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Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

Electrical impedance spectroscopy (EIS) has the capability to detect dysfunction of the skin barrier and to identify the differences in skin of children with atopic dermatitis (AD) versus those without, according to recent findings, suggesting EIS’s potential ability to predict future development of AD.

This new data resulted from a study which sought to assess the utilization of EIS as a tool to identify skin barrier dysfunction in children, given that it has previously been studied in mice models and among adult patients with AD.

This new research into the use of EIS in children was led by Mari Sasaki, from the University Children's Hospital Zürich in Switzerland. Sasaki and colleagues sought to explore the use in this particular age group as they could benefit most from such a noninvasive and quick examination method.

“Here, we aimed to assess whether EIS can be used to identify skin barrier dysfunction or the changes in skin in children who developed AD in the first 3 years of life using data from the CARE (Childhood AlleRgy, nutrition, and Environment) birth cohort study,” Sasaki and colleagues wrote.

The investigators utilized data which was drawn from the CARE (Childhood AlleRgy, nutrition, and Environment) birth cohort study, an ongoing prospective birth cohort study done in St. Gallen, Switzerland since 2016. The study sought to assess the link between early life exposures and the development of allergic diseases such as AD.

Newborns were recruited at the Cantonal Hospital of St. Gallen and monitored through physical examinations at 4 months, 1, 2, and 3 years old. They also used questionnaires which were administered to the subjects at several different intervals up to their reaching 3 years of age.

The study’s data was on information on allergic disease symptoms, environmental elements, and demographic information. The investigators’ study doctor was instructed to examine AD presence and its severity through the SCORAD index at the time of their physical examinations, and skin prick tests for specific allergens were done as well.

The disease status of each of the subjects included in the data was decided upon by the research team through a combination of physical checkup findings and questionnaire responses, with the investigators maintaining a focus on diagnosis and on the onset of AD symptoms.

For children with the skin disease, their measurements were categorized by their investigators into active AD measurements, measurements taken prior to AD onset, non-active measurements, and measurements taken following the onset without active symptoms. EIS measurements were obtained by the investigators through the Nevisense EIS device, which determined electrical impedance at several different frequencies.

Each of the measurements included 220 data points, and they are taken on the ventral forearm where subjects’ skin is unaffected. The team’s EIS measurements began in April 2019, and the children who did not show earlier measurements or those who completed measurements up to 2 years old were still kept in the investigators’ analysis if they were shown to have clear AD status.

The investigators differentiated between control measurements with no AD and those with active AD measurements by developing a machine learning algorithm using the EIS measurements and subjects’ AD status as the input. A distinct algorithm—the EIS/AD score—was created to distinguish between measurements taken at 4 months and those at 3 years old, with the overall goal of assessing the impact of subject age on EIS using a parallel approach.

Using the childrens’ EIS/AD scores, the investigators found that the EIS algorithm effectively distinguished between subjects having ‘normal’ skin and having unaffected skin that still had active AD, with an area under the curve of 0.92 (95% CI, 0.85 - 0.99). Additionally, the team found that the algorithm identified disparities between skin deemed as healthy and skin affected by AD in situations where the subject did not have active symptoms of the disease.

Notably, the investigators found no apparent link between the EIS/AD score and the severity of the skin disease or the existence of sensitization to the allergens they had tested in their research. Additionally, they noted that the algorithm's performance was shown to have been consistent across each of the age ranges.

“In conclusion, we were able to show that EIS can detect skin barrier dysfunction in children with AD, including when they did not have active symptoms,” they wrote. “Whether EIS can be used as a predictor of AD development, by itself or in combination with other known genetic or environmental risk factors is an interesting topic of future research.”

Sasaki, M, Sundberg, M, Frei, R, et al. Electrical impedance spectroscopy detects skin barrier dysfunction in childhood atopic dermatitis. Allergy. 2023; 00: 1-11. doi:10.1111/all.15895.

Rinaldi AO, Morita H, Wawrzyniak P, et al. Direct assessment of skin epithelial barrier by electrical impedance spectroscopy. Allergy. 2019; 74(10): 1934-1944.

Rinaldi AO, Korsfeldt A, Ward S, et al. Electrical impedance spectroscopy for the characterization of skin barrier in atopic dermatitis. Allergy. 2021; 76(10): 3066-3079.

Articles

This new data resulted from the first study that found EIS could detect skin barrier dysfunction among children found to have developed atopic dermatitis early on in life.


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Electrical Impedance Spectroscopy Effective in Differentiating Eczema Versus Healthy Skin in Children

The US Food and Drug Administration (FDA) has approved tocilizumab-bavi (TOFIDENCE) a 

 option referencing ACTMRA, for the treatment of moderately to severely active rheumatoid arthritis (RA), polyarticular juvenile idiopathic arthritis (PJIA), and systemic juvenile idiopathic arthritis (JIA).

The new agent, from Biogen, is the first tocilizumab biosimilar approved for the US. In their statement announcing the approval, the company noted that autoimmune disease therapy spending has consistently increased by up to 25% annually over the last decade, per Association for Accessible Medicines data.

“The approval of TOFIDENCE in the US marks another positive step toward helping more people with chronic autoimmune conditions gain access to leading therapies,” Ian Henshaw, Global Head of Biosimilars at Biogen, said in the statement. “With the increasing numbers of approved biosimilars, we expect increased savings and sustainability for healthcare systems and an increase in physician choice and patient access to biologics.”

The tocilizumab reference biosimilar was approved on the basis of findings from a randomized, double-blind, single-dose, parallel phase 1 trial data comparing the pharmacokinetics, safety and immunogenicity to both US and EU reference tocilizumab across 3 patient arms.

Another randomized, double-blind, multiple-dose, 3-arm phase 3 trial assessed the reference biologic to tocizilumab’s equivalent efficacy and comparable safety, pharmacokinetic and immunogenetic profiles in patients with RA inadequately controlled by methotrexate. Biogen reported that the totality of clinical and analytic evidence supported the reference biosimilar’s equivalence to tocizilumab.

The intravenous formulation is indicated for adult patients with moderately to severely active RA who had an inadequate response to ≥1 disease-modifying antirheumatic drug (DMARDs); patients ≥2 years old with active PJIA; and patients ≥2 years old with active systemic JIA.

Biogen. FDA Approves Biogen’s TOFIDENCE™ (tocilizumab-bavi), a Biosimilar Referencing ACTEMRA®. Press release. Published September 29, 2023. https://investors.biogen.com/news-releases/news-release-details/fda-approves-biogens-tofidencetm-tocilizumab-bavi-biosimilar

Association for Accessible Medicines. The U.S. Generic & Biosimilars Medicines Savings Report, September 2022. https://accessiblemeds.org/sites/default/files/2022-09/AAM-2022-Generic-Biosimilar-Medicines-Savings-Report.pdf Accessed August 2023.

The indication for the intravenous formulation is for adults with RA, as well as adults and children with either active PJIA or systemic JIA.

Biosimilars

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FDA Approves First Tocilizumab Biosimilar for US Arthritis Patients

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A new investigation identified nearly 30% of adult patients in a real-world cohort with 

 had poor disease control, with demographic and comorbid risk factors including male gender, congestive heart failure, and Malay ethnicity.

The investigative team from SingHealth Polyclinics, led by Prawira Oka, MD, highlighted the low allopurinol prescription rates and suboptimal dosing regimen as of particular concern for patients with poorly controlled gout.

“Overall, the low allopurinol prescription rates and suboptimal dosing in patients with poorly-controlled gout are of concern,” wrote Oka and colleagues. “Primary care physicians need to optimize urate-lowering therapy for their patients to regain and sustain gout control.”

Gout is associated with significant morbidity and mortality, but disease control remains suboptimal globally.

 Achieving serum uric acid targets is understood to reduce the frequency of acute gout attacks, but a large percentage of patients have not attained these targets. But, gout control, or lack thereof, has been associated with both modifiable and non-modifiable risk factors.

Demographic and clinical risk factors are factors that can influence gout control, as male gender is associated with the disease, and chronic kidney disease and congestive heart associated with an increased risk. Improved recognition of these epidemiological factors associated with gout could lead to the increased identification of at-risk patients and the development of targeted interventions for those with poor disease control.

Oka and colleagues analyzed both the prevalence of poor gout control and the associated demographic and clinical risk factors among urbanized community-dwelling adults in primary healthcare clinics in Singapore.

 The retrospective analysis extracted data from the electronic health records of patients with clinician-diagnosed gout and ≥2 visits to the clinics between January 2018 and December 2019.

​​The extracted data included socio-demographic factors, anthropological measurements, comorbidities, serum uric acid levels, and medication prescriptions. Socio-demographic factors included gender, age, ethnicity, smoking, and medical subsidy status. Associated comorbid conditions including congestive heart failure, CKD, diabetes, hyperlipidemia, hypertension, and ischemic heart disease were also collected.

A patient was considered to have poorly controlled gout if they suffered two or more gout attacks within a year period. An attack was defined as a clinic visit with an electronic medical record diagnosis of “gout” and a colchicine prescription not prescribed as prophylaxis or standby.

A total of 7,970 patients with gout, corresponding to 24,624 clinic visits between 2018 and 2019, were included in the analysis. Most patients were male (83.6%) and Chinese (76.8%) and had a mean age of 61.7 years.

Upon analysis, investigators found 28.2% (n = 2,244) of patients had poorly controlled gout. Of the population with poorly controlled disease, only 46.3% of patients (n = 1039) were prescribed allopurinol, with 13.4% (n = 301) taking doses ≥300mg.

After logistic regression, the analysis showed the factors associated with poor gout control were male gender (adjusted odds ratio [aOR], 1.66; 

 = .007), congestive heart failure (aOR, 1.64; 

 = .037). In addition, those prescribed allopurinol (aOR, 1.52; 

 <.001), non-steroidal anti-inflammatory drugs (aOR, 2.76; 

 <.001), and corticosteroids (aOR, 2.83; 

 <.001) were more likely to have poorly controlled gout.

Oka and colleagues noted the low allopurinol prescription observed in the study is likely due to therapeutic inertia from both physicians and patients with gout, who may be concerned about the risk of allopurinol-induced severe cutaneous adverse reactions.

“Concerningly, allopurinol was only prescribed in approximately half of patients with poorly-controlled gout, placing these patients at increased morbidity and mortality risks,” investigators wrote.

Oka P, Chong WM, Ng DX, Aau WK, Tan NC. Epidemiology and risk factors associated with gout control among adult Asians: a real-world retrospective cohort study. Front Med (Lausanne). 2023;10:1253839. Published 2023 Sep 7. doi:10.3389/fmed.2023.1253839

Dehlin, M., Jacobsson, L. & Roddy, E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. 

, 380–390 (2020). https://doi.org/10.1038/s41584-020-0441-1

Low allopurinol prescription rates and suboptimal dosing are of particular concern in adult patients in Asia with poorly controlled gout. 

Gout

On the HCPLive gout page, resources on the topics of medical news and expert insight into gouty arthritis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on gout, and more.

Real-World Study Reveals Poor Disease Control in Adults with Gout 

Laundry detergents—specifically their sodium dodecyl sulfate (SDS) component—impact the epidermal barrier of both living human skin and ex vivo skin, according to recent findings, and consistent exposure to detergents could disrupt the skin's protective barrier and affect the emergence of 

These findings were observed in a new study conducted following a rising tide of research showing an epidemiological link between domestic and professional cleaning agents such as detergents, with studies often highlighting increases in prevalence of rhinitis, asthma, and allergic contact dermatitis.

Led by Arturo O. Rinaldi from the Swiss Institute of Allergy and Asthma

Research reveals that sodium dodecyl sulfate (SDS) in laundry detergents can potentially contributing to the development of atopic conditions.

Conducted on mice and ex vivo human skin, demonstrates exposure to common household laundry detergents reduces skin barrier integrity, with a marked decrease in electric impedance and increased transepidermal water loss.

Indicated that changes in gene expression and protein levels related to skin barrier function.

Highlighted the need for further investigation into the long-term effects of detergents on the skin, especially in those with skin disturbances.

This new research into the components of detergent and their effects on the skin’s barrier was led by Arturo O. Rinaldi, from the Swiss Institute of Allergy and Asthma Research (SIAF) at University of Zürich in Davos, Switzerland.

“The present study aims to evaluate the in vivo effects of household laundry detergents on skin barrier integrity, even used at low concentration,” Rinaldi and colleagues wrote. “We treated mouse skin with different dilutions of two household laundry detergents…”

The study’s investigators bought C57BL/6 mice from Charles River in Germany, keeping them in a specific-pathogen-free area within the AO Research Institute in Davos. The team utilized these mice for experiments when they were 8 - 12 weeks of age.

After removing the hair from their back skin with an epilation cream, the investigators gave the mice an incubation period of 3 days and, subsequently, the mice were subjected to the application of 2 common household laundry detergents, denoted as detergents A and B.

These 2 detergents were applied by the research team with a skin patch and were administered at varying dilutions (1:100, 1:1000, and 1:10,000 with phosphate-buffered saline [PBS]) for a total duration of 4 hours. In the initial experiments, the team assessed various time intervals, ultimately deciding that the most suitable time frame for the investigation was 4 hours.

As a control and for the purpose of dilution, PBS was used in the investigators’ research. After the specified time intervals, the mice in the experiment were humanely euthanized, and samples of the treated skin were meticulously gathered. Ex vivo human skin samples were acquired by the team through purchase.

Human skin samples were obtained from individuals who had undergone abdominoplasty procedures and had provided written informed consent, and the investigators noted that the donors had no history of dermatological conditions, allergies, or corticosteroids.

The adult skin explants used by the research team originated from 2 female donors—aged 32, 37, and 57 years—all of whom were shown to be in good health. Each sample consisted of naturally obtained 15mm diameter circular skin biopsies, and these were encased by the team in custom-built plastic inserts.

Following their 4-hour exposure process with the detergents, the investigators evaluated the skin's barrier function through electric impedance spectroscopy (EIS) and measurements of transepidermal water loss (TEWL). The research team’s skin biopsy samples were given both RNA sequencing (RNA-seq) and targeted multiplex proteomics analyses. Furthermore, they noted that the impact of a 6-hour treatment with detergent and SDS on ex vivo human skin was examined.

The team noted in their conclusions that the detergent exposure led to a distinct reduction in EIS as well as an increase in TEWL versus untreated skin. In fact, EIS was shown to have a more heightened sensitivity to the treatment and it indicated a clear dose-response relationship.

The investigators’ RNA-seq analysis’s results indicated a reduction in the expression of several different genes known to be necessary for the skin's barrier integrity, including ones known to be responsible for tight junctions and adherens junction proteins. In contrast, the team reported an upregulation in the genes linked to lipid metabolic processes, keratinization, and differentiation of epidermal cells.

The research team’s proteomics analysis led to the conclusion that there was a general downregulation of proteins linked to cell adhesion, such as epithelial cell adhesion molecule and contactin-1. Meanwhile, proinflammatory proteins such as interleukin-1 beta and interleukin-6 were upregulated.

The investigators noted the importance of acknowledging that both SDS and detergents resulted in a major decrease in EIS values in the ex vivo human skin model.

“Overall, our data indicate that laundry detergents can impact the epidermis integrity and suggest further research to evaluate the long-term effect of detergents on the skin barrier, particularly in patients with skin disturbances,” they wrote.

Rinaldi, AO, Li, M, Barletta, E, et al. Household laundry detergents disrupt barrier integrity and induce inflammation in mouse and human skin. Allergy. 2023; 00: 1-13. doi:10.1111/all.15891.

Folletti I, Siracusa A, Paolocci G. Update on asthma and cleaning agents. Curr Opin Allergy Clin Immunol. 2017; 17(2): 90-95.

This new research into detergent’s impact on human skin barrier dysfunction may lead to investigation by public health authorities in the near future due to its implications.


Allergy

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Consistent Exposure to Laundry Detergent Shown to Contribute to Emergence of Atopic Conditions

The use of sodium-glucose cotransporter-2 (SGLT2) inhibitors was associated with a similar risk of fracture as incretin-based drugs among postmenopausal individuals with 

Analyses showed the risk of fractures was not increased with the use of SGLT2 inhibitors and remained consistent regardless of the incretin-based comparator drug, including dipeptidyl-peptidase 4 inhibitors (DPP4i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA).

“These findings indicate that SGLT2i has either similar or lower risks of fractures than incretin-based drugs even in a population at higher risk for fractures, providing reassurance to and helping health care professionals with their clinical decision-making,” wrote the investigative team, led by Ju-Young Shin, PhD, School of Pharmacy, Sungkyunkwan University.

A heightened risk of fractures in postmenopausal individuals with T2D has been linked to the interaction of elevated blood glucose levels and declining estrogen levels due to menopause. These potential fracture risks are important for clinicians to consider when choosing an optimal pharmacologic regimen for glycemic control in these patients.

 Recent meta-analyses of trials have reported no significant associations between SGLT2i and fracture risk.

However, Shin and colleagues noted, to their knowledge, that no observational studies have assessed the association between their use and fracture risk in postmenopausal individuals with T2D.

 Given this gap in data, Shin and colleagues conducted a nationwide, population-based cohort study to separately compare SGLT2 inhibitors with incretin-based drugs in 2 independent cohorts: SGLT2 inhibitors vs. DPP4i and SGLT2 vs. GLP-1 RA.

The analysis used health administrative claims data from January 2013 - December 2020 obtained from the National Health Insurance Service in South Korea. All female individuals in the database aged 45 years or older were included in the analysis. The index date was the date of the first prescription of either SGLT2 inhibitor or comparator incretin-based drug from September 2014 to December 2020.

Of eligible participants, the investigative team excluded those with severe kidney impairment within the year prior to the index date, to consider for contraindication to SGLT2 inhibitors. Patients were followed up from the index date until the earlier outcome occurrence, drug discontinuation (90-day grace period), switch, death, or end of the study period.

Investigators confirmed the primary outcomes for the analysis were overall fractures, consisting of vertebral, hip, humerus, and distal radius fractures. Secondary outcomes included the invisible components of the primary composite outcome.

A total of 369,570 patients were chosen for the first cohort: 37,532 patients initiating SGLT2 inhibitors (mean age, 60.6 years) and 332,039 patients initiating DPP4 inhibitors (mean age, 66.0 years). For the second cohort, a total of 121,803 patients were selected: 113,622 patients initiating SGLT2 inhibitors (mean age, 61.4 years) and 8181 patients initiating GLP-1 RA (mean age, 62.5 years).

Those in the second cohort showed a higher prevalence of diabetes-related conditions, insulin usage, and more diabetic medication use, suggesting a more severe diabetic profile. Propensity score weighting and trimming left 37,530 patients initiating SGLT2i and 332,004 patients initiating DPP4i in the first cohort, while the second cohort had 111,835 patients initiating SGLT2i and 8177 patients initiating GLP-1 RA.

Upon analysis, in the first cohort, users of SGLT2 inhibitors and DPP4i yielded a weighted incidence of 1.41 and 1.81 events per 100 person-years for the overall fractures, respectively. The data corresponded to a 22% lower rate of incident overall fractures with SGLT2 inhibitors versus DPP4i (weighted hazard ratio [HR], 0.78; 95% CI, 0.72 - 0.84).

Over a mean follow-up of 1.43 years and 0.82 years, the weighted incidence of overall fractures was 1.67 per 100 person-years for SGLT2 inhibitors and 1.92 per 100 person-years for GLP-1 RA. Overall, the analysis showed the use of SGLT2 inhibitors compared with GLP-1 RA was not associated with an increased risk of fractures (weighted HR, 0.92; 95% CI, 0.68 - 1.24).

Similar trends for the secondary outcome were identified across both study cohorts where SGLT2 inhibitors did not increase the risk of fractures, regardless of the comparator drug. Results from subgroup and sensitivity analyses were consistent with the findings in the main analysis.

Shin and colleagues noted that SGLT2 inhibitors potentially disrupt calcium and phosphate homeostasis in serum, which could lead to detrimental effects on bone fragility. Given the decreased levels of estrogen in postmenopausal women, this risk has the potential to be further exacerbated, but more research is required to confirm this mechanism.

“Despite such biological plausibility, our results found a modest potential protective effect of SGLT2 inhibitors against overall fractures, which may be explained by the role of SGLT2i in the trajectory of impaired bone metabolism caused by the accumulation of advanced glycation end products in bone collagen fibers in advanced diabetes,” investigators wrote.

Ko HY, Bea S, Jeong HE, et al. Sodium-Glucose Cotransporter 2 Inhibitors vs Incretin-Based Drugs and Risk of Fractures for Type 2 Diabetes. JAMA Netw Open. 2023;6(9):e2335797. doi:10.1001/jamanetworkopen.2023.35797

Khosla S﻿, Samakkarnthai P﻿, Monroe DG﻿, Farr JN﻿. Update on the pathogenesis and treatment of skeletal fragility in type 2 diabetes mellitus.

. 2021;17(11):685-697. doi:10.1038/s41574-021-00555-5PubMed

The use of SGLT2 inhibitors was associated with similar or lower risks of fractures as incretin-based drugs, even in the high-risk patient population.

Endocrinology

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Type 2 Diabetes

SGLT2 Inhibitors Did Not Increase Fracture Risk in Postmenopausal Patients with T2D

Patrick Campbell is the managing editor of HCPLive. Formerly the editorial lead of Endocrinology Network, Practical Cardiology, and Rheumatology Network, Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. He now helps to lead coverage in each of these respective areas for HCPLive. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA, and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

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Geriatrics

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Clinical Support Tool, Shared Decision-Making Can Reduce Hypoglycemia in Older Adults

When cognitively healthy older adults performed a road test when taking a medicine with adverse effects, 35% of participants received a marginal/fail rating.

Psychiatry

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Older Age Does Not Cause Car Accidents—Medication with Adverse Effects Do

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More than 90% of patients with CDI treated with WMT achieved clinical cure, while only 3.8% of WMTs resulted in adverse events.

Gastroenterology

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Washed Microbiota Transplantation Demonstrates Safety, Efficacy in Patients with C Diff 

Videos

An expert nurse practitioner comments on recent advances in the treatment of plaque psoriasis, as well as the continuous need for more treatment options.

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Recent Breakthroughs in Treatment of Plaque Psoriasis

Lauren Miller, MPAS, PA-C; and Jayme Heim, MSN, FNP-BC, discuss the role of advanced practice providers (APPs) within dermatology, highlighting the medical, surgical, and cosmetic categories in the space.

The Role of Advanced Practice Providers (APPs) in Dermatology

Podcasts

In this episode of MEDcast, the expert panelists examine some underutilized therapies in type 2 diabetes (T2D) and explore their potential as effective treatment choices for many patients.

Medcast Podcasts

Untapped Potentials: Exploring Overlooked Therapies for Type 2 Diabetes

A study from UCLA suggests a pharmacist-led intervention contributed to improved HbA1c in Hispanic adults with type 2 diabetes management, underlining its potential to enhance outcomes in underserved populations.

Internal Medicine

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Pharmacist-Led Interventions Can Improve HbA1c in Underserved Communities

Investigators believe their findings may help reduce the negative of self-stigma and subjective symptom reporting burdening patients with depression.

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EEG-Based Model Predicts Antidepressant Responses in Depression Patients

Results highlighted a growing number of incident cases of asthma, inflammatory bowel disease, multiple sclerosis, psoriasis, atopic dermatitis, and rheumatoid arthritis from 1990-2019.

Immune-Mediated Inflammatory Diseases Increase Despite Available Treatment

Most patients were able to achieve clear or almost clear skin, and improvement of arthritis and difficult-to-treat areas, with guselkumab and risankizumab treatment. 

Psoriatic Arthritis

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Latest News

Electrical Impedance Spectroscopy Effective in Differentiating Eczema Versus Healthy Skin in Children

FDA Approves First Tocilizumab Biosimilar for US Arthritis Patients

Real-World Study Reveals Poor Disease Control in Adults with Gout

Consistent Exposure to Laundry Detergent Shown to Contribute to Emergence of Atopic Conditions

SGLT2 Inhibitors Did Not Increase Fracture Risk in Postmenopausal Patients with T2D