Recent research has found a link between a high consumption of nutrient stripped white rice and the development of Type 2 diabetes. The research team made comments to the British Medical Journal, stating the link they found came about from analyzing four previously published studies carried out in China, Japan, Australia and the United States. The studies carried out in China and Japan found the people who ate the most rice had a 55 per cent chance of developing Type 2 diabetes compared to those who ate the least. The participants living in Japan and China typically ate three or four servings of rice a day on average, compared to just one or two servings a week in the Western countries. So when looking to make healthier choices as a Type 2 diabetic you are advised to opt for brown rice to help keep your blood sugar levels under control. Even if you live outside of Japan and China, it should be remembered if you consume, on average, the same amount of white rice as they do in those two countries, then your chances of developing Type 2 diabetes increase from 12 percent to a massive 55 per cent.
This entry was posted in Diet, Lifestyle, Obesity, Pre-Diabetes, Type 2 diabetes and tagged Beverleigh H Piepers RN, blood sugar, brown rice, diabetes, glycemic index, increase the risk of developing Type 2 diabetes, Type 2 diabetes, white rice on February 16, 2014 by Beverleigh H Piepers RN.
Gives me a guide to preventing diabetes“I liked the conversational way the author discusses this subject. Kategorie(n): Allgemein Keine KommentareHatte ich die Symptome schon fruher gekannt ware ich naturlich eher zum Arzt gegangen.
Der starke Durst und das haufige Wasserlassen ist dann erst 2 Wochen vor der Diagnose aufgetreten. Als ich meine Einkaufe nicht mehr die Stiegen hoch tragen konnte weil ich so schwach war bin ich ins Krankenhaus gefahren. On January 8, the FDA approved Farxiga (dapaglifozin) for the treatment of type 2 diabetes. In order to understand the long-term effects of Farxiga better, the FDA is requiring six long-term studies for the drug after it is put on the market, which includes a cardiovascular outcomes trial (CVOT), two bladder cancer risk studies, a pediatric study, and a program that will monitor other side effects.
As we begin 2014, it seems appropriate to step back for a moment and reflect on the past year in diabetes. Moving onto the bud, I’m not sure I’ve seen anything in my decade of writing about diabetes research that has more potential than the artificial pancreas. On July 25, Bristol-Myers Squibb (BMS) and AstraZeneca (AZ) announced the resubmission of Forxiga (dapagliflozin), their SGLT-2 inhibitor for type 2 diabetes, to the FDA. The new SGLT-2 inhibitor class of type 2 drugs works by causing users to excrete excess glucose through their urine. One key therapy study was of dapagliflozin, an SGLT-2 inhibitor from Bristol-Myers Squibb and AstraZeneca. On the technology side of ADA, there were two major studies that examined the Medtronic Veo with low glucose suspend.
An accurate continuous glucose monitor (CGM) is one of the key building blocks of an artificial pancreas, and many have said that it is one of the biggest barriers to such a system gaining FDA approval. A CGM’s accuracy is measured by its mean absolute relative difference (MARD) from reference blood glucose levels, and a lower value means the sensor is more accurate. This year’s ADA marked a major anniversary, as the Diabetes Control and Complications Trial (DCCT) turned 30 years old. One unexpected negative finding in the latest EDIC data is a previously under-recognized diabetes complication. Earlier this month, an FDA advisory panel voted 10 to 5 in favor of approving a new treatment for type 2 diabetes called canagliflozin, which will likely be sold under the brand name Invokana.
Phlorizin was indeed found to improve glycemic control in diabetic animals, but a key factor precluding its use in humans concerned dosage: since the vast majority of phlorizin is converted to another compound in the gut before it can be of any use, massive doses are required to see any glucose-lowering benefit. As is not uncommon for new drug classes, the initial development of SGLT-2 inhibitors saw multiple early candidates discontinued due to safety issues. One of the most basic biological factors driving the diabetes and obesity epidemics is that our bodies have evolved to never waste food and energy.
In people without diabetes, there is a certain threshold at which glucose levels in the bloodstream are so high that the body begins to expel glucose in the urine – this level is determined by the number of SGLT-2 proteins (when too much glucose filters through the kidneys, there are not enough available SGLT-2s to bring glucose back to the blood, and glucose spills into the urine). SGLT-2 inhibitors work by preventing the reabsorption of glucose in the kidneys, and by reversing the fine-tuned biological process for storing energy. As with many therapies however, the benefits of SGLT-2 inhibitors are tempered by side effects. There are two main ways in which SGLT-2 inhibitors like Invokana can become part of the type 2 diabetes treatment paradigm: as a first-line treatment or as part of a combination therapy. We mainly expect Invokana and future SGLT-2 inhibitors to be used as part of a combination type 2 diabetes therapy, either as a second- or third-line therapy.
In the early going, we believe physicians will tend to consider SGLT-2 inhibitors only after more established treatment options prove unsuccessful. While SGLT-2 inhibitors have an uncertain place in the already crowded field of type 2 medications, 2013 should still be a big year for the class. In terms of SGLT-2 inhibitors and type 1 diabetes, it should be stressed that the FDA is currently only considering Invokana’s potential as a treatment for type 2 diabetes. Also known as chronic renal disease, chronic kidney disease (CKD) occurs when the kidneys are unable to properly filter all the fluids that pass through them. Diabetes is the primary cause of chronic kidney disease, accounting for 38% of all CKD cases in the United States in 2012. The majority of CKD cases involve damage to the kidney’s blood vessels, although there are several possible underlying causes for the progressive loss of renal function.
The early phases of chronic kidney disease often do not present any noticeable symptoms – this makes blood tests that can calculate GFR and thus kidney function extremely important, as they are one of the only ways to detect CKD. On November 14, the European Commission approved AstraZeneca and Bristol-Myers Squibb’s Forxiga (dapagliflozin) for type 2 diabetes throughout the European Union.
Forxiga is a once-daily pill and can be taken either alone or in conjunction with other type 2 diabetes medications. Forxiga’s most common side effect is urinary and genital tract infections, which should be relatively easy to treat should they occur. The new year could see the approval of multiple new SGLT-2 inhibitors in both the United States and Europe. Irisin induces browning of white adipose tissues in vivo and protects against diet-induced obesity and diabetes.
Figure 6: Irisin induces browning of white adipose tissues in vivo and protects against diet-induced obesity and diabetes. You can use these free cliparts for your documents, web sites, art projects or presentations.Don't forget to link to this page for attribution! All together these particular studies followed 350,000 people over a timescale of 4 to 22 years and, at the end of these studies, more than 13,000 of the participants went onto develop full-blown Type 2 diabetes. Whereas, when the researchers looked at the US and Australian studies where consumption of white rice is far lower, the difference was a 12 percent chance of developing the disease compared to those who also ate the least.
Brown rice is less processed than white rice and has a lower glycemic index measurement – 44 compared to 72 for short-grain white rice.
I have struggled with this health issue for a few years and have only followed what my GP told me. Leider werden sie aber nicht haufig genug gezeigt und vor allem unter jungen Leuten nicht besprochen.
Until the long-term effects of Farxiga are well established, Farxiga is not recommended for patients with active bladder cancer or with moderate to severe kidney impairment.
In December 2013, the Advisory Committee (a panel of experts that provides recommendations to the FDA on the safety and effectiveness of new therapies) reviewed the data and decided that these concerns did not appear to be serious enough to keep the drug from reaching the American public, and voted an overwhelming 13-1 in favor of approving Farxiga. Merlin Thomas (Baker IDI, Melbourne, Australia) on using fixed-dose combinations for diabetes at the World Diabetes Congress in Melbourne, Australia on December 2-6.
Lars Ryden (Karolinska Institute, Stockholm, Sweden) on sending patients the right messages about insulin therapy at the  World Diabetes Congress.
Hamilton Moses III (Alerion Institute) in his author interview at JAMA about the paper “The Anatomy of Health Care in the United States”.
Abraham Thomas (Henry Ford Hospital, Detroit) on how regulation should not slow down drug development at the FDA Advisory Committee on Forxiga (dapagliflozin) on December 12.
I like to use a game called “Rose, Bud, Thorn” to think of one big trend that was positive (the rose), one that has potential (the bud), and one that remains a problem (the thorn).
No advance was more exciting this year than the progress made on SGLT-2 inhibitors for type 2 diabetes. Frankly, it’s hard not to be pessimistic about the current state of diabetes care in the big picture, due to giant challenges in reimbursement and access. The current state of reimbursement is a problem that we have to solve, and when I say “we,” I really do mean the entire diabetes community.
Last month at ADA, researchers shared results from a 14-day trial of dapagliflozin in type 1 patients.


As a reminder, this type 2 diabetes drug class causes patients to excrete excess blood glucose through their urine. There is generally some increased risk of urinary tract and genital infections, though these are usually successfully treated and caused few participants to leave clinical trials – many experts believe these are not a major concern and we certainly believe they should be more manageable than many other side effects like weight gain, nausea, etc. In the US, the pump is called the MiniMed 530G and is still under FDA review (the latest timeline calls for approval before the end of 2013). Trang Ly (Princess Margaret Hospital, Perth, Australia) presented results from a six-month study that compared using the Veo pump (with CGM, with low glucose suspend) to a pump alone (no CGM, no low glucose suspend) in people who are hypoglycemia unaware.
Richard Bergenstal presented the much-awaited Automation to Simulate Pancreatic Insulin Response (ASPIRE) trial, which used the MiniMed 530G. Of these three CGMs, Dexcom’s G4 Platinum was the most accurate sensor, with a MARD of 10.8%. Cheiroarthropathy, popularly known as frozen shoulder, involves the progressive stiffening of tissues around joints, also leading to carpal tunnel syndrome or trigger fingers. We will report on this as soon as possible – as we understand it, now that there have been 50 deaths, the data on mortality can be unveiled.
This drug was developed by Johnson & Johnson (the maker of LifeScan blood glucose strips and Animas pumps) and belongs to a new type (class) of diabetes drugs called sodium-glucose linked transporter-2 (SGLT-2) inhibitors. In 1835, French chemists first isolated a substance known as phlorizin from the bark of apple trees, and in 1886, German physician and early diabetes pioneer Joseph von Mering demonstrated that the ingestion of high doses of phlorizin caused people to expel glucose in their urine (glucosuria). Forxiga and Invokana are now set to be the first of their class to reach the European and US markets, respectively. For most species, including our hunter-gatherer ancestors who could never be entirely sure where their next meal would come from, such aggressive conservation of energy made perfect sense.
Interestingly, in people with diabetes, the threshold is actually higher because diabetes patients have excess SGLT-2 proteins, meaning that a greater amount of glucose can be reabsorbed before glucosuria occurs (this of course exacerbates hyperglycemia). SGLT-2 inhibitors cause glucosuria, but this is because the inhibitors decrease the number of available SGLT-2, and thereby lower the threshold for glucose excretion. Some potential negative side effects include genital and urinary tract infections and decreases in bone density, though none of these were sources of significant concern for the FDA’s advisory committee.
In isolation, SGLT-2 inhibitors would seem to have considerable potential as a first-line therapy, but the class looks less impressive when compared to other treatment options, particularly metformin.
An SGLT-2 inhibitor in conjunction with a DPP-4 inhibitor could be a strong pairing for those who cannot tolerate metformin, although the cost of both medications could well prove prohibitive for many.
Whether a person can benefit from SGLT-2 inhibitors will also heavily depend on the state of his or her kidney – the FDA will likely disallow the drug’s use in patients with impaired kidney function, with the precise cutoff to be determined at the time of approval. Invokana’s approval by the FDA isn’t quite finalized, but there’s good reason to think it could come as early as this March, with a launch perhaps as soon as mid-year. J&J has informed us that an indication for the use of Invokana with type 1 is a long-term possibility, but they have not set a timeline for clinical trials, so this remains several years away. Their primary purpose is to filter waste products out of the blood and other bodily fluids.
CKD can present a wide variety of symptoms, with most being traced to the buildup of waste products in the blood that should have been excreted in urine. The other major cause of CKD is hypertension (25%), which itself is an extremely common complication of diabetes.
Indeed, this makes treating CKD complicated – while certain forms of CKD can be treated depending on the specific cause, there are no universally successful treatments known to slow down or reverse the loss of kidney function.
Forxiga is an SGLT-2 inhibitor, the first drug of its type to be approved for use anywhere in the world.
Regulatory agencies have also raised some concerns regarding a potential increased risk of bladder and breast cancer and potential damage to the liver. J&J has submitted Invokana (canagliflozin) to regulators in both regions with an eye toward approval in 2013.
Although it will be very interesting to see if any of the newer medications are “cardio-protective,” we continue to wonder about the value of CVOTs since they are so expensive to design and execute and the safety data is still not clear. Notably, the vote was a closer 10-4 on whether the drug met the FDA’s cardiovascular safety guidelines, which suggests that some panelists don’t see the guidance as necessary for having a drug approved.
It’s a bit formulaic, admittedly – it’s how my children are often asked to reflect on their day at school – but simplicity can be good when we’re trying to bring some clarity to an entire year’s worth of progress in diabetes research.
Ed Damiano’s system, “The Bionic Kids put the Artificial Pancreas Through the Rigors of Summer Camp”, and our artificial pancreas stories, which are already among diaTribe’s most widely read articles! The new emphasis on efficacy seems like it should be a good thing: it’s hard to argue with cheap, effective therapy and technology.
Advocates need to create effective arguments to be heard, and we need to present a unified front. The companies were asked by the FDA in January 2012 to provide additional data before approval would be considered in the US.
For more information on SGLT-2 inhibitors and how they work, see learning curve in diaTribe #51.
While there was originally concern about increased rates of bladder and breast cancer, there haven’t been any major pieces written yet by researchers on this front. As more studies report results in type 1 diabetes, a clearer view of the drug’s effects and optimal usage will emerge. As a reminder, this first step toward the artificial pancreas includes a “threshold suspend” feature.
In the six-month study, those using the Veo with low glucose suspend decreased their number of severe hypoglycemic events (seizure or coma) from six to zero, while those in the pump-only group saw an increase from five to six events. In ASPIRE, half the participants used the MiniMed 530G with low glucose suspend while the remaining half used a typical CGM and insulin pump system (no automated suspension). Steven Russell (Massachusetts General Hospital, MA) and his colleagues directly compare the accuracy of three CGMs: the Dexcom G4 Platinum, the Abbott FreeStyle Navigator (currently only available outside the US), and the Medtronic Enlite (currently only available outside the US, with FDA approval expected by the end of 2013 according to Medtronic).
Patients were randomized to either intensive glucose control or conventional therapy, were followed for an average of 6.5 years, and assessed for their risk of complications. It was found that two-thirds of DCCT participants showed signs of this condition and it wasn’t any better for those with tighter control – depressingly! The FDA could announce final approval for the drug as soon as this March, which would make Invokana the first member of the SGLT-2 inhibitor drug class to become available in the United States.
Of course, it would take over a century before researchers recognized the potential usefulness of a substance that induces glucosuria for the treatment of type 2 diabetes. Still, its underlying biological mechanism was sound, and so the history of the entire SGLT-2 inhibitor class has really been about the search for compounds capable of replicating phlorizin’s ability to induce glucosuria while sidestepping the massive dosing requirement and unpleasant side effects. But modern humans live in an era of plentiful food, where there’s far greater danger of eating too much rather than too little. SGLT-2 inhibitors reduce the threshold to below-normal levels and thus promote glucosuria at lower blood glucose concentrations. The infections most likely occur because fungi and bacterial cultures can grow more quickly in the sweeter, glucose-rich urine. Even in the roughly 20% of people with type 2 diabetes who cannot tolerate metformin, SGLT-2 inhibitors will likely have difficulty replacing DPP-4 inhibitors, which provide slightly lower reductions in A1c but have the benefits of fewer side effects, more long-term safety data, and potentially lower cost. Since impaired kidney function tends to worsen the longer one has type 2 diabetes, this may limit SGLT-2 inhibitors’ usefulness as a later-stage therapy. Forxiga should be available in Europe in the near future, and the FDA is expected to reconsider and announce a new decision for this drug in the middle of 2013. Like GLP-1 agonists and DPP-4 inhibitors, the SGLT-2 inhibitor class is thought to have some potential as a way for people with type 1 to reduce their A1c levels, stabilize their blood glucose levels, and potentially lower their insulin requirements.
Since CKD is a chronic condition, this decrease in kidney function is observed over months or years. CKD can ultimately result in kidney failure, which can only be treated with dialysis or a kidney transplant. These can all potentially slow down the loss of kidney function, especially when combined with the right medications. Since CKD involves a slowdown of the movement of filtered fluids through the kidney, GFR is the main measuring stick used to determine how well the kidneys are working.
Like other SGLT-2 inhibitors, Forxiga works by allowing excess glucose to escape the body through urine (see learning curve in diaTribe #24). Research suggests that the addition of an SGLT-2 inhibitor could potentially benefit patients on any kind of pre-existing treatment since its the way it works is distinct from that of other medications. These concerns ultimately led the FDA to deny dapagliflozin approval in the United States in January of this year (see new now next in diaTribe #39), although AstraZeneca and BMS have resubmitted dapagliflozin to the FDA with a new decision expected in mid-2013.
The FDA will hold an advisory committee meeting on January 10 to discuss Invokana (we’ll be there!), and a decision from the Agency is expected this coming March.
In this case, the CVOT is required after approval, which is a big positive – other drugs in development are often delayed because they require a CVOT pre-approval.


Having more options in diabetes treatment is essential – especially since only around half of patients are at their A1c goal – and the approval of Farxiga is positive news for the future of SGLT-2 inhibitors and other drugs in development.
This past year’s round of regulatory meetings have offered several opportunities to see new data on the efficacy and potential side effects of SGLT-2s, and the results have been encouraging. It’s still too early to know exactly how the major logistical challenges will be overcome, but the progress and level of funding support have been encouraging. The problem with this pricing pressure is that it leaves little room to encourage innovation.
It isn’t necessarily our job to completely fix the complex rules of reimbursement, nor do we have it in our power to do so, but we need to get better at communicating with one another and speaking with one voice. The resubmission means FDA must now decide whether to approve the new drug by January 14, 2014. Increased urinary tract and genital infections (see new now next in diaTribe #35) were also viewed as a risk, though manageable. Hypoglycemia appeared slightly higher in the group on dapagliflozin, though it’s still too early to quantify exactly how much higher, since four doses of dapagliflozin were tested. We are hopeful that all companies developing SGLT-2 inhibitors for type 2 diabetes will also pursue FDA approval of the drug class in type 1. The low glucose suspend group experienced a 32% reduction in nocturnal hypoglycemia events and a 38% reduction in the severity and duration of those events.
What was cool about this study was its design: every patient wore all three CGMs at the same time, meaning results could really be compared in a head-to-head-to-head fashion. Additionally, the G4 Platinum and the FreeStyle Navigator had fewer large errors (relative to the Enlite) that could impair a closed-loop system’s performance. As so many people remember, the study’s initial results in 1993 showed absolutely striking results – there were very significant reductions in eye, kidney, and nerve complications by as much as 76%. Frozen shoulder is quite common in the general population as people get older, and that fact may have obscured the link between the complication and diabetes in the past.
Meanwhile, a different SGLT-2 inhibitor, called Forxiga (dapagliflozin) from AstraZeneca and Bristol-Myers Squibb, has already been approved in Europe and is expected to reach the market there in the near future. SGLT-1 and SGLT-2 evolved to prevent the loss of seemingly vital sugar by transporting glucose from the kidney back into the body’s circulation, with SGLT-2 reabsorbing 90% of glucose in the kidney and SGLT-1 accounting for the final 10% in the kidney. Indeed, clinical trials for Invokana, Bristol Myers Squibb and AstraZeneca’s Forxiga, and other SGLT-2 candidates have all shown weight loss, which may be beneficial if patients are also trying to lose weight.
The excretion of glucose through the urinary tract is clearly linked with an increase in infection, but clinical data and key endocrinologists suggest that these infections have thus far generally proven easily treatable with medication. While there likely is a patient population for whom SGLT-2 inhibitors really are the best choice as a first-line therapy, identifying them would be a challenge for our current healthcare system – see this month’s letter from the editor for more thoughts on this tricky topic. Pfizer’s ertugliflozin and Eli Lilly and Boehringer Ingelheim’s empagliflozin are both currently in Phase 3 trials, setting them up for FDA approval perhaps as early as 2014 or 2015.
The kidneys also help maintain the optimal blood pressure and produce several vital hormones. The drug works in a glucose-dependent way, meaning more glucose will be excreted when blood sugar levels are higher.
AstraZeneca and BMS have yet to announce specifics regarding Forxiga’s cost, launch timeline, or reimbursement options in Europe.
The European Commission has also acknowledged these potential safety risks, but they judged that the potential benefits of Forxiga outweighed the risks and so recommended these concerns be assessed in post-approval clinical trials. Pfizer’s ertugliflozin and Eli Lilly and Boehringer Ingelheim’s empagliflozin are two other SGLT-2 inhibitors that are currently in phase 3 trials, although it’s not clear when the companies expect to submit these for approval. Urination of excess glucose also means losing some excess calories each day, and indeed, participants in clinical trials lost a few pounds on average and saw a small drop in blood pressure.
Invokana and Farxiga are once-daily oral drugs with, for most patients, manageable side effects, a low risk of hypoglycemia, and slight weight loss that make them appealing for patients.
More than anything else, wearing a device that automated (!) insulin delivery made me appreciate just how complex and elegant the body is.
The higher cost of drugs helps fund research and development and brings greater investment into the field. The pump has the most utility at night, when people often do not wake up to alarms and consequently, cannot treat their low blood glucose. Better still, there was no severe nocturnal hypoglycemia in the group using the Medtronic 530G, compared to four events in the control group.
While after the initial trial finished, the participants in both groups gravitated together and their glucose control became similar, the positive impact of tight glycemic control was absolutely clear. In this learning curve, we’ll explore how this new drug class reached this point, as well as what role it might play in diabetes care in the coming years. The true inconvenience of these infections will become clearer once people begin taking Invokana, especially once it becomes clear whether or not these infections are a persistent, recurring issue for users over a longer time period than has thus far been explored in clinical trials.
SGLT-2 inhibitors have been a long time in the making – almost 200 years – and they are definitely not a perfect, one-size-fits-all solution. In the near future, we could see exciting growth for the drug class as well as possible fixed-dose combinations. The sophistication that the pancreas needs to make the necessary micro-adjustments in insulin levels is mind-boggling. There’s no room left for innovation, and big companies may well start pulling out of R&D altogether if they can no longer justify the costs.
Every patient needs to be a patient advocate, because if we’re not going to stand up for ourselves, then who is? Looking to the future, we are especially interested in seeing SGLT-2 inhibitors combined with other glucose lowering medications in a single pill – these are known as fixed dose combinations. Even with the benefits on hypoglycemia, A1c did not change in those using the MiniMed 530G. The follow-up observational study, the Epidemiology of Diabetes Interventions and Complications (EDIC) has tracked participants for the last two decades to study how earlier tight control affects complications long-term. And while there isn’t yet the long-term data to assess this either way, it’s worth noting that chronic hyperglycemia often impairs the function of the body’s white blood cells, which are of course essential to fighting infection.
But for type 2 patients who have had little success lowering their blood glucose and A1c levels with existing medications, this new group of drugs might just be a reason for renewed optimism.
We look forward to learning much more about the advantages and optimal use of this drug class as it comes to market in the coming years. I also remain optimistic about the class’s potential for type 1 patients, much as I do for GLP-1 agonists like Victoza and Bydureon; we already know anecdotally from off-label GLP-1 use that these drugs can work for people with type 1, and anything that expands the breadth of options is a very good thing.
All of us try so hard to manage our insulin and keep our glucose levels on-target while avoiding dangerous highs and lows.
Earlier this year, BMS sold off its diabetes business, perhaps related to these very reasons. If we can all start living by that credo, then 2014 and beyond can be a time of limitless potential for us all.
It could be that in a decade, the notion of a single formulation pill may be only a memory. He said that calibration is still the “Achilles’ heel” of CGM technology, and that it will be a critical area to improve before a closed loop system can become available.
Based on the brand-new, long-term EDIC data, those who originally received intensive therapy continue to show striking benefits: a 50% reduced risk of impaired kidney function, nearly 60% reduced incidence of heart disease and stroke, and 50% less need for ocular surgery to deal with eye-related complications.
Long-term SGLT-2 inhibition might not only lower glucose levels, but also strengthen the body’s white blood cells, which in turn would be more able to fight off urinary tract infections in the long run. Certainly, patients should discuss these issues with their healthcare providers, but we know that they are really working for many people.
However, it was humbling to realize that even our best management is still the roughest approximation of what the pancreas – be it natural or artificial – can do.
Also, Lexicon, which we had been counting on for developing advanced compounds in diabetes, announced it will no longer pursue early stage “discovery” work.
Other potential side effects of SGLT-2 inhibitors tend to be more specific to particular drugs rather than the class a whole, such as the increase in breast and bladder cancer risk associated with Forxiga. All data in d–j were performed at least twice in a separate mouse cohort with similar results.



Glucose test diabetes results qld
Blood sugar be after eating


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