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Individuals with type 2 diabetes (T2D) are prone to developing dangerous blood clots, interfering with future treatments aimed at reducing cardiovascular risk. However, research from the Charles Perkins Centre at the University of Sydney, published in the Journal of Clinical Investigation, discovered a new biological pathway that explains this increased risk.^1,2

“[Individuals] living with type 2 diabetes are vulnerable to increased risk of blood clots,” Freda Passam, MD, PhD, FRACP, FRCPA, a professor from the Central Clinical School, said in a news release. “These exciting findings identify a whole new way to reduce this risk and help prevent life-threatening complications like heart attack and stroke.”²

Relationship Between Blood Clots and T2D

As cell fragments, platelets are the smallest component of the blood and essentially stop bleeding when an individual is injured. Platelets cluster together to form a plug when the blood vessel is damaged and then clot to stop the blood loss. Platelet hyperactivity refers to the tendency of platelets to become overactive and release their contents when stimulated. This condition is commonly observed in individuals with diabetes. The study authors noted that in Australia alone, where the study was conducted, around 1.2 million individuals were living with T2D as of 2021, and the condition is more common in Aboriginal and Torres Strait Islander individuals and in rural and regional populations.^1,3

“Cardiovascular disease [CVD] is a leading cause of death in this group, partly due to the heightened activity of platelets—the tiny blood cells that help form clots. This heightened platelet sensitivity to clotting also makes traditional anticoagulant treatments less effective in people with [T2D], limiting the options to reduce the risk of [CVD],” Passam said in the news release.²

SEC61B Targeting for Prevention

Researchers used a high-sensitivity proteomic platform to identify protein changes in platelets that may explain platelet hyperactivity among individuals with diabetes. The study authors compared platelets from individuals with diabetes and coronary artery disease to those from individuals with similar risk factors but without diabetes.¹

A total of 76 participants were included, 42 with T2D and 34 without, from 2020 and 2021. The researchers detected over 2400 intracellular proteins and found that platelets release proteins differently in individuals with T2D. They discovered increased SEC61B levels in platelets from both humans and mice with hyperglycemia, as well as megakaryocytes from hyperglycemic mice. This protein, SEC61B, is reported to disrupt calcium balance inside platelets, which causes them to clump together and clot.^1,2

The results demonstrated that SEC61B was significantly higher in platelets from individuals with high fructosamine, while other proteins like SEC61A and SEC61G were not different. To confirm this data, researchers studied another group of patients and found that SEC61B was low in healthy individuals but significantly increased in platelets from individuals with T2D.^1,2

The findings suggest that SEC61B causes calcium leakage in platelets, leading to increased platelet reactivity. Although treatments targeting SEC61B are still in development, the study authors noted that preclinical animal trials could begin within 1 to 2 years, with potential therapies for patients estimated in the next decade.^1,2

REFERENCES

1. Kong Y, Rehan R, Moreno C, et al. SEC61B regulates calcium flux and platelet hyperreactivity in diabetes. Journal of Clinical Investigation. 2025. doi: 10.1172/JCI184597

2. New discovery could lower heart attack and stroke risk for people with type 2 diabetes. EurekAlert! News release. August 15, 2025. Accessed August 20, 2025. https://www.eurekalert.org/news-releases/1094712

3. Cleveland Clinic. Platelets. News release. Updated August 26, 2024. Accessed August 20, 2025. https://my.clevelandclinic.org/health/body/22879-platelets

Skipping the use of a nasogastric (NG) tube after esophageal cancer surgery may not be as safe as the routine five-day decompression, according to results published in The Lancet Regional Health that suggest using the tube could lower the risk of anastomotic leaks.

Esophageal and gastroesophageal junction cancers are among the deadliest cancers worldwide, responsible for more than 500,000 deaths each year, according to the study’s authors. Surgical removal of the esophagus, or esophagectomy, remains the primary treatment option for patients with curable disease.

While this procedure increases the chance of long-term survival, it carries a high risk of serious complications. Pneumonia is the most common postoperative issue, but an anastomotic leak—when the surgical connection between the esophagus and stomach fails—is often the most dangerous.

To lower these risks, surgeons in many centers continue to use NG tubes after surgery. The tube drains and decompresses the stomach, with the goal of reducing pressure on the surgical joint, limiting the chance of leaks and preventing aspiration into the lungs.

At the same time, NG tubes are increasingly being questioned. They are one of the last areas in gastrointestinal surgery where routine use persists, even as other surgical fields have moved toward minimizing or eliminating them.

Additional studies have also raised questions on the use.

For instance, research published in the Journal of Thoracic Disease reported that routine NG decompression after gastrointestinal surgery did not significantly lower the risk of leaks or pulmonary complications. In addition, studies in gastric cancer surgery, including those cited in the International Surgery Journal, found that early removal of NG tubes can be safe and may help speed recovery.

Patient comfort has also emerged as an important factor.

A review in the World Journal of Gastroenterology noted that NG tubes are consistently associated with discomfort and can even raise the risk of respiratory problems. In addition, Enhanced Recovery After Surgery (ERAS) guidelines recommend avoiding routine NG tube placement after esophagectomy unless there is a specific clinical need.

However, many surgeons have been reluctant to abandon NG tubes without stronger evidence from randomized controlled trials (RCTs).

The new Lancet study aimed to fill that gap by providing high-quality data on the risks and benefits of omitting NG decompression after esophagectomy.

The trial was a multicenter RCT conducted at 12 university hospitals across Sweden, Norway, Denmark and Finland. Eligible patients were adults with resectable, or removable, esophageal or gastroesophageal junction cancer who were scheduled for surgery with a gastric tube.

After giving consent, patients were randomized 1:1 into two groups: immediate removal of the NG tube after surgery (intervention group) or routine NG decompression for five days (control group).

Randomization was grouped by sex, neoadjuvant therapy, anastomotic site and hospital. Surgeries were performed by experienced oncologic surgeons following local standards.

The primary outcome was the rate of anastomotic leaks. The secondary outcomes included complication severity, pneumonia, length of hospital stay, intensive care use and both 30- and 90-day mortality.

CT scans were also performed on day seven and were reviewed by blinded radiologists to ensure objective detection of leaks.

Between January 2022 and March 2024, 564 patients were screened, and 448 were enrolled in the trial. Out of these patients, 217 were assigned to immediate NG-tube removal and 231 to standard five-day decompression. Most participants were men (82%) with an average age of 67.5, and a majority had locally advanced disease.

Data revealed that 95 patients in the control group did not complete the full five days of decompression, often due to discomfort or accidental removal. In the intervention group, 9 patients required NG tube placement after surgery because of bloating or poor emptying.

Anastomotic leaks occurred in 83 patients. Rates were higher in the no-tube group (22.1%) compared with the NG-tube group (15.2%). This difference This difference meant the study could not prove that taking the tube out right away was just as safe. Most leaks were managed with endoscopic or interventional treatments, and survival outcomes remained similar between groups.

Serious complications occurred in about 42% of patients, and pneumonia was slightly more common in the no-tube group, though the difference was not statistically significant. Thirty- and 90-day mortality rates were low and comparable across both arms.

The trial’s strengths stand out for a number of reasons.

It was large and conducted across multiple centers, making the findings more relatable of real-world practice. Patient follow-up was also strong, and blinded radiologist review of CT scans strengthened the reliability of leak detection.

Additionally, the intervention was simple—NG tube or no NG tube—without altering other forms of care.

However, limitations exist.

A significant number of patients in the control group did not complete the full five-day NG tube protocol, potentially weakening the comparison. The study also did not address the optimal duration of NG tube use, leaving uncertainty about whether shorter decompression might be safe. The open-label design could have introduced bias, although the blinded imaging review helps mitigate this risk.

The authors of the study advise caution before changing clinical practice. While ERAS guidelines favor avoiding routine NG tube use, this trial suggests that immediate removal may increase the risk of leaks, even if other outcomes remain similar. Until more research clarifies the safest approach, the authors stated that routine NG tube decompression after esophagectomy should continue.