Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by hyperglycemia. While lifestyle modifications and oral medications are initial treatments, many patients require injectable therapies like insulin and incretin-based drugs. Insulin therapy, a cornerstone treatment for T2DM, can effectively control blood sugar but is associated with hypoglycemia and weight gain. Incretin-based therapies, such as glucagon-like peptide-1 (GLP-1) receptor agonists offer improved glycemic control, weight loss, and reduced cardiovascular risk. Recent studies have shown the superiority of incretin-based therapies over basal insulin. Among these, GLP-1/GIP (glucose-dependent insulinotropic polypeptide) receptor dual agonists like tirzepatide have demonstrated significant weight loss and improved glycemic control. Selection of injectable therapy should be individualized based on factors like glycemic goals, cardiovascular risk, hypoglycemia risk, and patient preference. While insulin remains a useful option, incretin-based therapies, especially newer agents, offer promising therapeutic benefits for many patients with T2DM.

Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by hyperglycemia. While lifestyle modifications and oral medications are initial treatments, many patients require injectable therapies like insulin and incretin-based drugs. Insulin therapy, a cornerstone treatment for T2DM, can effectively control blood sugar but is associated with hypoglycemia and weight gain. Incretin-based therapies, such as glucagon-like peptide-1 (GLP-1) receptor agonists offer improved glycemic control, weight loss, and reduced cardiovascular risk. Recent studies have shown the superiority of incretin-based therapies over basal insulin. Among these, GLP-1/GIP (glucose-dependent insulinotropic polypeptide) receptor dual agonists like tirzepatide have demonstrated significant weight loss and improved glycemic control. Selection of injectable therapy should be individualized based on factors like glycemic goals, cardiovascular risk, hypoglycemia risk, and patient preference. While insulin remains a useful option, incretin-based therapies, especially newer agents, offer promising therapeutic benefits for many patients with T2DM.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Background: The oxygen reserve index (ORi) noninvasively measures oxygen levels within the mild hyperoxia range. To evaluate whether a degree of increase in the ORi during preoxygenation for general anesthesia is associated with the occurrence of postoperative pulmonary complications (PPCs). Methods: We enrolled 154 patients who underwent preoperative pulmonary function tests and were scheduled for elective surgery under general anesthesia. We aimed to measure the increase in ORi during preoxygenation before general anesthesia and analyze its association with PPCs. Results: PPCs occurred in 76 (49%) participants. Multivariate logistic regression analysis revealed that the three-minute preoxygenation ORi was significantly associated with PPCs (Odds ratio [OR]: 0.02, 95% CI [0.00–0.16], P < 0.001). The areas under the curve (AUC [95% CI]) in the receiver operating characteristic curve analysis for the three-minute preoxygenation ORi for PPCs were 0.64 (0.55–0.73). After a subgroup analysis, multivariate logistic regression showed that the three-minute preoxygenation ORi was significantly associated with PPCs among patients who underwent thoracic surgery (OR: 0.01, 95% CI [0.00–0.19], P = 0.006). The AUC of the three-minute preoxygenation ORi for PPCs was 0.72 (0.57–0.86) in patients who underwent thoracic surgery. Conclusions A low ORi measured after 3 min of preoxygenation for general anesthesia was associated with an increased risk of PPCs, including those undergoing thoracic surgery. This study demonstrated the potential of ORi, measured after oxygen administration, as a tool for evaluating lung function that complements traditional lung function tests and scoring systems.

Purpose: This study aimed to evaluate long-term treatment outcomes in patients with localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma treated with radiotherapy (RT). Materials and Methods: A total of 229 patients who received RT in 10 tertiary hospitals between 2010 and 2019 were included in this multicenter analysis. Response after RT was based on esophagogastroduodenoscopy after RT. Locoregional relapse-free survival (LRFS) and disease-free survival (DFS), and overall survival (OS) were evaluated. Results: After a median follow-up time of 93.2 months, 5-year LRFS, DFS, and OS rates were 92.8%, 90.4%, and 96.1%, respectively. LRFS, DFS, and OS rates at 10 years were 90.3%, 87.7%, and 92.8%, respectively. Of 229 patients, 228 patients (99.6%) achieved complete remission after RT. Five-year LRFS was significantly lower in patients with stage IIE than in those with stage IE (77.4% vs. 94.2%, p=0.047). Patients with age ≥ 60 had significantly lower LRFS than patients with age < 60 (89.3% vs. 95.1%, p=0.003). In the multivariate analysis, old age (≥ 60 years) was a poor prognostic factor for LRFS (hazard ratio, 3.72; confidence interval, 1.38 to 10.03; p=0.009). Grade 2 or higher gastritis was reported in 69 patients (30.1%). Secondary malignancies including gastric adenocarcinoma, malignant lymphoma, lung cancer, breast cancer, and prostate cancer were observed in 11 patients (4.8%) after RT. Conclusion Patients treated with RT for localized gastric MALT lymphoma showed favorable 10-year outcomes. Radiation therapy is an effective treatment without an increased risk of secondary cancer. The toxicity for RT to the stomach is not high.

Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by hyperglycemia. While lifestyle modifications and oral medications are initial treatments, many patients require injectable therapies like insulin and incretin-based drugs. Insulin therapy, a cornerstone treatment for T2DM, can effectively control blood sugar but is associated with hypoglycemia and weight gain. Incretin-based therapies, such as glucagon-like peptide-1 (GLP-1) receptor agonists offer improved glycemic control, weight loss, and reduced cardiovascular risk. Recent studies have shown the superiority of incretin-based therapies over basal insulin. Among these, GLP-1/GIP (glucose-dependent insulinotropic polypeptide) receptor dual agonists like tirzepatide have demonstrated significant weight loss and improved glycemic control. Selection of injectable therapy should be individualized based on factors like glycemic goals, cardiovascular risk, hypoglycemia risk, and patient preference. While insulin remains a useful option, incretin-based therapies, especially newer agents, offer promising therapeutic benefits for many patients with T2DM.