice

@astriferdiana Granted brp hari? Multiple entries ga?

Got my UK visa ready in less than 4 weeks. Initially they said it would take 7 weeks. Thank God.

If Twitter dies, please remember: 1. Running isn’t bad for your knees 2. The best exercise = the one that gets done 3. Have fun 4. 45 min/day moderate intensity activity 5. Your easy runs can probably be easier 6. Lift something heavy 7. Emphasis on 3 & 4

After a shake out run, this morning, over the Fifth avenue and Central Park of New York. Behind was the stunning St Patrick Cathedral

See you tomorrow, runners. ❤️, The Verrazzano