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Round Up Email March 2023

This month's Round Up highlights the CLEAR Outcomes Trial providing evidence of benefit for "statin intolerant" patients with high cardiovascular risk, SSRI withdrawal syndrome , continuous glucose monitoring (CGM) and antidepressants and female sexual dysfunction.

Question 1
Guillain-Barre Syndrome (GBS) – what is the lifetime risk of GBS? Is GBS more common in men or women? What is the mortality rate with GBS?: Guillain-Barre syndrome (GBS)
1) With respect to Guillain-Barre Syndrome (GBS), which statement is false?
- the incidence of GBS increases in incidence with age and there is a small predominance of females
- the most common subtypes are acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN)
- can cause severe muscle weakness, and death occurs in about 5% of patients
Question 2
SSRI withdrawal syndrome – which SSRI is most associated with SSRI withdrawal syndrome? How does a primary care clinician differentiate between SSRI withdrawal syndrome and relapse of the original mental health condition? What is the effect of recommencing the original SSRI and dose if SSRI withdrawal syndrome?: Discontination syndromes with SSRIs
2) With respect to SSRI withdrawal syndrome, which statement is false?
- characteristics of the discontinuation syndrome have been linked to the half-life of a given SSRI, with a greater number of reports emerging from paroxetine compared to other SSRIs
- the majority of antidepressant discontinuation reactions are of short duration, resolving spontaneously between 1 day and 3 weeks after onset
- among the SSRIs several prospective studies have show that paroxetine is associated with the highest incidence of discontinuation symptoms and sertraline the lowest
Question 3
antidepressants and female sexual dysfunction – what are the most reported adverse sexual effects in women taking antidepressants? What is the typical duration to onset of female sexual dysfunction symptoms after initiation of an antidepressant? Which antidepressant classes are more commonly associated with causing female sexual dysfunction?: Antidepressants and female sexual dysfunction
3) With respect to antidepressants and female dysfunction, which statement is false?
- sexual dysfunction is a common side effect of antidepressants, particularly of selective serotonin reuptake inhibitor (SSRIs) and serotonin norepinephrine reuptake inhibitor (SNRIs) medications
- onset of adverse sexual effects (across all phases) occurs within about 3 to 5 days of initiating a treatment regimen
- most commonly reported adverse sexual effects in women taking antidepressants are problems with sexual desire (72%) and sexual arousal (83%)
Question 4
Continuous glucose monitoring (CGM) – this section has been updated on GPnotebook.: Continuous glucose monitoring (CGM)
4) With respect to continuous glucose monitoring, which statement is false?
- use of isCGM has been associated with improvement in glucose control in both uncontrolled T2 and T1DM, and maintained for up to 24 weeks of using the device
- is no "lag time" between the plasma and interstitial fluid; therefore, interstitial glucose values correspond exactly to blood glucose concentration
- in well-controlled patients with T1DM, the use of isCGM reduced the time spent in hypoglycaemia by 38% at 6 months (intervention group) versus controls (SMBG)
Question 5
CLEAR Outcomes Trial – this trial is summarised and analysed on GPnotebook.: CLEAR Outcomes study - bempedoic acid and cardiovascular outcomes in statin intolerant patients
5) With respect to the CLEAR Outcomes Trial, which statement is false?
- showed benefit for the use of bempedoic acid in high risk cardiovascular patients
- the patient population in the CLEAR Outcomes Trial were "statin intolerant"
- the CLEAR Outcomes Trial revealed that less patients with bempedoic acid had "renal impairment" than those on placebo
Question 6
Low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes – this section has been updated on GPnotebook.: Low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes
6) With respect to low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes, which statement is false?
- patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences
- among people with T2D, greater adherence to LCD patterns that emphasize high-quality sources of macronutrients was significantly associated with lower total, cardiovascular, and cancer mortality
- VLCDs were more effective than less restrictive LCDs for weight loss at six months

Round Up Email March 2023

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6