Tag: Diabetes

Pfizer to discontinue twice-daily weight loss pill due to high rates of adverse side effects

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Pfizer on Friday said it would stop developing the twice-daily version of its experimental weight loss pill after obese patients taking the drug lost significant weight but had trouble tolerating the drug in a mid-stage clinical study.

The drugmaker observed high rates of adverse side effects, which were mostly mild and gastrointestinal, among patients. A significant share of patients also stopped taking the drug.

“At this time, twice-daily danuglipron formulation will not advance into Phase 3 studies,” the company said.

But Pfizer said it still plans to release phase two trial data on a once-a-day version of the drug in the first half of 2024, which will “inform a path forward.” The pharmaceutical giant will wait to see that data before deciding whether to start a phase three study on the once-daily pill, which Wall Street views as the more competitive form of the treatment.

Shares of Pfizer fell 4% in premarket trading Friday after it announced the trial results.

Still, the data on the twice-daily drug is a blow to Pfizer’s hopes to win a $10 billion slice of the booming weight loss drug market, which CEO Albert Bourla has said could grow to $90 billion. The company is betting on a successful weight loss pill to help it rebound from plummeting demand for its Covid products and a roughly 40% share price drop this year.

But investors have been pessimistic about Pfizer’s potential in the weight loss drug space since the company scrapped a different once-daily pill in June and proceeded with the less attractive danuglipron. Now, Friday’s data puts Pfizer even further behind the dominant players in the weight loss drug market, Eli Lilly and Novo Nordisk, which are racing to develop more convenient pill versions of their blockbuster weight loss and diabetes injections.

Pfizer’s phase two trial on its twice-daily pill followed around 600 obese adults who did not have Type 2 diabetes. The trial examined the drug’s effect on weight loss after 26 or 32 weeks, at different dosage amounts ranging from 40 milligrams to 200 milligrams.

Like Novo Nordisk’s Wegovy and Ozempic, Pfizer’s pill works by mimicking a hormone produced in the gut called GLP-1, which signals to the brain when a person is full.

Pfizer said the trial on danuglipron met the primary goal of demonstrating “statistically significant” reductions in body weight.

Patients who took the pill twice a day lost 6.9% to 11.7% of their body weight on average at 32 weeks, and from 4.8% to 9.4% at 26 weeks.

Meanwhile, patients on a placebo gained 1.4% of their body weight at 32 weeks and 0.17% at 26 weeks.

When adjusting for the difference between the weight gain observed in patients who took the placebo, Pfizer’s twice-daily pill caused 8% to 13% weight loss on average at 32 weeks and 5% to 9.5% at 26 weeks.

The company said high rates of adverse events were observed among patients in the study, with up to 73% experiencing nausea, up to 47% vomiting and up to 25% experiencing diarrhea. More than 50% of patients across all dose sizes stopped taking the pill, compared to roughly 40% among those on the placebo, according to Pfizer.

No new safety issues were observed, and danuglipron was not associated with increased liver enzymes like Pfizer’s other discontinued weight loss pill.

Data from the phase two trial will be presented at a future scientific conference or published in a peer-reviewed journal.

Wall Street’s expectations

The tolerability issues align with some analysts’ predictions ahead of the data release.

Leerink Partners analyst David Risinger wrote in a Monday note that the proportion of patients who discontinue treatment with Pfizer’s twice-daily danuglipron in the phase two trial would likely be higher than those who stopped taking a once-daily pill from Eli Lilly.

By comparison, 10% to 21% of patients who took Eli Lilly’s pill, orforglipron, in a mid-stage trial discontinued the treatment at 32 weeks due to adverse side effects, he noted.

Risinger said that’s likely because danuglipron’s total daily dose is far higher, which may cause more adverse effects. Patients on the highest dose size of Pfizer’s pill took 400 milligrams each day, while those on the highest dosage of Eli Lilly’s drug took 45 milligrams a day.

Pfizer’s phase-two trial also didn’t allow downtitration, or decreasing the dose of a drug over time once a specific response has been achieved. Eli Lilly’s mid-stage trial on its pill did.

There is hope that patients will better tolerate the once-daily version of danuglipron compared to the twice-daily form. Pfizer appears to believe a once-daily version of the drug could lessen gastrointestinal side effects, according to some analysts.

They pointed to Pfizer’s second-quarter earnings call, when the company’s chief scientific officer, Mikael Dolsten, suggested that a once-daily version may improve a patient’s tolerability of the drug, which could lessen the gastrointestinal side effects “that have been seen as limiting” danuglipron.

But the effects will be unclear until the mid-stage trial data is released next year.

Notably, the weight loss caused by twice-daily danuglipron appeared to fall short of analysts’ expectations.

Ahead of the data release, several analysts said Pfizer’s twice-daily pill has to be about as effective as Eli Lilly’s once-a-day pill to be competitive. That means at least a 14% to 15% weight loss, Cantor Fitzgerald analyst Louise Chen told CNBC earlier this month.

Risinger also wrote in October that Pfizer’s danuglipron needs to show weight reduction in the “mid-teens” percentages to be considered competitive with Eli Lilly’s pill.

Obese or overweight patients who took 45 milligrams of Eli Lilly’s pill once a day lost up to 14.7% of their body weight, or 34 pounds, after 36 weeks, according to the company’s phase-two trial results.

Eli Lilly’s results appear consistent with the weight reduction caused by a high-dose oral version of Novo Nordisk’s semaglutide – the active ingredient used in the diabetes drug Ozempic and weight loss treatment Wegovy – but came over a shorter trial period.

More than 2 in 5 adults have obesity, according to the National Institutes of Health. About 1 in 11 adults have severe obesity.

Clarification: This story was updated to reflect that some weight-loss data was adjusted to include results from the placebo group.

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December 1, 2023
A ‘game-changing’ study backs Wegovy use to cut heart attacks and strokes: ‘This is not just about weight and appearance’
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Novo Nordisk A/S unveiled details from a closely watched study that support use of Wegovy, its blockbuster weight-loss drug, to cut heart attacks and strokes in obesity patients with a history of cardiovascular disease.
People taking the highest dose of Wegovy saw a drop in blood sugar levels and inflammation — two harbingers of heart disease — that help explain the 20% reduction in cardiovascular events that Novo reported in August. While none of the patients had diabetes, two-thirds started the study with blood sugar levels in the prediabetic range, which is associated with a higher risk of heart disease and death. Patients also saw significant reductions in blood pressure.

Three-quarters of patients had suffered heart attacks before the study began and a quarter had heart failure. In this highly vulnerable population, the results help cement the argument for using Novo’s drug as a heart treatment alongside statins and blood pressure therapies. Patients on Wegovy also lost weight in the trial.

The results, presented on Saturday at the American Heart Association’s annual conference in Philadelphia, are “game-changing,” Eugene Yang, the chair of the American College of Cardiology’s prevention section, said in an interview. The room at the city’s Convention Center erupted into several rounds of applause when the data were presented.

Heart disease is the number one killer in the US and accounts for about a third of deaths globally. While obesity is known to raise the risk for such ailments, Novo’s trial was designed to show whether Wegovy could ward off future heart attacks and strokes in people with established cardiovascular disease.

Novo said it will seek expanded US approval for reducing risk of major adverse cardiovascular events in adults with a body mass index, or BMI, of 27 or higher and established cardiovascular disease.

Read More: All About the New Obesity Drugs Causing a Big Stir

“Increasingly, physicians are understanding that this is not just about weight and appearance,” Lars Fruergaard Jorgensen, Novo’s chief executive officer, said in an interview on Friday before the details were released. “It’s about real health benefits.”

Weight-loss drugs such as Wegovy, which increased sales more than 700% last quarter, have become a phenomenon this year. Celebrities are touting their benefits, while investors handicap how much they will disrupt a wide swath of sectors that includes apparel companies, restaurants and packaged food producers. Novo is already struggling to keep up with demand. And competition is increasing with Eli Lilly & Co. just receiving approval for its weight-loss drug, Zepbound.

However, the drugs are expensive. Zepbound will cost about $1,050 for a month’s supply, which is cheaper than Wegovy’s monthly list price of roughly $1,350. The cost is a barrier to widespread access, Yang said. Based on the trial results, to prevent one heart attack or cardiovascular death, 67 people will need to be treated with Wegovy for almost three years and four months, according to a Bloomberg analysis. At list prices, this would cost $3.8 million.

Along with reducing weight, blood sugar control and anti-inflammatory effects are likely what’s driving the benefit for heart disease shown in the study, Martin Holst Lange, Novo’s development chief, said in an interview. In the trial of more than 17,600 overweight and obese adults who were 45 and older, taking Wegovy lowered body weight by an average of 9.4% over two years, compared to a less than 1% loss in the placebo group. The treatment group also saw reduced weight circumference and blood pressure that’s often associated with shedding pounds.

At the same time, blood sugar fell into a healthy range in two-thirds of those treated. That was enough to ward off diabetes in about 70% of patients. C-reactive protein, a liver product that’s linked to inflammation, fell about 40% among those taking Wegovy.

Only 28% of the patients in the trial were women and just 4% were Black, meaning the results may not translate to those populations, according to the ACC’s Yang. About 17% of the patients in the trial stopped taking Wegovy due to side effects. The most common cause was gastrointestinal issues, which were responsible for most of the discontinuations.

— With assistance from Robert Langreth
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Madison Muller, Naomi Kresge, Bloomberg

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November 11, 2023
Antibodies to Cow’s Milk Linked to Increased Risk of Cardiovascular Death

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BYLINE: Analyses led by Corinne Keet, MD, PhD, at the University of North Carolina School of Medicine, of two longitudinal studies reveal how an increased level of an antibody called immunoglobin (IgE) to cow’s milk is associated to cardiovascular-related death.

Newswise — CHAPEL HILL, NC – Sensitivity to common food allergens such as cow’s milk and peanuts could be an important and previously unappreciated cause of heart disease, new research suggests – and the increased risk for cardiovascular death includes people without obvious food allergies.

In a paper published in The Journal of Allergy and Clinical Immunology that describes analyses led by Corinne Keet, MD, PhD, pediatric allergy and immunology professor in the UNC Department of Pediatrics of two longitudinal studies, the authors show that the people who produced IgE antibodies to cow’s milk and other foods were at significantly increased risk of cardiovascular mortality. This was true even when traditional risk factors for heart disease, such as smoking, high blood pressure, and diabetes were accounted for. The strongest link was for cow’s milk, but IgE to other allergens such as peanut and shrimp were also significant among those who eat the foods.

This troubling finding represents the first time that IgE antibodies to common foods have been linked to increased risk of cardiovascular mortality, the researchers report. The findings do not conclusively prove that food antibodies are causing the increased risk, but the work builds on previous studies connecting allergic inflammation and heart disease.

“People who had an antibody called IgE to foods that they regularly eat seemed to be at increased risk for dying from heart disease,” said Keet, who is the corresponding author of the paper. “We were surprised by these findings because it is very common to have IgE to foods (about 15% of American adults have IgE to common food allergens), and most people don’t have any symptoms when they eat the food. As allergists, our thinking has been that it is not important if people have IgE to foods, as long as they don’t have symptoms when they eat the food,” she said.

Funded by the National Institute of Allergy and Infectious Disease and an AAAAI Faculty Development Award to her collaborator Jeff Wilson at the University of Virginia, this research used two methods to examine the association between IgE sensitization to foods and cardiovascular mortality. Data from 4,414 adults who participated in The National Health and Examination Survey (NHANES) and 960 participants in the Wake Forest site of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort were used. Participants were enrolled in MESA from 2000-2002 and followed for up to 19 years. Participants were enrolled in NHANES from 2005 to 2006 and data on mortality up to 14 years were tracked. Total and specific IgE was measured to cow’s milk, egg, peanut, shrimp, and a panel of aeroallergens for the NHANES group. IgE to cow’s milk, alpha-gal, peanut, dust mite and timothy grass were measured in the MESA group. In NHANES, 229 cardiovascular deaths were recorded and 960 deaths from MESA were also reported. Milk sensitization was particularly associated in both NHANES & MESA. Researchers also discovered that food sensitization to shrimp and peanut were both additional risk factors for heart disease.

It is also important to note that associations in the findings related to food sensitization rather than clinical allergy. Although researchers did not have access to information about clinical food allergy in either cohort, they expect that individuals who report regularly eating a food allergen on food frequency questionnaires were not showing symptoms of a food allergy. Thus, the findings that showed how associations were strengthened when researchers excluded those who avoided the food suggest that these findings were most relevant to those who have not been diagnosed with food allergy. Keet says the results raise questions about whether these apparently non-allergic individuals may have long-term consequences from consuming foods to which they are sensitized.

The study states that aside from two recent reports linking IgE to the unusual carbohydrate allergen alpha-gal to coronary artery disease, cardiovascular disease had not previously been identified as a long-term complication of food sensitization. However, there is now substantial evidence for the importance of allergic-type immune pathways in normal cardiac physiology and heart disease. Because discovering the link between milk sensitization with cardiovascular mortality is new, Keet says there’s more to explore as far as the relevance of food sensitization and diet in cardiovascular disease development.

“More research needs to be done about how sensitization to common food allergens is related to cardiovascular disease,” she said. “While this study provides good evidence of an association between sensitization to these allergens and death from cardiovascular disease, there is much work to be done to understand if this is a causal relationship.”

Media contact: Brittany T. Phillips, Communications Specialist, UNC Health | UNC School of Medicine

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University of North Carolina Health Care System

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November 9, 2023
Real-World Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Kidney Transplant Recipients
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Highlights
- Compared with kidney transplant recipients who did not receive sodium-glucose cotransporter-2 inhibitors, those treated with the medications had lower risks of experiencing kidney transplant failure, kidney transplant rejection, major adverse cardiac events, all-cause mortality, and genitourinary infections.
- Results from the study will be presented at ASN Kidney Week 2023 November 1–November 5.
Newswise — Philadelphia, PA (November 4, 2023) — Sodium-glucose cotransporter-2 (SGLT2) inhibitors lower blood sugar levels and have additional beneficial effects on kidney and heart health for individuals with and without diabetes, but little is known about the safety and efficacy of these medications in kidney transplant recipients. Research that examined this will be presented at ASN Kidney Week 2023 November 1–November 5.

For the study, investigators analyzed the electronic medical records of 3,450 adult kidney transplant recipients treated with SGLT2 inhibitors who were matched to 3,450 similar patients who did not receive SGLT2 inhibitors, using a statistical technique called propensity matching adjusted for demographic data, baseline heart disease and blood test.

Kidney transplant patients treated with SGLT2 inhibitors were 59%, 64%, 33%, and 40% less likely to experience kidney transplant rejection, kidney transplant failure, major adverse cardiac events, and mortality, respectively, over 3 years. They were also 44% less likely to experience urinary tract infections.

“To date, all major SGLT2 inhibitor studies have excluded kidney transplant patients. This study was the largest observational study demonstrating the benefits of SGLT2 inhibitors in patients with kidney transplants,” said corresponding author Nageen, Anwar, MD, of the Liverpool University Hospitals NHS Foundation Trust. “This study is a big step towards qualifying transplant patients to benefit from the many positive effects of SGLT2 inhibitor use and sets the precedence for a randomized controlled trial to evaluate the long-term kidney and cardiovascular outcomes of SGLT2 inhibitor therapy in kidney transplant patients.”

Study: “Outcomes Associated with Sodium-Glucose Cotransporter-2 Inhibitors in Kidney Transplant Recipients: A Real-World Analysis Using a Global Federated Database”

The world’s premier nephrology meeting, ASN Kidney Week, brings together approximately 12,000 kidney professionals from across the world. The largest nephrology meeting provides participants with exciting and challenging opportunities to exchange knowledge, learn the latest scientific and medical advances, and listen to engaging and provocative discussions with leading experts in the field.

About ASN

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge and advocating for the highest quality care for patients. ASN has nearly 21,000 members representing 140 countries. For more information, visit www.asn-online.org and follow us on Facebook, X, LinkedIn, and Instagram.

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American Society of Nephrology (ASN)

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November 4, 2023
Usher uses first Super Bowl performance as ‘cheat sheet’ for 2024 show and urges diabetes screening

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LOS ANGELES — While Usher gears up for his 2024 Super Bowl halftime performance, the singer will lean on his previous experience of hitting the NFL’s biggest stage to help prepare for the 13-minute set.

The Grammy winner said he’s using his appearance with Black Eyed Peas frontman will.i.am in 2011 as a “cheat sheet.” He was recently chosen to headline the halftime festivities from Allegiant Stadium in Las Vegas on Feb. 11 — the same day he’s expected to release his ninth studio album “Coming Home.”

“I got a chance to see a bit of what it felt like,” Usher told The Associated Press in a recent interview. In his first Super Bowl performance, he descended from the stadium ceiling to perform “OMG” in Arlington, Texas.

Usher’s appearance lasted less than two minutes, but the moment gave him plenty of insight into conducting a show with such limited time. His album “Confessions” ranks among one of the best-selling music projects of all time and launched No. 1 hits such as “Yeah!” with Ludacris and Lil Jon, “Burn” and “Confessions Part II.” He’s had other hits such as “U Got It Bad,” “U Remind Me,” “You Make Me Wanna” and “Love in the Club” — lots of material to cover during one of the year’s biggest cultural moments.

“Don’t take the moments for granted because you only get 13 of them,” said the singer, who is currently headlining his “Usher: My Way” sold-out residency in Las Vegas. “The hardest part is trying to figure out how to squeeze it all in when you actually have a large catalog, or a lot of records people celebrate and love.”

Usher called his musical opportunities to perform part of “God’s plan to entertain the world.” As he prepares for the Super Bowl stage, the singer is taking a moment to bring awareness to early Type 1 diabetes screening through The 1 Pledge movement, which launched Wednesday.

Usher’s child was diagnosed with Type 1 diabetes at age 6 in 2014. He wants to urge those to get screened as early as possible.

“Had I known about this opportunity early, I would feel better,” said Usher, who is a paid spokesperson of the healthcare company Sanofi on the ad campaign. “There’s a range of things that you have to get acclimated to like identifying the doctors, the philosophy of how you want to live your life and manage you blood glucose levels.”

He added: “It’s not just a journey for the child. It’s a journey for the entire family.”

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November 1, 2023
I tried the carnivore diet, it had unexpected health benefits

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Have you ever wondered about alternative methods for managing chronic conditions like arthritis obesity or even diabetes? In my quest for answers, I often overlooked unconventional approaches; solutions that were right in front of me.

As a long-time diagnosed diabetic, managing my blood sugar levels had become a daily battle. After following my doctor’s recommended diet and constantly monitoring my glucose levels, I was left feeling overwhelmed and frustrated.

That’s when I stumbled upon the carnivore diet, a unique eating plan that revolves around consuming only animal-based products.

Anthony Girouard tried the carnivore diet. He said it turned his diabetes around, gave him greater mental clarity, and he dropped 30lbs in weight.
Anthony Girouard

I don’t remember exactly when I first saw the carnivore diet, but I vividly recall reaching out to YouTube for answers. Being someone who has always had a curious mind, but always followed my doctor’s recommendations, I was immediately drawn to this controversial way of eating.

The idea of consuming solely animal products seemed both enticing and strange, prompting a flurry of questions in my mind. What fascinated me most about the carnivore diet was its direct opposition to conventional nutritional wisdom.

For years, my doctors have consistently recommended a low-fat diet approach as the key to controlling my diabetes, so it was refreshing—and slightly perplexing—to see an alternative perspective gaining traction. Could it be possible that they have been wrong all along?

I was intrigued by the idea of reversing my diabetes naturally, so I decided to try this unconventional diet to see if it was the answer I’ve searched for.

When I first decided to try the diet, I had mixed feelings. On the one hand, I was curious about its potential health benefits, but on the other I couldn’t help but wonder if it would be too restrictive or even sustainable in the long run.

To my surprise, the first couple of weeks were quite challenging as my body adjusted to the drastic changes, but soon enough I found myself enjoying the simplicity of the diet.

The meals I relied on were uncomplicated, yet satisfying. Each morning, I delighted in the classic combination of crispy bacon and eggs scrambled in rich butter. And when it came to dinner, I indulged in juicy beef patties adorned generously with a dollop of creamy butter.

The first few months were the most challenging and the most physically demanding. Initially, my body did struggle to adapt to the different nutritional profile. I experienced flu-like symptoms, digestive problems, fatigue, headaches, and brain fog.

Adapting to a diet without carbohydrates initially drained my body’s energy levels and it took about three months for my system to get back on track.

The fourth month brought some unexpected benefits that I couldn’t have foreseen. Apart from the initial weight loss and increased energy levels, which I did expect, I noticed a significant improvement in my mental health.

As someone who has struggled with concentration issues, this newfound clarity cannot be overstated. Problems that seemed overwhelming before became more manageable. It’s as if a veil has been lifted, allowing me to approach things with a renewed sense of purpose and capability.

My mind felt like a well-oiled machine ready to tackle anything thrown its way. Furthermore, it was during this time that I began to embrace the simplicity and convenience of the carnivore lifestyle in a world filled with complicated diets and countless food restrictions.

Being able to rely solely on animal-based products for nutrition provided a sense of ease and freedom. I no longer worry about measuring portions or obsess over calorie counting. It’s just pure simplicity in every meal.

I was astonished when I stepped on the scale and saw that after six months, I had lost a whopping 30lbs overall. It was incredible to think that my efforts to control my diabetes led to such a significant drop in weight.

The best part was that I wasn’t even trying to lose weight—it was simply a pleasant side effect of the diet.

Initially, my main focus was on managing my diabetes. I wanted to take control of my blood sugar levels. Little did I know that this journey would also lead to shedding those extra pounds that had been weighing me down for years.

As I entered the seventh month of the diet, my weight loss had plateaued. I was expecting to see the same pattern in terms of weight loss and increased energy levels. However, that wasn’t the case. But what came as a complete surprise were other benefits that started popping up.

First, I noticed a significant Improvement in the quality of my sleep. Gone were the days of tossing and turning. Now I fell asleep quickly and woke up feeling refreshed. This newfound restfulness had a profound impact on my overall health.

Another unexpected benefit during these months was a noticeable reduction in inflammation throughout my body. Not only did my chronic joint pain diminish drastically, but also things like itchy skin and my high glucose level seemed to vanish overnight.

It was an unbelievable moment when I realized I could finally let go of my diabetes medication. I went from taking 2,000 milligrams of Metformin twice a day to no diabetes medication at all. This alone solidifies my dedication to this unconventional diet.

The transition to an all-meat diet has left me quite sensitive to other foods. After a year of mostly eating meat, I have noticed that whenever I deviate and include any type of processed food, I experience issues.

It’s as if my palette has become finely tuned and even the smallest traces of additives or toxic ingredients trigger rashes, bloating, digestive discomfort, and fatigue.

This newfound sensitivity forced me to re-evaluate not only my dietary choices but also how I approach food in general. Gone are the days when I could mindlessly indulge in various culinary delights without consequences. Instead, every decision has become deliberate and purposeful, weighing potential repercussions against momentary pleasures.

While I initially had doubts about the diet’s sustainability and health implications, I was pleasantly surprised by the positive changes it has brought to my overall health.

It’s important to acknowledge that this diet may not be suitable for everyone, especially those with certain medical conditions or perhaps ethical concerns. Before embarking on any dietary change, it’s crucial to consult with a health care professional for personalized advice.

Ultimately, this past year highlights to me the importance of personalized nutrition and the need to find a diet that suits an individual’s needs and goals.

Anthony Girouard is exploring his journey with the carnivore diet through his YouTube channel.

All views expressed in the article are the author’s own.

Do you have a unique experience or personal story to share? Email the My Turn team at myturn@newsweek.com.

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Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.

Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.

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October 28, 2023
Diabetes Associations Recognize Plant-Based Diets | NutritionFacts.org

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Plant-based diets are the single most important—yet underutilized—opportunity to reverse the pending obesity and diabetes-induced epidemic of disease and death.

Dr. Kim Williams, immediate past president of the American College of Cardiology, started out an editorial on plant-based diets with the classic Schopenhauer quote: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” In 2013, plant-based diets for diabetes were in the “ridiculed” stage in the official endocrinology practice guidelines and placed in the “Fad Diets” section. The guidelines acknowledged that strictly plant-based diets “have been shown to reduce the risk for T2DM [type 2 diabetes] and improve management of T2DM” better than the American Diabetes Association recommendations, then inexplicably went on to say that it “does not support the use of one type of diet over another” with respect to diabetes or in general. “The best approach for a healthy lifestyle is simply the ‘amelioration of unhealthy choices’”—whatever that means.

But, by 2015, the clinical practice guidelines from the same professional associations explicitly endorsed a plant-based diet as its general recommendation for diabetic patients. The times they are a-changin’!

As I discuss in my video Plant-Based Diets Recognized by Diabetes Associations, the American Diabetes Association itself is also now on board, listing plant-based eating as one of the dietary patterns acceptable for the management of the condition. The Canadian Diabetes Association, however, has really taken the lead. “Type 2 diabetes mellitus is considered one of the fastest growing diseases in Canada, representing a serious public health concern,” so it isn’t messing around and recommends plant-based diets for disease management “because of their potential to improve body weight and A1C [blood sugar control], LDL-cholesterol, total cholesterol and non-HDL-cholesterol levels, in addition to reducing the need for diabetes medications.” The Canadian Diabetes Association uses the Kaiser Permanente definition for that eating pattern: “a regimen that encourages whole, plant-based foods and discourages meats, dairy products and eggs, as well as all refined and processed foods,” that is, junk.

It recommends that diabetes education centers in Canada “improve patients’ perceptions of PBDs [plant-based diets] by developing PBD-focused educational and support as well as providing individualized counseling sessions addressing barriers to change.” The biggest obstacle identified to eating plant-based was ignorance. Nearly nine out of ten patients interviewed “had not heard of using a plant-based diet to treat or manage T2DM.” Why is that? “Patient awareness of (and interest in) the benefits of a plant-based diet for the management of diabetes…may be “influenced by the perception of diabetes educators and clinicians.” Indeed, most of the staff were aware of the benefits of plant-based eating for treating diabetes, yet only about one in three were recommending it to their patients.

Why? One of the common reasons given was they didn’t think their patients would eat plant-based, so they didn’t even bring it up, but “[t]his notion is contrary to the patient survey results that almost two-thirds of patients were willing” to at least give it a try. The researchers cite the PCRM Geico studies I’ve covered in other videos, in which strictly plant-based diets were “well accepted with over 95% adherence rate,” presumably because the study participants just felt so much better, reporting “increased energy level, better digestion, better sleep, and increased satisfaction when compared with the control group.”

A number of staff members also expressed they were unclear about the supportive scientific evidence as their second reason for not recommending this diet, but it’s been shown to be more effective than an American Diabetes Association–recommended diet at reducing the use of diabetes medications, long-term blood sugar control, and cholesterol. It’s therefore possible that the diabetes educators were simply behind the times, as there is “a lag-time” in the dissemination of new scientific findings from the literature to the clinician and finally to the patient. Speeding up this process is one of the reasons I started NutritionFacts.org.

As Dr. Williams put it, “the ‘truth’ (i.e., evidence) for the benefits of plant-based nutrition continues to mount. This now includes lower rates of stroke, hypertension, diabetes mellitus, obesity, myocardial infarction, and mortality [heart attacks and cardiac death], as well as many non-cardiac issues that affect our patients in cardiology, ranging from cancer to a variety of inflammatory conditions.” We’ve got the science. The bigger challenge is overcoming the “inertia, culture, habit, and widespread marketing of unhealthy foods.” He concludes, “Reading the existing literature and evaluating the impact of plant-based nutrition, it clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes-induced epidemic of morbidity and mortality,” disease and death.

I highlighted the PCRM Geico studies in my videos Slimming the Gecko and Plant-Based Workplace Intervention.

Aren’t plant-based diets high in carbs? Get the “skinny” by checking out my video Flashback Friday: Benefits of a Macrobiotic Diet for Diabetes.

To learn more about diet’s effect on type 2 diabetes, see the related videos below.

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Michael Greger M.D. FACLM

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October 24, 2023
Just 2 Servings of Red Meat Per Week Raises Your Diabetes Risk

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THURSDAY, Oct. 19, 2023 (HealthDay News) — Think twice about ordering that double cheeseburger, salami on rye or juicy T-bone.

Just two servings of red meat a week — processed or unprocessed — can increase your risk of type 2 diabetes by 62%, according to a new study.

“A modest but statistically significant increase in risk was seen with even two servings of red meat per week, and risk continued to increase with higher intakes,” said lead author Xiao Gu, a postdoctoral research fellow at Harvard’s T.H. Chan School of Public Health in Boston. “Our findings suggest that replacing red meat with healthy plant-based protein sources, such as nuts and legumes, or modest intakes of dairy foods, would reduce the risk of diabetes.”

The study can’t prove that eating red meat causes type 2 diabetes, but there appears to be a link.

And a serving of meat is likely smaller than you might suspect.

One serving of unprocessed red meat is about 3 ounces of pork, beef or lamb; a serving of processed red meat is about 1 ounce of bacon or 2 ounces of hot dog, sausage, salami, bologna or other processed red meats, Gu said.
Red meat is usually high in saturated fat and low in polyunsaturated fat, Gu said.

“Studies have shown that saturated fat can reduce beta cell function and insulin sensitivity, which results in type 2 diabetes,” he explained.

“Red meat also has a high content of heme iron, which increases oxidative stress and insulin resistance and impairs beta cell function through its by-product of nitric oxide compounds,” Gu said. “For processed red meats, there is also a high content of nitrates and their byproducts, which promote cell dysfunction and insulin resistance.”

For the study, Gu and his colleagues collected data on nearly 217,000 participants from the Nurses’ Health Study and the Health Professionals Follow-up Study.

Their diets were assessed with food questionnaires for up to 36 years. During this time, more than 22,000 participants developed type 2 diabetes.

People who ate the most red meat had a 62% higher risk for type 2 diabetes, compared with those who ate the least.

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October 19, 2023
WTF Fun Fact 13589 – A Voice Test for Diabetes

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If you’re scared of needles, you might be interested to know that researchers are investigating a possible voice test for diabetes.

That’s right. A brief recording of your voice could indicate whether or not you have diabetes.

A Voice Test for Diabetes?

A program designed to use no more than 10 seconds of speech has proven capable of identifying the presence of diabetes with remarkable accuracy.

In an experiment conducted by Klick Labs, 267 individuals recorded a short phrase on their smartphones six times a day over a span of two weeks. This group had recently undergone testing for Type 2 diabetes. The aim? To discern any acoustic differences between the voices of those who tested positive and those who didn’t.

By analyzing the participants’ voice prints in conjunction with data like age, sex, height, and weight, an AI model made astonishing predictions. The accuracy rate stood at 86% for men and an even higher 89% for women.

Unraveling the Science Behind Voice Analysis

The question arises: Why does diabetes influence one’s voice? The synthesis of our voice is a multifaceted process that integrates the respiratory system, nervous system, and the larynx. Factors that impact any of these systems can, in turn, alter the voice. While such changes might escape the human ear, computers, with their advanced analytical capacities, can detect them with precision.

Among the vocal attributes studied, pitch and its variation proved to be the most predictive of diabetes. Interestingly, some vocal attributes only enhanced prediction accuracy for one gender. For instance, “perturbation jitter” was a key factor for women, whereas “amplitude perturbation quotient shimmer” was significant for men.

It’s worth noting that prolonged elevated blood sugar can impair peripheral nerves and muscle fibers, leading to voice disorders. Moreover, even temporary elevations in blood glucose can potentially influence vocal cord elasticity, though this theory still awaits validation. Furthermore, emotional factors, such as anxiety and depression—both of which can be associated with diabetes—may further modulate voice characteristics.

Beyond Conventional Diabetes Testing

Jaycee Kaufman, the leading author of the study, emphasized the transformative potential of their findings: “Voice technology can potentially revolutionize the way the medical community screens for diabetes. Traditional detection methods can be cumbersome, both in terms of time and cost. This technology could eliminate these challenges altogether.”

Considering the global surge in diabetes cases, and the complications arising from late diagnoses, the introduction of a non-invasive, rapid testing tool can be a game-changer. The International Diabetes Federation has highlighted that nearly 50% of adults with diabetes remain unaware of their condition. Predictably, this unawareness is most pronounced in nations where healthcare infrastructure is stretched thin. The economic implications are staggering, with undiagnosed diabetes projected to cost an exorbitant $2.1 trillion annually by 2030.

Voice technology, as an alternative to blood sample-based tests, presents a promising avenue for early detection and intervention.

A Healthier Future Using A Voice Test for Diabetes

Buoyed by the success of their study, Klick Labs is planning a larger-scale project. They aim not only to refine the accuracy of their model but also to expand its scope. Their vision extends beyond diabetes detection, as they explore its applicability to conditions like prediabetes and hypertension.

Yan Fossat, co-author of the study, expressed enthusiasm for the innovation: “Voice technology has the potential to usher in a new era in healthcare, positioning itself as a vital digital screening tool that’s both accessible and economical.”

As the study gains traction and the technology evolves, the implications for global health are profound. With the power of voice technology, a world where early, easy, and efficient disease detection is the norm, may not be too far off.

— WTF fun facts

Source: “10 Seconds Of Recorded Speech Can Reveal If Someone Has Diabetes” — IFL Science

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October 16, 2023
Drug used in diabetes treatment Mounjaro helped dieters shed 60 pounds, study finds

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The medicine in the diabetes drug Mounjaro helped people with obesity or who are overweight lose at least a quarter of their body weight, or about 60 pounds on average, when combined with intensive diet and exercise, a new study shows.

By comparison, a group of people who also dieted and exercised, but then received dummy shots, lost weight initially but then regained some, researchers reported Sunday in the journal Nature Medicine.

“This study says that if you lose weight before you start the drug, you can then add a lot more weight loss after,” said Dr. Thomas Wadden, a University of Pennsylvania obesity researcher and psychology professor who led the study.

The results, which were also presented Sunday at a medical conference, confirm that the drug made by Eli Lilly & Co. has the potential to be one of the most powerful medical treatments for obesity to date, outside experts said.

“Any way you slice it, it’s a quarter of your total body weight,” said Dr. Caroline Apovian, who treats obesity at Brigham and Women’s Hospital and wasn’t involved in the study.

The injected drug, tirzepatide, was approved in the U.S. in May 2022 to treat diabetes. Sold as Mounjaro, it has been used “off-label” to treat obesity, joining a frenzy of demand for diabetes and weight-loss medications including Ozempic and Wegovy, made by Novo Nordisk.

All the drugs, which carry retail price tags of $900 a month or more, have been in shortage for months.

Tirzepatide targets two hormones that kick in after people eat to regulate appetite and the feeling of fullness communicated between the gut and the brain. Semaglutide, the drug used in Ozempic and Wegovy, targets one of those hormones.

The new study, which was funded by Eli Lilly, enrolled about 800 people who had obesity or were overweight with a weight-related health complication — but not diabetes. On average, study participants weighed about 241 pounds (109.5 kilograms) to start and had a body-mass index — a common measure of obesity — of about 38.

After three months of intensive diet and exercise, more than 200 participants left the trial, either because they failed to lose enough weight or for other reasons. The remaining nearly 600 people were randomized to receive tirzepatide or a placebo via weekly injections for about 16 months. Nearly 500 people completed the study.

Participants in both groups lost about 7% of their body weight, or almost 17 pounds (8 kilograms), during the diet-and-exercise phase. Those who received the drug went on to lose an additional 18.4% of initial body weight, or about 44 pounds (20 kilograms) more, on average. Those who received the dummy shots regained about 2.5% of their initial weight, or 6 pounds (2.7 kilograms).

Overall, about 88% of those taking tirzepatide lost 5% or more of their body weight during the trial, compared with almost 17% of those taking placebo. Nearly 29% of those taking the drug lost at least a quarter of their body weight, compared with just over 1% of those taking placebo.

That’s higher than the results for semaglutide and similar to the results seen with bariatric surgery, said Apovian.

“We’re doing a medical gastric bypass,” she said.

Side effects including nausea, diarrhea and constipation were reported more frequently in people taking the drug than those taking the placebo. They were mostly mild to moderate and occurred primarily as the dose of the drug was escalated, the study found. More than 10% of those taking the drug discontinued the study because of side effects, compared with about 2% of those on placebo.

Lilly is expected to publish the results soon of another study that the firm says shows similar high rates of weight loss. The U.S. Food and Drug Administration has granted the company a fast-track review of the drug to treat obesity, which Eli Lilly may sell under a different brand name. A decision is expected by the end of the year.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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October 15, 2023
‘Miracle drug’ euphoria: Experts warn widespread use of weight loss medicine faces major hurdles

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Two experts see major challenges facing the adoption of new obesity drugs.

Dr. Kavita Patel, a physician and NBC News medical contributor, believes fresh data from Novo Nordisk on Ozempic’s ability to delay the progression of chronic kidney disease is among the strongest supporting evidence for secondary uses of the drug.

However, she considers data supporting the use of obesity drugs for other conditions including Alzheimer’s and alcohol addiction as underdeveloped.

“Those trials … are nowhere near as robust as the data we have on [Novo Nordisk trial] FLOW, on sleep apnea, cardiovascular risks, on diabetes control — double-blind placebo, randomized controlled trials that are incredible,” she told CNBC’s “Fast Money” on Wednesday. “We have a long way to go for that. I’ve seen a lot of miracle drugs before.”

Novo Nordisk halted FLOW on Tuesday. According to the company’s press release, it happened more than a year after an interim analysis showed that Ozempic could treat chronic kidney disease in Type 2 diabetic patients.

As of Friday’s close, Novo Nordisk is up 9.82% since its announcement. Its obesity drug maker competitor Eli Lilly is up 5.16% in the same period.

Patel believes efficacy is just one of the major hurdles the medication needs to clear before it can be approved for uses outside of diabetes management.

“We know this drug works really well in diabetics. But there are so many barriers to getting there —including cost, adherence, prescriber rate,” said Patel, who also served as a White House Health Policy Director under President Obama.

Patients opting to use GLP-1 drugs — a group of medications initially designed to control diabetes — for weight management often must pay out-of-pocket.

“Right now, we are seeing active employers, entire states that are declining to cover on the weight loss indication,” Patel said.

If the U.S. Food and Drug Administration approves Ozempic for use in Type 2 diabetics with chronic kidney disease, which Patel believes will happen, it could force the hand of insurance companies to expand their coverage of the drug.

“We’ll see a final package of data that will just be so compelling, that it would be wrong not to cover this, because it should be superior to what we have available to us,” she noted. “That is something that I think the insurance companies will have a difficult time [with].”

Mizuho Health Care Sector Strategist Jared Holz also expects challenges related to insurance coverage as more patients begin taking GLP-1 drugs, which could limit overall adoption.

“The payers, at some point, are going to be saying, ‘We get it, but we cannot pay for these at this volume without seeing the benefit, which may be 10 years from now, 20 years from now, 30.’ We have no idea when the offset is going to be,” he also told CNBC’s “Fast Money.”

Holz also pointed out the divide emerging in the health care sector between Novo Nordisk, Eli Lilly and their pharmaceutical peers.

“We haven’t seen this kind of valuation disconnect between the peer group, maybe in the history of the sector,” he said.

The growth trend may not be sustainable for Novo Nordisk and Eli Lilly, based on current supply constraints that have left patients unable to secure dosages.

“The companies can’t make enough, I don’t think, to actually put out revenue that’s going to appease investors, given where the stocks are trading,” said Holz.

A Novo Nordisk spokesperson did not offer a comment due to the company’s quiet period ahead of earnings. Eli Lilly did not immediately respond to a request for comment.

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October 14, 2023
Make diagnosing serious geriatric diseases as easy as measuring blood sugar

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Newswise — In 2023, life expectancy in Korea will be 83.6 years, the third highest among OECD countries, and it is steadily increasing every year. As the proportion of the elderly population increases, the social cost of treating various geriatric diseases is also increasing rapidly, and there is a growing interest in early diagnosis of diseases. Among the various diagnostic methods, researchers are actively conducting research on measuring glutamine as an indicator of geriatric diseases by finding that the concentration of glutamine in the cells and blood of patients with serious diseases such as cancer, diabetes, and dementia is significantly changed compared to normal people.

Dr. Seo, Moon-Hyeong of the Natural Product Research Center at the Korea Institute of Science and Technology (KIST), together with Dr. Park, Keunwan of the Natural Product Informatics Research Center, have developed a technology that can quickly and accurately measure glutamine concentrations without complicated measurement processes and expensive analytical equipment through the principle of ‘ligand-induced protein assembly’.

Glutamine is an amino acid in the blood that is used by cells to synthesize proteins or as an energy source, and its rapid fluctuation in certain situations makes it a useful biomarker for the treatment and early diagnosis of disease. For this reason, researchers are actively studying glutamine metabolism in the body to diagnose metabolic and degenerative diseases, including cancer treatment by inhibiting the metabolism of glutamine, which is also a nutrient for cancer cells.

Until now, the measurement of glutamine concentration in the body has relied on expensive specialized analytical equipment such as amino acid analyzers, which cannot measure changes in glutamine concentration in living cells in real time. In the case of relatively low-cost research kits, cumbersome pre-treatment processes such as protein removal in biological samples were required, resulting in long measurement times and low accuracy.

The team developed a sensor protein for measuring glutamine based on the principle of “ligand-induced protein assembly” that can easily measure the concentration of glutamine in the blood. By separating a glutamine binding protein into two artificial proteins and then binding to the sample, and named it Q-SHINE by combining Q, the symbol for glutamine, and SHINE, which means brightly glowing. Experiments showed that the Q-SHINE sensor was highly selective, not responding to amino acids with similar structure such as glutamic acid and D-glutamine. The lowest concentration of glutamine that can be measured is 1 micromolar (µM, one millionth of a molar), which is 20 times lower than the enzymatic assay most commonly used in research kits. In addition, the sensor protein can be easily produced in E. coli, making it possible for a research kit to analyze glutamine concentrations at the same level as analytical instruments worth hundreds of millions of dollars.

The team also used the Q-SHINE sensor to monitor changes in glutamine concentration in the cytoplasm and mitochondria of living cells in real time. In particular, by verifying the difference in glutamine concentration between cancer cells and normal cells, it is expected to speed up the development of anticancer drugs by inhibiting glutamine metabolism.

“The Q-SHINE sensor developed by KIST will enable easy monitoring of glutamine concentration, similar to the self-monitoring of blood glucose by diabetics,” said Dr. Seo, Moon-Hyeong. “If used for glutamine metabolism research, it will greatly contribute to early diagnosis and identification of causes of severe geriatric diseases such as cancer, diabetes, and dementia, as well as development of cancer drugs that regulate glutamine metabolism.”

###

KIST was established in 1966 as the first government-funded research institute in Korea. KIST now strives to solve national and social challenges and secure growth engines through leading and innovative research. For more information, please visit KIST’s website at https://eng.kist.re.kr/

The research, which was supported by the Ministry of Science and ICT (Minister Lee Jong-ho) through the KIST Major Project and the Korea Research Foundation’s Excellent New Research Project, was published in the latest issue of the international journal Sensors and Actuators, B: Chemical (IF=8.4, top 0.8% in JCR).

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October 10, 2023
New insights into heart disease risk, prevention, and management

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Newswise — DALLAS, Oct. 9, 2023 — Health experts are redefining cardiovascular disease (CVD) risk, prevention and management, according to a new American Heart Association presidential advisory published today in the Association’s flagship journal Circulation.

Various aspects of cardiovascular disease that overlap with kidney disease, Type 2 diabetes and obesity support the new approach. For the first time, the American Heart Association defines the overlap in these conditions as cardiovascular-kidney-metabolic (CKM) syndrome. People who have or are at risk for cardiovascular disease may have CKM syndrome.

The new approach detailed in the presidential advisory includes:

CKM syndrome stages ranging from 0, or no risk factors and an entirely preventive focus, to Stage 4, the highest-risk stage with established cardiovascular disease. Stage 4 may also include kidney failure. Each stage correlates to specific screenings and therapies.

Screening for and addressing social factors that impact health.

Collaborative care approaches among multiple specialties to treat the whole patient.

Suggested updates to the algorithm, or risk calculator, that helps health care professionals predict a person’s likelihood of having a heart attack or stroke. The update adds a risk prediction for heart failure, which estimates risk for “total cardiovascular disease” — heart attack, stroke and/or heart failure.

The writing group suggest the updated algorithm provide both 10- and 30-year cardiovascular disease risk estimates.

According to the American Heart Association’s 2023 Statistical Update, 1 in 3 U.S. adults have three or more risk factors that contribute to cardiovascular disease, metabolic disorders and/or kidney disease. CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver. However, the biggest impact is on the cardiovascular system, affecting blood vessels and heart muscle function, the rate of fatty buildup in arteries, electrical impulses in the heart and more.

“The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” said Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, writing committee chair and an associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University in Baltimore. “Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease.”

CKM syndrome is a consequence of the historically high prevalence of obesity and Type 2 diabetes in both adults and youth, according to the advisory. Type 2 diabetes and obesity are metabolic conditions — the “M” in CKM — that are also risk factors for cardiovascular disease. Moreover, the most common cause of death for people with Type 2 diabetes and chronic kidney disease is cardiovascular disease.

“We now have several therapies that prevent both worsening kidney disease and heart disease,” Ndumele said. “The advisory provides guidance for health care professionals about how and when to use those therapies, and for the medical community and general public about the best ways to prevent and manage CKM syndrome.”

With multiple conditions to manage, Ndumele noted fragmented care is a concern in treating patients with CKM syndrome, particularly for those with barriers to care. “The advisory suggests ways that professionals from different specialties can better work together as part of one unified team to treat the whole patient.” Additionally, the advisory emphasizes the importance of systematically screening for and addressing social factors that act as determinants, or drivers, of health, such as nutrition insecurity and opportunities for exercise, as key aspects of optimal CKM syndrome care.”

A companion article published with the presidential advisory, a new American Heart Association scientific statement, “A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome,”, documents the evidence for the writing committee’s proposed approach. The scientific statement brings together evidence from current guidelines and large research studies and describes where gaps remain in knowledge needed to further improve CKM health.

CKM screening, stages and treatment

CKM-related screening is intended to detect cardiovascular, metabolic and kidney health changes early; identify social and structural barriers to care; and prevent progression to the next stage of CKM syndrome.

The advisory addresses care for adults. However, studies suggest CKM syndrome is progressive and begins early in life. Therefore, the advisory aligns with the American Academy of Pediatrics’ recommendations for children and youth to have annual assessments of weight, blood pressure, and mental and behavioral health, starting at age 3.

Stage 0 – No CKM risk factors. The goal at this stage is preventing CKM syndrome by achieving and maintaining ideal health based on the American Heart Association’s Life’s Essential 8 recommendations. The recommendations include healthy eating, physical activity and sleep habits; avoiding nicotine; and maintaining optimal weight, blood pressure, blood sugar and cholesterol levels. The advisory suggests screening adults in Stage 0 every three to five years to assess blood pressure, triglycerides, HDL (good) cholesterol and blood sugar.

Preventing unhealthy weight gain is important for CKM syndrome prevention because of the connection of obesity to Type 2 diabetes, high blood pressure and high triglycerides. At all stages, the advisory proposes yearly measurement of waist circumference and body mass index. Healthy lifestyle behaviors are also encouraged at every stage.

Stage 1 – Excess body fat and/or an unhealthy distribution of body fat, such as abdominal obesity, and/or impaired glucose tolerance or prediabetes. Support for healthy lifestyle changes (healthy eating and regular physical activity) and a goal of at least 5% weight loss in people with Stage 1 are suggested, with treatment for glucose intolerance if needed. Screening every two to three years is advised to assess blood pressure, triglycerides, cholesterol and blood sugar.

Stage 2 – Metabolic risk factors and kidney disease. Stage 2 includes people with Type 2 diabetes, high blood pressure, high triglycerides or kidney disease, and indicates a higher risk for worsening kidney disease and heart disease. The goal of care at this stage is to address risk factors to prevent progression to cardiovascular disease and kidney failure. Treatment may include medications to control blood pressure, blood sugar and cholesterol. In those with chronic kidney disease and in some people with Type 2 diabetes, SGLT2 inhibitors are advised to protect kidney function and reduce the risk of heart failure. SGLT2 inhibitors are a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with Type 2 diabetes. Glucagon-like peptide 1 (GLP-1) receptor agonists are also suggested for consideration in people with Type 2 diabetes to help reduce high glucose, facilitate weight loss and reduce risk for CVD. Other therapies to prevent worsening kidney function are also advised. Screening suggestions for Stage 2 CKM syndrome align with AHA/ACC guidelines, which include yearly assessment of blood pressure, triglycerides, cholesterol, blood sugar and kidney function.

For those with increased risk of kidney failure based on kidney function assessments, more frequent kidney screening is recommended.

Stage 3 – Early cardiovascular disease without symptoms in people with metabolic risk factors or kidney disease or those at high predicted risk for cardiovascular disease. The goal of care in Stage 3 is to intensify efforts to prevent people who are at high risk of progressing to symptomatic cardiovascular disease and kidney failure. This may involve increasing or changing medications, and additional focus on lifestyle changes. The writing committee advises coronary artery calcium (CAC) measurement in some adults to assess narrowing of the arteries when treatment decisions are unclear. CAC screening is used to guide decisions about cholesterol-lowering statin therapy. Test results indicating asymptomatic heart failure should lead to intensified therapy to prevent heart failure symptoms.

The advisory also describes CKM syndrome regression, an important concept and public health message in which people making healthy lifestyle changes and achieving weight loss may regress to lower CKM syndrome stages and a better state of health. The best opportunity for patients to experience regression is in Stages 1, 2 and 3. Some may see improvements in glucose control, cholesterol and blood pressure levels, weight, kidney function and types of heart dysfunction.

Stage 4 – Symptomatic cardiovascular disease in people with excess body fat, metabolic risk factors or kidney disease. Stage 4 CKM syndrome is divided into two subcategories: (4a) for those without kidney failure or (4b) for those with it. In this stage, people may have already had a heart attack or stroke or may already have heart failure. They also may have additional cardiovascular conditions such as peripheral artery disease or atrial fibrillation. The goal of care is individualized treatment for cardiovascular disease with consideration for CKM syndrome conditions.

Predicting Risk

A critical step in assessing risk and managing CKM syndrome is updating the risk prediction algorithm to help health care professionals predict cardiovascular disease in a way that includes CKM components: cardiovascular disease, chronic kidney disease and metabolic disorders.

The Pooled Cohort Equation, the current risk calculator for atherosclerotic cardiovascular disease, established in 2013, estimates the risk of a heart attack or stroke in the next 10 years for people ages 40-75. It includes health and demographic factors about a person and is used to guide lifestyle recommendations and treatment decisions for people at risk for cardiovascular disease. The risk factors are age, sex and race (as white, Black and other); cholesterol levels; and systolic blood pressure. The equation also includes yes/no responses to whether a person is receiving treatment for high blood pressure Type 2 diabetes, or smokes cigarettes.

The advisory proposes updating the risk calculator to include measures of kidney function, Type 2 diabetes control (using blood test results instead of a yes/no response) and social determinants of health for a more comprehensive risk estimate. Kidney function assessments include a measure of how well the kidneys filter waste from the blood and urine albumin levels, a measure of how well the kidneys reabsorb protein. Individual health measures in addition to demographic information will allow the calculator to produce an individual’s total CVD risk estimate.

The writing group recommends the risk calculator updates be expanded to assess risk in people as young as age 30 and to calculate both 10- and 30-year CVD risk. More comprehensive CVD risk assessment at younger ages will allow for earlier preventive strategies to mitigate progression to advanced stages of CKM syndrome. In the long term, this will help to reduce gaps in treatment and health equity and improve outcomes.

Calls to Action

The advisory calls for systemic changes to optimize CKM health.

“There is a need for fundamental changes in how we educate health care professionals and the public, how we organize care and how we reimburse care related to CKM syndrome,” Ndumele said. “Key partnerships among stakeholders are needed to improve access to therapies, to support new care models and to make it easier for people from diverse communities and circumstances to live healthier lifestyles and to achieve ideal cardiovascular health.”

Investing in research is important for advancing CKM care. Key research gaps include:

better understanding the pathways leading to heart disease in CKM syndrome;

better understanding of why some people may advance more quickly along CKM stages, while others may progress more slowly; and

understanding the best way to use newer therapies with multiple effects on CKM syndrome, including to improve metabolic factors such as obesity and Type 2 diabetes, and to reduce worsening kidney disease and prevent heart disease.

Co-authors and their disclosures are listed in the manuscript.

This presidential advisory was prepared by the volunteer writing group on behalf of the American Heart Association. Presidential advisories and scientific statements promote greater awareness about cardiovascular diseases and stroke and help facilitate informed health care decisions. They outline what is known about a topic and what areas need additional research. While scientific statements and advisories inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide official clinical practice recommendations.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

Additional Resources:

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October 9, 2023
Primary care intervention reduces hypoglycemia risk from type 2 diabetes overtreatment in older adults

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Newswise — WASHINGTON—A newly published quality improvement study shows how a simple intervention by health care providers reduced the number of older adult patients with type 2 diabetes at risk for hypoglycemia (low blood sugar) by almost 50% and led to de-escalation of diabetes medications that cause hypoglycemia in 20% of patients.

Twenty percent of Americans aged 65 and older have diabetes. This age group is particularly at risk for hypoglycemia because older people are often overtreated with insulin and other diabetes medications that can cause hypoglycemia. Severe hypoglycemia episodes in older adults can lead to adverse events such as falls, seizures, coma, and even death.

Severe hypoglycemia from insulin and certain oral type 2 diabetes medications is the second most common adverse drug event resulting in emergency room visits and hospitalizations in older people with diabetes.

“This study demonstrates that a low-cost clinical decision support tool, without the additional use of continuous glucose monitoring technology, can decrease the number of patients at high risk for hypoglycemia and reduce overtreatment with insulin and diabetes medications that cause hypoglycemia,” said study author Jeffrey B. Boord M.D., M.P.H., of Parkview Health System in Fort Wayne, Ind. Boord is the Chair of the Endocrine Society’s Hypoglycemia Prevention Initiative Steering Committee. “The patients in our study also reported significant reductions in the negative impact of hypoglycemia on their daily lives.”

The study included 94 patients at risk of treatment-related hypoglycemia at Pottstown Medical Specialists in Pottstown, Pa. Physicians were trained on how to use a clinical decision support (CDS) tool to facilitate shared decision making with patients and improve health outcomes.

During three clinic visits over 6 months, the clinicians used the tool to assess hypoglycemic risk, set individualized HbA1c (blood sugar level) goals, and reduce or discontinue the use of diabetes medications that can cause hypoglycemia.

The use of the clinical decision support tool and shared decision making reduced the at-risk population by 46% and led to the discontinuation of hypoglycemic medications in 20% of participants. Patients also completed a validated patient-reported outcome tool (TRIM-HYPO) to evaluate the impact of non-severe hypoglycemic events on their daily lives. The patients reported improvements in their daily functioning, emotional well-being, diabetes management, sleep disruption and work productivity related to reduction in non-severe hypoglycemic events.

“Because this intervention was so successful, we hope that our clinical decision support tool could be adopted for use in other primary care settings to lower the risk of hypoglycemia and improve the overall well-being of older adults with diabetes,” Boord said.

The HypoPrevent study was part of a larger, multi-year joint effort by the Endocrine Society and Avalere Health, known as the Hypoglycemia Prevention Initiative, to determine best practices in primary care to reduce the impact of hypoglycemia on older (65+) people with type 2 diabetes who use medications that cause hypoglycemia and have a recent A1c <7%, both of which put them at increased risk of hypoglycemia.

In conjunction with HypoPrevent, the Society formed a technical expert panel to develop quality measures—tools that help us measure or quantify healthcare processes, outcomes, patient perceptions and organizational structure—to reduce the risk of hypoglycemia in the outpatient setting. These performance measures are designed to help providers identify opportunities to improve patient care.

For details about the initiative including an implementation guide for how to use the clinical decision tool and resources on the key role of the diabetes educator, visit: endocrine.org/hypoglycemia-prevention-initiative.

The other authors of this study are Deborah A. Koehn of VCU Stony Point Women’s Health in Richmond, Va.; Kathleen Marie Dungan of The Ohio State University in Columbus, Ohio; Amisha Wallia of Northwestern University Feinberg School of Medicine in Chicago, Ill.; Deborah Otcasek Lucas of Avalere Health and BridgingCare LLC in Washington, D.C.; Robert W. Lash and Mila N. Becker of the Endocrine Society in Washington, D.C.; and Lawrence D. Dardick of David Geffen School of Medicine at UCLA in Los Angeles, Calif.

The study was funded by Abbott Laboratories, Eli Lilly and Company, Merck, Novo Nordisk and Sanofi.

The study, “Reducing Hypoglycemia From Overtreatment of Type 2 Diabetes in Older Adults: The HypoPrevent Study,” was published in the Journal of the American Geriatrics Society.

# # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

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September 27, 2023
Diabetes Treatments Less Studied in Black Patients

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Newswise — New research analysing the effects of two drugs used to treat type 2 diabetes indicates a consistent lack of cardiovascular and renal benefits in Black populations. Cardiovascular disease is the leading cause of severe illness and death associated with type 2 diabetes. Renal disease is also a common complication of type 2 diabetes.

The drugs, called sodium-glucose co-transporter 2 inhibitors (SGLT2-Is) and glucogen-like peptide 1 receptor agonists (GLP1-RAs), are some of the newer treatments prescribed to lower blood sugar levels in people with type 2 diabetes.

The research findings, published in the Journal of the Royal Society of Medicine, show that for White and Asian populations, SGLT2-Is and GLP1-RAs have beneficial effects on blood pressure, weight control and renal function, and significantly reduce the risk of severe heart problems and kidney disease. However, the research shows no evidence of these beneficial effects in Black populations.

Researchers at the Diabetes Research Centre at the University of Leicester analysed the results of 14 randomised controlled trials of SGLT2-Is and GLP1-RAs reporting cardiovascular and renal outcomes by race, ethnicity and region.

Lead researcher Professor Samuel Seidu, Professor in Primary Care Diabetes and Cardio-metabolic Medicine at the University of Leicester, said: “Given the well-documented evidence that Black and other ethnic minority populations are more likely to develop type 2 diabetes and at a younger age, the consistent lack of benefits we observed among Black populations is concerning.

“Minimising racial and ethnic variations in the cardiovascular and renal complications of type 2 diabetes requires targeted improved access to care and treatment for those most at risk.”

The researchers suggest there are many factors that could have contributed to the lack of evidence of beneficial effects for Black and other non-White populations. Low statistical power due to small sample sizes of these populations may be partly responsible.

“It is quite clear from the current data that some racial/ethnic groups such as Black populations were underrepresented in all the included trials,” pointed out Professor Seidu.

Enrolment in the trials ranged from 66.6% to 93.2% for White populations, 1.2% and 21.6% for Asian populations, and 2.4% to 8.3% for Black populations.

However, the researchers suggest that, given the consistent nature of the significant lack of beneficial effects across the majority of outcomes for Black populations, other factors may also be at play.

“”Whether the differences are due to issues with under-representation of Black populations and low statistical power, or to racial/ethnic variations in the way the body and these drugs interact with each other needs further investigation,” said Professor Seidu. “It is therefore important that prescribers don’t hasten to deny these newer treatments to Black populations on the back of this research.”

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SAGE Publications UK

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September 22, 2023
Food as Medicine: How Strawberries Can Reduce Diabetes Risk

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Strawberries may seem like a small dietary addition, but their health benefits pack a serious punch.

For more than a decade, UNLV professor Arpita Basu has been studying how strawberries can help reduce the risks of diabetes and improve overall metabolic and cardiovascular health.

“I’m quite passionate about the concept of food as medicine,” said Basu, a registered dietitian and associate professor in the School of Integrated Health Sciences. “It’s gratifying when working with patients and research study participants to give them something natural – instead of medication – to lower their risk of diabetes.”

Basu is now studying how bioactive compounds in strawberries may contribute to lowering a person’s risk for diabetes. She’s also conducted studies over the years examining the health benefits of tea, berries, and cocoa.

We caught up with Basu to learn more about her latest research and how a simple serving of strawberries each day can immensely improve our health.

What makes strawberries so healthy?

Any fruits with a deep color are typically good for you. The darker the color, the greater amount of health benefits.

This is especially true for strawberries because they are all red in color. All that red comes from different plant pigments. Some people use red wine as another common example, but berries have less sugar content than grapes.

How do strawberries reduce the risks of diabetes and other health afflictions?

A key takeaway from our strawberry studies – which I’ve been conducting at UNLV since 2017 – is a marked improvement in blood total and LDL cholesterol among participants. And better numbers in these areas is shown to reduce the possible risk of heart attack and stroke.

And one thing to point out is that you don’t need to consume a pound of strawberries a day to see a difference. There is some good research out there showing that consuming even half a cup of strawberries each day will provide your body with benefits.

Can you explain your theory of using food as medicine?

When people feel helpless about their situation, that’s when I generally see a lot of interest from them about which foods they should consume – whether it’s to prevent their risk of diabetes or something else. So, thinking of food as a form of medicine incentivizes people to eat better.

Americans don’t eat anywhere near enough fruits and vegetables in this country. It’s an urgent issue. According to the CDC, 80 million Americans have pre-diabetes and, most likely, one-in-two people with pre-diabetes will develop Type 2 diabetes. This will lead to both health and economic burdens on so many people.

In addition to my work with strawberries, I also do nutrition epidemiology research because I want to study what people are habitually consuming. I did an interventional study on the effectiveness of blueberries for women with gestational diabetes, for example, and saw improvements in blood glucose levels.

This is the importance of food as medicine. None of these adults were taking medications to manage blood glucose at the time.

There’s so much out there on which foods are healthiest for us. Any tips to cut through the clutter and make the right decision for ourselves?

As a registered dietician, I get questions about which foods certain people should eat all the time. And as a researcher, I know that there is so much information out there. When I put myself in someone else’s shoes, I think we tend to overload the public with information and it can become confusing.

I try to make recommendations by realizing what’s realistic in terms of dietary changes, food access, etc. Foods make up our diets, but if we don’t have the means, which should we focus on? Just food? Or a specific diet? It’s almost like the chicken and the egg. Something that works for me might not work for someone else.

What’s next for your research?

During our previous studies, which consisted of eight-week and 12-week trials, we worked with adults who had elevated LDL cholesterol and features of metabolic syndrome. Our studies showed some great results in that two-and-a-half servings of strawberries each day looked to be very beneficial in improving insulin resistance and lowering risk of diabetes.

Our study was funded by the USDA and the California Strawberry Commission, which gave us a wonderful opportunity to support our farmers producing these great fruits. For our next study, we are hoping to work with 60 adults who have pre-diabetes to measure the benefits of strawberries. It will be a larger study, but we are excited to see what the results show.

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University of Nevada, Las Vegas (UNLV)

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September 20, 2023
Implant Offers Diabetes Control

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Newswise — CAMBRIDGE, MA — One promising approach to treating Type 1 diabetes is implanting pancreatic islet cells that can produce insulin when needed, which can free patients from giving themselves frequent insulin injections. However, one major obstacle to this approach is that once the cells are implanted, they eventually run out of oxygen and stop producing insulin.

To overcome that hurdle, MIT engineers have designed a new implantable device that not only carries hundreds of thousands of insulin-producing islet cells, but also has its own on-board oxygen factory, which generates oxygen by splitting water vapor found in the body.

The researchers showed that when implanted into diabetic mice, this device could keep the mice’s blood glucose levels stable for at least a month. The researchers now hope to create a larger version of the device, about the size of a stick of chewing gum, that could eventually be tested in people with Type 1 diabetes.

“You can think of this as a living medical device that is made from human cells that secrete insulin, along with an electronic life support-system. We’re excited by the progress so far, and we really are optimistic that this technology could end up helping patients,” says Daniel Anderson, a professor in MIT’s Department of Chemical Engineering, a member of MIT’s Koch Institute for Integrative Cancer Research and Institute for Medical Engineering and Science (IMES), and the senior author of the study.

While the researchers’ main focus is on diabetes treatment, they say that this kind of device could also be adapted to treat other diseases that require repeated delivery of therapeutic proteins.

MIT Research Scientist Siddharth Krishnan is the lead author of the paper, which appears today in the Proceedings of the National Academy of Sciences. The research team also includes several other researchers from MIT, including Robert Langer, the David H. Koch Institute Professor at MIT and a member of the Koch Institute, as well as researchers from Boston Children’s Hospital.

Replacing injections

Most patients with Type 1 diabetes have to monitor their blood glucose levels carefully and inject themselves with insulin at least once a day. However, this process doesn’t replicate the body’s natural ability to control blood glucose levels.

“The vast majority of diabetics that are insulin-dependent are injecting themselves with insulin, and doing their very best, but they do not have healthy blood sugar levels,” Anderson says. “If you look at their blood sugar levels, even for people that are very dedicated to being careful, they just can’t match what a living pancreas can do.”

A better alternative would be to transplant cells that produce insulin whenever they detect surges in the patient’s blood glucose levels. Some diabetes patients have received transplanted islet cells from human cadavers, which can achieve long-term control of diabetes; however, these patients have to take immunosuppressive drugs to prevent their body from rejecting the implanted cells.

More recently, researchers have shown similar success with islet cells derived from stem cells, but patients who receive those cells also need to take immunosuppressive drugs.

Another possibility, which could prevent the need for immunosuppressive drugs, is to encapsulate the transplanted cells within a flexible device that protects the cells from the immune system. However, finding a reliable oxygen supply for these encapsulated cells has proven challenging.

Some experimental devices, including one that has been tested in clinical trials, feature an oxygen chamber that can supply the cells, but this chamber needs to be reloaded periodically. Other researchers have developed implants that include chemical reagents that can generate oxygen, but these also run out eventually.

The MIT team took a different approach that could potentially generate oxygen indefinitely, by splitting water. This is done using a proton-exchange membrane — a technology originally deployed to generate hydrogen in fuel cells — located within the device. This membrane can split water vapor (found abundantly in the body) into hydrogen, which diffuses harmlessly away, and oxygen, which goes into a storage chamber that feeds the islet cells through a thin, oxygen-permeable membrane.

A significant advantage of this approach is that it does not require any wires or batteries. Splitting this water vapor requires a small voltage (about 2 volts), which is generated using a phenomenon known as resonant inductive coupling. A tuned magnetic coil located outside the body transmits power to a small, flexible antenna within the device, allowing for wireless power transfer. It does require an external coil, which the researchers anticipate could be worn as a patch on the patient’s skin.

Drugs on demand

After building their device, which is about the size of a U.S. quarter, the researchers tested it in diabetic mice. One group of mice received the device with the oxygen-generating, water-splitting membrane, while the other received a device that contained islet cells without any supplemental oxygen. The devices were implanted just under the skin, in mice with fully functional immune systems.

The researchers found that mice implanted with the oxygen-generating device were able to maintain normal blood glucose levels, comparable to healthy animals. However, mice that received the nonoxygenated device became hyperglycemic (with elevated blood sugar) within about two weeks.

Typically when any kind of medical device is implanted in the body, attack by the immune system leads to a buildup of scar tissue called fibrosis, which can reduce the devices’ effectiveness. This kind of scar tissue did form around the implants used in this study, but the device’s success in controlling blood glucose levels suggests that insulin was still able to diffuse out of the device, and glucose into it.

This approach could also be used to deliver cells that produce other types of therapeutic proteins that need to be given over long periods of time. In this study, the researchers showed that the device could also keep alive cells that produce erythropoietin, a protein that stimulates red blood cell production.

“We’re optimistic that it will be possible to make living medical devices that can reside in the body and produce drugs as needed,” Anderson says. “There are a variety of diseases where patients need to take proteins exogenously, sometimes very frequently. If we can replace the need for infusions every other week with a single implant that can act for a long time, I think that could really help a lot of patients.”

The researchers now plan to adapt the device for testing in larger animals and eventually humans. For human use, they hope to develop an implant that would be about the size of a stick of chewing gum. They also plan to test whether the device can remain in the body for longer periods of time.

“The materials we’ve used are inherently stable and long-lived, so I think that kind of long-term operation is within the realm of possibility, and that’s what we’re working on,” Krishnan says.

“We are very excited about these findings, which we believe could provide a whole new way of someday treating diabetes and possibly other diseases,” Langer adds.

###

The research was funded by JDRF, the Leona M. and Harry B. Helmsley Charitable Trust, and the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health.

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Massachusetts Institute of Technology (MIT)

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September 18, 2023
Medicare targets 10 drugs for price cuts

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Medicare targets 10 drugs for price cuts – CBS News

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The White House on Tuesday released a list of 10 medications that will be subject to price negotiations under Medicare. Ed O’Keefe reports on how this could affect prices and what other drugs could be added going forward.

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August 29, 2023
E. Dale Abel Receives Endocrine Society Lifetime Achievement Award

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Newswise — E. Dale Abel, MD, PhD, chair of the Department of Medicine at the David Geffen School of Medicine at UCLA and executive medical director of the UCLA Health Department of Medicine has received the Endocrine Society Fred Conrad Koch Lifetime Achievement Award. The award, the group’s highest honor, recognizes individuals who have made exceptional contributions to the field of endocrinology through their lifetime.

Dr. Abel’s pioneering work on glucose transport and mitochondrial metabolism in the heart guided his research interest in molecular mechanisms responsible for cardiovascular complications of diabetes. His laboratory has provided important insights into the contribution of mitochondrial dysfunction and aberrant insulin signaling to heart failure risk in diabetes.

Dr. Abel’s research on cardiovascular complications of obesity and insulin resistance has garnered recognition and continuous support from the National Institutes of Health (NIH) for over two decades. Among the honors he has received for scholarship, scientific and academic achievement, Dr. Abel is an elected member of the National Academy of Medicine, the National Academy of Sciences, the Association of American Physicians and the American Society for Clinical Investigation.

In addition, Dr. Abel has been recognized for a longstanding commitment to mentoring the next generation of endocrine researchers and biomedical scientists. He has served as the program chair for the annual Network of Minority Investigators workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Disorders to increase the success of minority biomedical researchers. Since 2012, he has been a principal investigator for the Endocrine Society’s FLARE program, which has successfully increased the pipeline of underrepresented groups into productive careers in endocrinology and diabetes research.

“I am humbled to be the recipient of the highest award from the Endocrine Society, the world’s largest professional association of endocrinologists,” said Dr. Abel. “The Endocrine Society has been my professional home for nearly 30 years. During this time, I have benefitted immensely through the Society, from mentorship to numerous opportunities for professional development within the field. As such it has been easy to give back and provide mentorship to emerging leaders in the field. My accomplishments as an endocrine investigator reflects the efforts of many trainees with whom I have been privileged to work over the past three decades and generosity of mentors and collaborators. I hope that our work, will ultimately impact the lives of many patients with diabetes.”

Abel has held several leadership positions at the Endocrine Society including Past President. He is currently a Deputy Editor for the peer-reviewed journal Endocrine Reviews. Before joining the David Geffen School of Medicine at UCLA, he served as the Chair and Executive Officer of the Department of Internal Medicine and Professor of Medicine, Biochemistry and Biomedical Engineering at the University of Iowa in Iowa City, Iowa. Since 2012, he has been a principal investigator for the Endocrine Society’s Future Leaders Advancing Research in Endocrinology (FLARE) program, which has helped individuals from underrepresented groups establish successful careers in endocrinology and diabetes research.

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University of California, Los Angeles (UCLA), Health Sciences

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August 17, 2023
Higher risk of Type 2 Diabetes for victims of partner violence and child abuse

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Newswise — Ann Arbor, August 17, 2023 – According to the results of a new study in the American Journal of Preventive Medicine, published by Elsevier, exposure to interpersonal violence throughout childhood or adulthood increases an individual’s chance of developing adult-onset diabetes by more than 20%. Data showed the risk level is similar among adult males and females and lower income Black and White Americans.

Lead investigator Maureen Sanderson, PhD, Department of Family and Community Medicine, Meharry Medical College, explained, “While previous research has linked exposure to interpersonal violence with a higher risk for developing type 2 diabetes, our study is the first to confirm a consistent association among different genders and races within a large, diverse population. Moreover, we were able to establish the temporal sequence for experiencing violence and the subsequent risk of developing diabetes over time.”

Previous research has linked lifetime exposure to interpersonal violence or abuse to an increased risk of chronic psychosocial stress, anxiety, depression, and obesity. The investigators took a deeper look at the relationship between these factors, particularly obesity, and the risk of developing adult-onset diabetes using data from the Southern Community Cohort Study, a large study of an economically and ethnically diverse population in the southeastern US. More than 25,000 participants were contacted multiple times from 2002 to 2015, answering questions about partner violence (including adult psychological harm, physical violence, and threats), child abuse and neglect (physical, sexual, or emotional abuse), and current health (including diagnoses for adult-onset diabetes).

Co-investigator Ann Coker, PhD, Department of Obstetrics and Gynecology, College of Medicine and Center for Research on Violence Against Women, University of Kentucky, noted, “From this uniquely diverse cohort of over 25,000 participants, we saw that two commonly occurring forms of interpersonal violence, partner violence and child abuse (36% and 32%, respectively, in the study group), increased the risk of developing adult-onset diabetes by 20-35% when compared to individuals in this same cohort who had not experienced interpersonal violence. These forms of violence increase the risk of trauma-associated stress disorders, which can cause adult-onset diabetes.”

Experiencing both child abuse and adult violence increased the risk of developing diabetes by 35% for both Black and White participants and males and females.

Rates of interpersonal violence, psychosocial distress, and obesity all increased during the COVID-19 pandemic. Dr. Sanderson commented, “Our finding that lifetime interpersonal violence was associated with a significantly increased risk of developing diabetes across race and gender before the additional social stress of the COVID-19 pandemic strongly suggests the need for helping professionals across disciplines to implement effective violence prevention and intervention strategies to reduce the short- and long-term social and health consequences of partner violence and child abuse.”

Dr. Coker added, “The good news is that effective intervention and prevention resources exist that can help patients and communities prevent or reduce partner violence and child abuse/neglect and have an impact on health outcomes including type 2 diabetes.”

The US Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control provides toolkits for clinicians’ and communities’ use to prevent violence. Key strategies include strengthening economic supports for families, promoting social norms to protect against adversity and violence, ensuring strong starts for children, teaching skills, connecting youth to caring adults, and intervening to lessen harm.

In clinics, professionals can use safe, sensitive, trauma-informed approaches to ask patients about their current or lifetime experiences with child abuse or neglect and partner violence.

Co-investigator L. Lauren Brown, PhD, Department of Psychiatry & Behavioral Sciences, Meharry Medical College, noted, “These violence prevention strategies can reduce and ultimately prevent the lifelong consequences of child abuse and partner violence — but only if we screen and engage people for care. Asking about past violence can begin to address the chronic stress response that leads to diabetes. Asking about current violence can interrupt the violence with skillful follow-up from clinical and community-based resources.”

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Elsevier

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August 17, 2023

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