From the Guidelines
PPG technology is a reliable and effective method for detecting atrial fibrillation (AF) in individuals without a known history of the disease, with a positive predictive value of 84% (95% CI 76–92%) as shown in the Apple Heart study 1. The use of PPG-enabled devices for AF detection has been studied in several trials, including the Apple Heart study, which enrolled 419,297 participants in the USA over 8 months 1. The study found that PPG technology could detect AF in individuals without a known history of the disease, with a positive predictive value of 84% (95% CI 76–92%) 1. Another study, the HUAWEI Heart study, conducted by the MAFA II investigators, assessed the use of a wristband or wristwatch with PPG technology to monitor pulse rhythm in 246,541 individuals and found a positive predictive value of 91.6% (95% CI 91.5–91.8%) 1. Some of the key benefits of using PPG technology for AF detection include:
- Non-invasive and relatively inexpensive method for continuous health monitoring
- Ability to detect arrhythmias, assess blood pressure trends, and evaluate peripheral circulation
- High positive predictive value for AF detection, as shown in the Apple Heart study and the HUAWEI Heart study 1 However, it's also important to consider the limitations of PPG technology, such as:
- Accuracy of PPG measurements can be affected by factors like skin pigmentation, ambient light, and movement
- Potential for false positives, which can lead to unnecessary treatment and psychological risks Overall, the evidence suggests that PPG technology is a valuable tool for detecting AF in individuals without a known history of the disease, and can be used to inform the design of future screening trials and the best target populations for such a strategy 1.
From the Research
Postprandial Glycemic Response
- Postprandial glycemic response is a crucial aspect of managing type 2 diabetes, as maintaining good glycemic control can prevent complications 2.
- Different strategies can be employed to improve glycemic control, including lifestyle interventions, which may be more effective than pharmaceutical interventions in lowering hyperglycemia 2.
- Nutritional strategies can be applied to attenuate postprandial hyperglycemia, such as reducing total carbohydrate intake, consuming carbohydrates with a lower glycemic index, and adding or substituting sweeteners and fibers 2, 3.
GLP-1 Receptor Agonists
- GLP-1 receptor agonists have been shown to be effective in reducing postprandial glucose levels and improving glycemic control in patients with type 2 diabetes 4, 5.
- These agents work by augmenting hyperglycemia-induced insulin secretion, suppressing glucagon secretion, and decelerating gastric emptying, which prevents large post-meal glycemic increments 5.
- GLP-1 receptor agonists are recommended as the preferred first injectable glucose-lowering therapy for type 2 diabetes, due to their effectiveness in reducing HbA1c levels and body weight, with minimal risk of hypoglycemic episodes 5.
Combination Therapy
- Combination therapy using premixed insulin, metformin, and a GLP-1 receptor agonist has been shown to be effective in improving glycemic control in patients with uncontrolled type 2 diabetes 6.
- This combination therapy can lead to significant reductions in A1C levels and cumulative daily insulin dose, with minimal changes in weight 6.
- Further research is needed to fully assess the potential benefits of this combination therapy, but it may offer a promising approach for managing type 2 diabetes 6.