Diabetes treatment is getting better every day. Scientists may be just a few years away from making an artificial pancreas that can safely detect and adjust blood sugar (glucose) levels. In the meantime, new medications and insulin devices can make living with diabetes easier and safer now.
“We’re getting more and more options,” says Michael German, MD, clinical director of the Diabetes Center at the University of California, San Francisco. “That’s good because no two people with diabetes are the same. It helps us get the right medicine for each person.”
If you’ve ever gone too long between meals to eat and suddenly felt shaky, lightheaded, anxious, and cranky, you’ve had hypoglycemia. These unpleasant symptoms are your body’s way of warning you that your blood sugar (glucose) levels have fallen too low. (That’s what “hypoglycemia” means.)
Glucose is the body’s main source of energy. In most people, blood sugar levels should be within a range of 70 to 99 milligrams per deciliter (mg/dL).
Most healthy people only need a quick high-carb snack, such…
These treatments are or will soon be available in the U.S.
Afrezza. This insulin inhaler for adults with type 1 and type 2 diabetes hit the market in February 2015. You use it at the beginning of a meal for a boost of short-acting insulin. Unlike an older inhaler, which was the size of a can of shaving cream, Afrezza is easier to use and not as clunky to carry around. “It’s quite small – a little bigger than a whistle,” says Sethu K. Reddy, MD, chief of adult diabetes at Joslin Diabetes Center at Harvard Medical School in Boston. It’s probably not for you if you smoke or have a lung condition like asthma or emphysema.
Medtronic MiniMed 640G. This combined insulin pump and continuous glucose monitor is a step toward the artificial pancreas. It automatically stops pumping insulin when your blood sugar levels are trending down and starts again when they’re back up. “Hypoglycemia [low blood sugar] is a real problem, particularly for people with type 1 diabetes,” German says. It could be especially useful for people who have hypoglycemia but feel no symptoms. The device isn’t available in the U.S. yet, but it may come to the FDA for approval soon.
Lucentis. Doctors already use this drug to treat the eye disease macular edema in people who don’t have diabetes. But in February 2015, the FDA made it the first eye medication for diabetic retinopathy, a serious eye problem linked to diabetes and a leading cause of blindness among U.S. adults.
Diabetes treatment is getting better every day. Scientists may be just a few years away from making an artificial pancreas that can safely detect and adjust blood sugar (glucose) levels. In the meantime, new medications and insulin devices can make living with diabetes easier and safer now.
“We’re getting more and more options,” says Michael German, MD, clinical director of the Diabetes Center at the University of California, San Francisco. “That’s good because no two people with diabetes are the same. It helps us get the right medicine for each person.”
Progress in Diabetes Care
These treatments are or will soon be available in the U.S.
Afrezza. This insulin inhaler for adults with type 1 and type 2 diabetes hit the market in February 2015. You use it at the beginning of a meal for a boost of short-acting insulin. Unlike an older inhaler, which was the size of a can of shaving cream, Afrezza is easier to use and not as clunky to carry around. “It’s quite small – a little bigger than a whistle,” says Sethu K. Reddy, MD, chief of adult diabetes at Joslin Diabetes Center at Harvard Medical School in Boston. It’s probably not for you if you smoke or have a lung condition like asthma or emphysema.
Medtronic MiniMed 640G. This combined insulin pump and continuous glucose monitor is a step toward the artificial pancreas. It automatically stops pumping insulin when your blood sugar levels are trending down and starts again when they’re back up. “Hypoglycemia [low blood sugar] is a real problem, particularly for people with type 1 diabetes,” German says. It could be especially useful for people who have hypoglycemia but feel no symptoms. The device isn’t available in the U.S. yet, but it may come to the FDA for approval soon.
Lucentis. Doctors already use this drug to treat the eye disease macular edema in people who don’t have diabetes. But in February 2015, the FDA made it the first eye medication for diabetic retinopathy, a serious eye problem linked to diabetes and a leading cause of blindness among U.S. adults.
Newswise — Just over a century has passed since the discovery of insulin, a time period during which the therapeutic powers of the hormone have broadened and refined. Insulin is an essential treatment for type 1 diabetes and often for type 2 diabetes, as well. Roughly 8.4 million Americans use insulin, according to the American Diabetes Association.
One hundred years of research have greatly advanced medical and biochemical understanding of how insulin works and what happens when it is lacking, but the reverse, how potentially fatal insulin hyper-responsiveness is prevented, has remained a persistent mystery.
In a new study, published in the April 20, 2023 online edition of Cell Metabolism, a team of scientists at the University of California San Diego School of Medicine, with colleagues elsewhere, describe a key player in the defense mechanism that safeguards us against excessive insulin in the body.
“Although insulin is one of the most essential hormones, whose insufficiency can result in death, too much insulin can also be deadly,” said senior study author Michael Karin, PhD, Distinguished Professor of Pharmacology and Pathology at UC San Diego School of Medicine.
“While our body finely tunes insulin production, patients who are treated with insulin or drugs that stimulate insulin secretion often experience hypoglycemia, a condition that if gone unrecognized and untreated can result in seizures, coma and even death, which collectively define a condition called insulin shock.”
Hypoglycemia (low blood sugar) is a significant cause of death among persons with diabetes.
In the new study, Karin, first author Li Gu, PhD, a postdoctoral scholar in Karin’s lab, and colleagues describe “the body’s natural defense or safety valve” that reduces the risk of insulin shock.
That valve is a metabolic enzyme called fructose-1,6-bisphosphate phosphatase or FBP1, which acts to control gluconeogenesis, a process in which the liver synthesizes glucose (the primary source of energy used by cells and tissues) during sleep and secretes it to maintain steady supply of glucose in the bloodstream.
Some antidiabetic drugs, such as metformin, inhibit gluconeogenesis but without apparent ill effect. Children born with a rare, genetic disorder in which they do not produce sufficient FBP1 can also remain healthy and live long lives.
But in other cases, when the body is starved for glucose or carbohydrates, an FBP1 deficiency can result in severe hypoglycemia. Without a glucose infusion, convulsions, coma and possibly death can ensue.
Compounding and confounding the problem, FPB1 deficiency combined with glucose starvation produces adverse effects unrelated to gluconeogenesis, such as an enlarged, fatty liver, mild liver damage and elevated blood lipids or fats.
To better understand the roles of FBP1, researchers created a mouse model with liver specific FBP1 deficiency, accurately mimicking the human condition. Like FBP1-deficient children, the mice appeared normal and healthy until fasted, which quickly resulted in the severe hypoglycemia and the liver abnormalities and hyperlipidemia described above.
Gu and her colleagues discovered that FBP1 had multiple roles. Beyond playing a part in the conversion of fructose to glucose, FBP1 had a second non-enzymatic but critical function: It inhibited the protein kinase AKT, which is the primary conduit of insulin activity.
“Basically, FBP1 keeps AKT in check and guards against insulin hyper-responsiveness, hypoglycemic shock and acute fatty liver disease,” said first author Gu.
Working with Yahui Zhu, a vising scientist from Chongqing University in China and second author of the study, Gu developed a peptide (a string of amino acids) derived from FBP1 that disrupted the association of FBP1 with AKT and another protein that inactivates AKT.
“This peptide works like an insulin mimetic, activating AKT,” said Karin. “When injected into mice that have been rendered insulin resistant, a highly common pre-diabetic condition, due to prolonged consumption of high-fat diet, the peptide (nicknamed E7) can reverse insulin resistance and restore normal glycemic control.”
Karin said the researchers would like to further develop E7 as a clinically useful alternative to insulin “because we have every reason to believe that it is unlikely to cause insulin shock.”
Co-authors include: Kosuke Watari, Maiya Lee, Junlai Liu, Sofia Perez, Melinda Thai, Joshua E. Mayfield, Bichen Zhang, Karina Cunha e Rocha, Alexander C. Jones, Igor H. Wierzbicki, Xiao Liu, Alexandra C. Newton, Tatiana Kisseleva, Wei Ying, David J. Gonzalez and Alan R. Saltiel, all at UC San Diego; Fuming Li, University of Pennsylvania and Fudan University, China; Laura C. Kim and M. Celeste Simon, University of Pennsylvania; Jun Hee Lee, University of Michigan.
Funding for this research came, in part, from the National Institutes of Health (grants R01DK120714, R01CA234128, R01DK133448, P01CA104838, R35CA197602, R01DK117551, R01DK125820, R01DK76906, P30DK063491, R21HD107516, R00DK115998, R01DK125560 AND R35GM122523), the UC San Diego Graduate Training Program in Cellular and Molecular Pharmacology (GM007752) and the National Science Foundation Graduate Research Fellowship (#DGE-1650112).
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Disclosure: Michael Karin and Alan Saltiel are founders and stockholders in Elgia Pharmaceuticals. Karin has received research support from Merck and Janssen Pharmaceuticals.
Put aside for a moment all that nutritional advice about eating fruits and vegetables, whole grains and lean proteins. Could one key to good health actually be a diet rich in … ice cream?
That’s the tantalizing question raised by a new story in the Atlantic, which states, “Studies show a mysterious health benefit to ice cream. Scientists don’t want to talk about it.”
Newswise — Scientists in Melbourne have designed a new type of oral capsule that could mean pain-free delivery of insulin and other protein drugs.
Co-lead researcher Professor Charlotte Conn, a biophysical chemist from RMIT University, said protein drugs had proven challenging to deliver orally as the drugs degrade very quickly in the stomach – until now.
“These types of drugs are typically administered with an injection – thousands of diabetics in Australia need insulin injections up to several times a day, which can be unpleasant for the patient and results in high healthcare costs,” said Conn, from RMIT’s School of Science.
She said the new technology could also be used to deliver other protein drugs orally – including a new type of oral antibiotic developed by the RMIT team that can avoid resistance by dangerous superbugs.
“Other protein drugs such as monoclonal antibodies have been developed to treat inflammatory conditions, cancer and other diseases with a projected market value of about $400 billion by 2030,” Conn said.
An international patent application has been filed for RMIT’s technology.
Strong pre-clinical results provide optimism for a new way to deliver insulin
The team has tested the new oral capsule with insulin in a pre-clinical study and the results have been published in the international journal Biomaterials Advances.
“We think the results are really exciting, and we’re doing a suite of pre-clinical testing so we can move to clinical trials as soon as possible,” Conn said.
The research paper assessed the performance of the oral capsules with both fast-acting and slow-acting insulin.
“When controlling the blood-sugar, you need a very fast response if you’re eating a meal. That’s known as fast-acting insulin,” Conn said.
A slow-acting form acts over a much longer timeframe – up to a day or so – to keep the insulin in the body steady. Most diabetics take a combination of both types of insulin.
“We had excellent absorption results for the slow-acting form – about 50% better than injection delivery for the same quantity of insulin,” Conn said.
The capsule achieved good absorption results for fast-acting insulin, but the significant lag in the insulin taking effect compared with injection delivery would likely make it less practical.
“Our results show there is real promise for using these oral capsules for slow-acting insulin, which diabetics could one day take in addition to having fast-acting insulin injections,” Conn said.
“The oral capsules could potentially be designed to allow dosing over specific time periods, similar to injection delivery. We need to investigate this further, develop a way of doing so and undergo rigorous testing as part of future human trials.”
How does the team’s drug capsule work?
Dr Jamie Strachan, the first author on the paper, said the capsule protected the drug inside so that it passed safely through the stomach to the small intestine.
“The capsule has a special coating designed to not breakdown in the low pH environment of the stomach, before the higher pH levels in the small intestine trigger the capsule to dissolve,” said Strachan, from RMIT’s School of Science.
“We package the insulin inside a fatty nanomaterial within the capsule that helps camouflage the insulin so that it can cross the intestinal walls.
“It’s actually similar to how the Pfizer and the Moderna COVID vaccines work where the mRNA in those vaccines is also packaged within fats, helping to keep the drugs active and safe during delivery in the body.”
These vaccines contain mRNA, which is similar to DNA, to safely carry the instructions for making a viral protein within the body, activating our immune system.
A cheaper and more efficient way to deliver protein drugs
Dr Céline Valéry, a pharmaceutical scientist from RMIT and study co-author, said they used the same amount of insulin in the oral capsules and in the injection delivery.
“For many pre-clinical trials the oral formulations by necessity contain much higher levels of insulin to achieve the same response as the injection delivery. This is not a very cost-effective way to deliver protein drugs which tend to be expensive,” said Valéry, from RMIT’s School of Health and Biomedical Sciences.
“It’s a great starting point but we need to do further trials to develop an alternative, pain-free method for the delivery of insulin and other protein drugs.”
‘A promising new oral delivery mode for insulin using lipid-filled enteric-coated capsules,’ is published in Biomaterials Advances (DOI: 10.1016/j.bioadv.2023.213368).
Jamie Strachan, Brendan Dyett, Stanley Chan, Brody McDonald, Ross Vlahos, Céline Valéry and Charlotte Conn are co-authors.
Newswise — Patients with type 1 diabetes live with a constant risk of hyper- or hypoglycemia. Precisely controlled insulin release could help to improve regulation of their blood sugar levels. In the journal Angewandte Chemie, a research team has now introduced a novel insulin formulation that can be switched on by glucose: Lipid nanoparticle carriers release more or less insulin depending on the blood sugar level.
In our bodies, the insulin level in our plasma is primarily regulated by β-cells in the pancreas and reflects fluctuations in the blood sugar level. Patients with type 1 diabetes can produce very little or no insulin and require several daily injections of a fast-acting insulin as well as one or two injections of a long-acting insulin to keep their blood sugar at a normal level. Alternatively, they wear an insulin pump that provides continuous infusion. The insulin formulations cannot react to changes in the blood sugar level and thus do not allow for the precise regulation of blood sugar. If an insulin overdose is administered, a meal is missed, or too little carbohydrate consumed before strenuous physical activity, there is increased risk of acute, life-threatening hypoglycemia.
Insulin formulations that respond to glucose, mimicking the function of β-cells, could improve insulin therapy. Various approaches with insulin “carriers” made of polymers with incorporated glucose oxidase as a glucose detector suffer from two problems: The polymer carriers are not of uniform molecular weight and glucose oxidase is toxic if released into the body.
A Chinese team led by Jinqiang Wang and Zhen Gu at Zhejiang University, Zhejiang Cancer Hospital, and the University of Hong Kong chose a different approach based on biocompatible lipid nanoparticles used as carriers with lipids with uniform chemical structures. Lipid nanoparticles are already in wide clinical use as drug carriers.
A section of the lipids was modified so that the surfaces of the self-aggregated nanoparticles carry many positive charges. Insulin molecules with a negative charge electrostatically bind to the nanoparticles and are released slowly when the blood sugar level is normal. If the blood sugar level is high, certain lipids in the nanoparticles form chemical bonds with the glucose, reducing the positive charge at the surface and significantly accelerating the release of insulin. In diabetic mice treated with the new insulin formulation, it was possible to maintain a normal blood sugar level for six hours. After injection of glucose, the blood sugar in the treated diabetic mice decreased to a normal level just as rapidly as that of healthy mice.
In the Future, a combination of this glucose-responsive insulin formulation with a dispensation device controlled by a wearable electronic sugar detector could significantly improve regulation of the blood sugar level in diabetes patients.
About the Author
Dr Zhen Gu is a Qiushi Distinguished Chair Professor and Dean of the College of Pharmaceutical Sciences at Zhejiang University (China). His research is focused on the design of bioinspired materials for physiological-signal-responsive drug delivery for treating various diseases including cancer and diabetes.
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Gobbling up too many refined wheat and rice products, along with eating too few whole grains, is fueling the growth of new cases of type 2 diabetes worldwide, according to a new study that modelsdata through 2018.
“Our study suggests poor carbohydrate quality is a leading driver of diet-attributable type 2 diabetes globally,” says senior author Dr. Dariush Mozaffarian, a professor of nutrition at Tufts University and professor of medicine at Tufts School of Medicine in Boston, in a statement.
Another key factor: People are eating far too much red and processed meats, such as bacon, sausage, salami and the like, the study said. Those three factors — eating too few whole grains and too many processed grains and meats — were the primary drivers of over 14 million new cases of type 2 diabetes in 2018, according to the study, which was published Monday in the journal Nature Medicine.
In fact, the study estimated 7 out of 10 cases of type 2 diabetes worldwide in 2018 were linked to poor food choices.
“These new findings reveal critical areas for national and global focus to improve nutrition and reduce devastating burdens of diabetes,” said Mozaffarian, who is also the editor in chief of the Tufts Health & Nutrition Letter.
Mozaffarian and his team developed a research model of dietary intake between 1990 and 2018 and applied it to 184 countries. Compared with 1990, there were 8.6 million more cases of type 2 diabetes due to poor diet in 2018, the study found.
Researchers found eating too many unhealthy foods was more of a driver of type 2 diabetes on a global level than a lack of eatingwholesome foods, especially for men compared with women, younger compared to older adults, and in urban versus rural residents.
Over 60% of the total global diet-attributable cases of the disease were due to excess intake of just six harmful dietary habits: eating too much refined rice, wheat and potatoes; too many processed and unprocessed red meats; and drinking too many sugar-sweetened beverages and fruit juice.
Inadequate intake of five protective dietary factors — fruits, nonstarchy vegetables, nuts, seeds, whole grains and yogurt — was responsible for just over 39% of the new cases.
People in Poland and Russia, where diets tend to focus on potatoes and red and processed meat, and other countries in Eastern and Central Europe as well as Central Asia, had the highest percentage of new type 2 diabetes cases linked to diet.
Colombia, Mexico and other countries in Latin America and the Caribbean also had high numbers of new cases, which researchers said could be due to a reliance on sugary drinks and processed meat, as well as a low intake of whole grains.
“Our modeling approach does not prove causation, and our findings should be considered as estimates of risk,” the authors wrote.
Newswise — A research model of dietary intake in 184 countries, developed by researchers at the Friedman School of Nutrition Science and Policy at Tufts University, estimates that poor diet contributed to over 14.1 million cases of type 2 diabetes in 2018, representing over 70% of new diagnoses globally. The analysis, which looked at data from 1990 and 2018, provides valuable insight into which dietary factors are driving type 2 diabetes burden by world region. The study was published April 17 in the journal NatureMedicine.
Of the 11 dietary factors considered, three had an outsized contribution to the rising global incidence of type 2 diabetes: Insufficient intake of whole grains, excesses of refined rice and wheat, and the overconsumption of processed meat. Factors such as drinking too much fruit juice and not eating enough non-starchy vegetables, nuts, or seeds, had less of an impact on new cases of the disease.
“Our study suggests poor carbohydrate quality is a leading driver of diet-attributable type 2 diabetes globally, and with important variation by nation and over time,” says senior author Dariush Mozaffarian, Jean Mayer Professor of Nutrition and dean for policy at the Friedman School. “These new findings reveal critical areas for national and global focus to improve nutrition and reduce devastating burdens of diabetes.”
Type 2 diabetes is characterized by the resistance of the body’s cells to insulin. Of the 184 countries included in the Nature Medicine study, all saw an increase in type 2 diabetes cases between 1990 and 2018, representing a growing burden on individuals, families, and healthcare systems.
The research team based their model on information from the Global Dietary Database, along with population demographics from multiple sources, global type 2 diabetes incidence estimates, and data on how food choices impact people living with obesity and type 2 diabetes from multiple published papers.
The analysis revealed that poor diet is causing a larger proportion of total type 2 diabetes incidence in men versus women, in younger versus older adults, and in urban versus rural residents at the global level.
Regionally, Central and Eastern Europe and Central Asia —particularly in Poland and Russia, where diets tend to be rich in red meat, processed meat, and potatoes —had the greatest number of type 2 diabetes cases linked to diet. Incidence was also high in Latin America and the Caribbean, especially in Colombia and Mexico, which was credited to high consumption of sugary drinks, processed meat, and low intake of whole grains.
Regions where diet had less of an impact on type 2 diabetes cases included South Asia and Sub-Sharan Africa —though the largest increases in type 2 diabetes due to poor diet between 1990 and 2018 were observed in Sub-Saharan Africa. Of the 30 most populated countries studied, India, Nigeria, and Ethiopia had the fewest case of type 2 diabetes related to unhealthy eating.
“Left unchecked and with incidence only projected to rise, type 2 diabetes will continue to impact population health, economic productivity, health care system capacity, and drive heath inequities worldwide,” says first author Meghan O’Hearn. She conducted this research while a PhD candidate at the Friedman School and currently works as Impact Director for Food Systems for the Future, a non-profit institute and for-profit fund that enables innovative food and agriculture enterprises to measurably improve nutrition outcomes for underserved and low-income communities. “These findings can help inform nutritional priorities for clinicians, policymakers, and private sector actors as they encourage healthier dietary choices that address this global epidemic.”
Other recent studies have estimated that 40% of type 2 diabetes cases globally are attributed to suboptimal diet, lower than the 70% reported in the Nature Medicine paper. The research team attributes this to the new information in their analysis, such as the first ever inclusion of refined grains, which was one of the top contributors to diabetes burdens; and updated data on dietary habits based on national individual-level dietary surveys, rather than agricultural estimates. The investigators also note that they presented the uncertainty of these new estimates, which can continue to be refined as new data emerges.
Research reported in this article was supported by the Bill and Melinda Gates Foundation. Complete information on authors, funders, methodology, and conflicts of interest is available in the published paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
Newswise — Analysing changes to DNA in the blood can improve the ability to predict a person’s risk of developing type 2 diabetes within a decade.
Scientists looked at the influence of these changes – known as DNA methylation – alongside other risk factors in almost 15,000 people to predict the likelihood of developing the condition years in advance of any symptoms developing.
The findings could lead to preventative measures being put in place earlier, reducing the economic and health burden caused by type 2 diabetes.
Methylation is a chemical process in the body in which a small molecule called a methyl group is added to DNA.
Current risk prediction tools for type 2 diabetes use information such as age, sex, BMI and family history of the disease.
Researchers from the University of Edinburgh found that the inclusion of DNA methylation data alongside these risk factors provided a more accurate prediction.
The scientists used their results to estimate the predictive performance using a hypothetical screening scenario of 10,000 people, where one in three individuals develop type 2 diabetes over a 10-year period.
The model that used DNA methylation correctly classed an extra 449 individuals compared with traditional risk factors alone.
The addition or removal of these methyl groups can affect how some molecules act in the body. These methylation patterns can help to track ageing processes and development of disease.
Data came from 14,613 volunteers in the Generation Scotland study – a large study designed to help scientists investigate the causes of disease, understand the country’s healthcare priorities, and inform future medical treatments and health policies.
The team also repeated the analyses in 1,451 individuals from a study based in Germany to ensure their findings could be replicated in people from different backgrounds.
Type 2 diabetes is a serious condition where the insulin a pancreas makes cannot work properly, or a pancreas cannot make enough insulin. This can lead to high blood sugar levels and, in turn, a range of health issues such as heart diseases and stroke, nerve damage and foot problems.
More than 4.9 million people live with diabetes in the UK, with 90 per cent of those with type 2.
The study is published in the journal Nature Aging: https://www.nature.com/articles/s43587-023-00391-4. Researchers from the University of Edinburgh were supported by experts at the University of Helsinki, the German Research Center for Environmental Health (GmbH) and the German Center for Diabetes Research (DZD).
Yipeng Cheng, a PhD student from the University of Edinburgh’s Centre for Genomic and Experimental Medicine, said: “It is promising that our findings were observed in the Scottish and German studies with both showing an improvement in prediction above and beyond commonly used risk factors. Delaying onset is important as diabetes is a risk factor for other common diseases, including dementias.”
The study’s principal investigator, Professor Riccardo Marioni, also from the University of Edinburgh’s Centre for Genomic and Experimental Medicine, said: “Similar approaches could be taken for other common diseases to generate broad health predictors from a single blood or saliva sample. We are incredibly grateful for our study volunteers who make this research possible – the more people that join our study, the more precisely we can identify signals that will help delay or reduce the onset of diseases as we age.”
Generation Scotland is currently recruiting volunteers and has recently opened to young people aged between 12 and 15 for the first time. Anyone who lives in Scotland can sign up online at www.generationscotland.org
Advisers to the World Health Organization will consider next month whether to add liraglutide, the active ingredient in certain diabetes and obesity medications, to its list of essential medicines.
The list, which is updated every two years, includes medicines “that satisfy the priority health needs of the population,” WHO says. “They are intended to be available within the context of function health systems at all times, in adequate amounts in the appropriate dosage forms, of assured quality and at prices that individuals and the community can afford.”
The list is “a guide for the development and updating of national and institutional essential medicine lists to support the procurement and supply of medicines in the public sector, medicines reimbursement schemes, medicine donations, and local medicine production.”
The WHO Expert Committee on the Selection and Use of Essential Medicines is scheduled to meet April 24-28 to discuss revisions and updates involving dozens of medications. The request to add GLP-1 receptor agonists such as liraglutide came from four researchers at US institutions including Yale University and Brigham and Women’s Hospital.
These drugs mimic the effects of an appetite-regulating hormone, GLP-1, and stimulate the release of insulin. This helps lower blood sugar and slows the passage of food through the gut. Liraglutide was developed to treat diabetes but approved in the US as a weight-loss treatment in 2014; its more potent cousin, semaglutide, has been approved for diabetes since 2017 and as an obesity treatment in 2021.
The latter use has become well-known thanks to promotions from celebrities and on social media. It’s sold under the name Ozempic for diabetes and Wegovy for weight loss. Studies suggest that semaglutide may help people lose an average of 10% to 15% of their starting weight – significantly more than with other medications. But because of this high demand, some versions of the medication have been in shortage in the US since the middle of last year.
The US patent on liraglutide is set to expire this year, and drugmaker Novo Nordisk says generic versions could be available in June 2024.
The company has not been involved in the application to WHO, it said in a statement, but “we welcome the WHO review and look forward to the readout and decision.”
“At present, there are no medications included in the [Essential Medicines List] that specifically target weight loss for the global burden of obesity,” the researchers wrote in their request to WHO. “At this time, the EML includes mineral supplements for nutritional deficiencies yet it is also described that most of the population live in ‘countries where overweight and obesity kills more people than underweight.’ “
WHO’s advisers will make recommendations on which drugs should be included in this year’s list, expected to come in September.
“This particular drug has a certain history, but the use of it probably has not been long enough to be able to see it on the Essential Medicines List,” Dr. Francesco Blanca, WHO director for nutrition and food safety, said at a briefing Wednesday. “There’s also issues related to the cost of the treatment. At the same time, WHO is looking at the use of drugs to reduce weight excess in the context of a systematic review for guidelines for children and adolescents. So we believe that it is a work in progress, but we’ll see what the Essential Medicines List committee is going to conclude.”
Newswise — Most of the time, when someone gets a cut, scrape, burn, or other wound, the body takes care of itself and heals on its own. But this is not always the case. Diabetes can interfere with the healing process and create wounds that will not go away and that could become infected and fester.
These kinds of chronic wounds are not just debilitating for the people suffering from them. They are also a drain on healthcare systems, representing a $25 billion financial burden in the United States alone each year.
A new kind of smart bandage developed at Caltech may make treatment of these wounds easier, more effective, and less expensive. These smart bandages were developed in the lab of Wei Gao, assistant professor of medical engineering, Heritage Medical Research Institute Investigator, and Ronald and JoAnne Willens Scholar.
“There are many different types of chronic wounds, especially in diabetic ulcers and burns that last a long time and cause huge issues for the patient,” Gao says. “There is a demand for technology that can facilitate recovery.”
Unlike a typical bandage, which might only consist of layers of absorbent material, the smart bandages are made from a flexible and stretchy polymer containing embedded electronics and medication. The electronics allow the sensor to monitor for molecules like uric acid or lactate and conditions like pH level or temperature in the wound that may be indicative of inflammation or bacterial infection.
The bandage can respond in one of three ways: First, it can transmit the gathered data from the wound wirelessly to a nearby computer, tablet, or smartphone for review by the patient or a medical professional. Second, it can deliver an antibiotic or other medication stored within the bandage directly to the wound site to treat the inflammation and infection. Third, it can apply a low-level electrical field to the wound to stimulate tissue growth resulting in faster healing.
In animal models under laboratory conditions, the smart bandages showed the ability to provide real-time updates about wound conditions and the animals’ metabolic states to researchers, as well as offer speed healing of chronic infected wounds similar to those found in humans.
Gao says the results are promising and adds that future research in collaboration with the Keck School of Medicine of USC will focus on improving the bandage technology and testing it on human patients, whose therapeutic needs may be different than those of lab animals.
“We have showed this proof of concept in small animal models, but down the road, we would like to increase the stability of the device but also to test it on larger chronic wounds because the wound parameters and microenvironment may vary from site to site,” he says.
The paper describing the research, “A stretchable wireless wearable bioelectronic system for multiplexed monitoring and combination treatment of infected chronic wounds,” appears in the March 24 issue of the journal Science Advances. Co-authors are postdoctoral scholar research associates in medical engineering Ehsan Shirzaei Sani and Yu Song; medical engineering graduate students Changhao Xu (MS ’20), Canran Wang, Jihong Min (MS ’19), Jiaobing Tu (MS ’20), Samuel A. Solomon, and Jiahong Li; and Jaminelli L. Banks and David G. Armstrong of the Keck School of Medicine of USC.
Funding for the research was provided by the National Institutes of Health, the National Science Foundation, the Office of Naval Research, the Heritage Medical Research Institute, the Donna and Benjamin M. Rosen Bioengineering Center at Caltech, the Rothenberg Innovation Initiative at Caltech, and a Sloan Research Fellowship.
Newswise — In early March, Eli Lilly made headlines after announcing a new $35 price cap on insulin for individuals with private insurance. Novo Nordisk and Sanofi made their own price reduction announcements shortly after Eli Lilly’s move.
Can you discuss the impact the new price caps will have for patients?
Pop-Busui: Diabetes is the most expensive chronic disease in the United states. As many as one in four Americans compromise their health by rationing insulin because they cannot afford it, and as a result skip or ration doses to make ends meet. For millions of Americans, skyrocketing insulin prices have made it financially out of reach. Additionally, diabetes prevalence is inversely related to household income level, with the poorest communities seeing the highest rates.
According to the National Institutes of Health, those who earn less than $30,000 per year are three times as likely to have diabetes than those who make over $80,000 per year; additionally, those lower on the socioeconomic status ladder are more likely to develop diabetes, experience more complications and die sooner than those higher up on the SES ladder. Moreover, Black and Hispanic individuals are more than 50% more likely to have diabetes than non-Hispanic white individuals and are 2.3 times more likely to die from diabetes than their white counterparts.
Prices for insulin nearly tripled between 2002 and 2013. Thus, there is an insulin affordability crisis in America that impacts over 90 million Americans living with diabetes. Often, they must choose between basic living expenses and lifesaving medication.
The American Diabetes Association has been at the forefront and is the leading voice advocating for insulin affordability for years. The ADA is working to ensure that all people with diabetes have access to the care they need.
Would this have any impact on how insurers can cover insulin?
Pop-Busui: Policymakers must use co-pay caps and other policies to make diabetes treatment more affordable. The Inflation Reduction Act is helping 3.9 million Americans living with diabetes on Medicare to afford insulin. But millions are not able to afford their insulin, even with their employer insurance.
Representatives Angie Craig, Dan Kildee and Lucy McBath reintroduced the Affordable Insulin Now Act, creating a $35 monthly copay cap for insulin in commercial insurance plans. The legislation previously failed to pass, but the ADA is actively supporting it today.
The ADA also supported the INSULIN Act, introduced by Senators Jeanne Shaheen and Susan Collins last year and continues to work with the Diabetes Caucus co-chairs to advance a price limit on insulin in commercial plans.
What implications does this have for other companies like Eli Lilly? Is it possible that others will follow in their footsteps?
Pop-Busui: This step Eli Lilly is taking is an important one. By limiting cost-sharing for its insulin, it’s encouraging other insulin manufacturers to do the same.
While we have been able to help achieve significant progress on the issue of insulin affordability, including Medicare’s new out-of-pocket cost cap on insulin, state copay caps and patient assistance developments from insulin developers, our work is far from done. For instance, a key area the ADA is focused on includes supporting insulin co-pay cap legislation in more than 10 states. States that have passed legislation include Alabama, Colorado, Connecticut, Delaware , District of Columbia, Illinois, Kentucky, Louisiana, Maine, Maryland, Minnesota, New Hampshire, New Mexico, New York, Oklahoma, Oregon, Rhode Island, Texas, Utah, Vermont, Virginia, Washington and West Virginia.
WEDNESDAY, March 15, 2023 (HealthDay News) — Diabetes is a known risk factor for mental decline and dementia. Paired with total tooth loss, the potential harm to the brain is even more significant, new research indicates.
The findings highlight the importance of good dental care and diabetes control in aging adults, said Bei Wu, lead author of a new study of nearly 10,000 adults.
“Access to dental care for older adults, especially those with diabetes, is really important,” said Wu, vice dean for research at the New York University Rory Meyers College of Nursing and co-director of the NYU Aging Incubator in New York City.
The American Diabetes Association recommends regular dental checkups for anyone with diabetes — “but how many people are following that and how many clinicians are recommending this?” Wu said.
On its own, poor oral health, especially gum disease and tooth loss, has also been linked to cognitive impairment and dementia.
Wu notes that researchers are now beginning to understand how oral health, diabetes and cognitive decline may exacerbate one another.
“We need to raise awareness of this,” she said.
Inflammation plays a role in both diabetes and gum disease, the study notes. These inflammatory processes may contribute to declines in reasoning and thinking skills — so-called cognitive decline.
Poor nutrition is another pathway. Having painful gums and missing teeth can make it difficult to chew healthy food. This can lead to nutritional deficiency. The impaired blood sugar levels and insulin sensitivity found in diabetes can also worsen nutritional deficiency, according to the study.
And certain bacteria related to chronic periodontitis, or gum disease, may also affect cognitive function, Wu said.
To study this in combination, the researchers divided older adults into groupings by age: 65 to 74, 75 to 84 and 85 and older.
The researchers used data from the University of Michigan’s Health and Retirement Study for 2006 to 2018, which measured memory and cognition every two years. This included 9,948 older adults.
In adults ages 65 to 84, those with diabetes and complete tooth loss together had the highest rate of accelerated mental decline compared to those with neither condition.
Those with just diabetes ages 65 to 74 or just complete tooth loss ages 65 to 84 also had faster cognitive decline.
But mental decline was fastest in those ages 65 to 74 with both diabetes and total tooth loss.
Researchers did not find conclusive evidence linking mental decline with toothlessness and diabetes in adults ages 85 and older.
They theorized that perhaps the less healthy among this group had already died before their reaching their late 80s. Or it’s possible that this age group already had greater cognitive impairment.
Wu noted that the study is observational and can’t prove cause and effect.
Cautioning that he is not a diabetes expert, Dr. Cyprien Rivier, a postdoctoral fellow in neurology at Yale School of Medicine, said the connections between diabetes and periodontitis make sense. Rivier was not involved in the study.
Experts are aware that inflammation leads to changes in the microarchitecture of the brain.
“We know that when there are high levels of systemic inflammations, the white matter is getting a bit more disorganized,” Rivier said.
This leads to worse brain health and cognitive outcomes, he said.
Mouth health is very important for other areas of the body, including heart health, Rivier noted. For example, the American Heart Association says patients who’ve had heart valve issues must take antibiotics before certain dental procedures because of bacteria that can travel through the bloodstream.
“The effects of oral health on the whole body are now really well-defined,” Rivier said.
More studies are needed to assess these connections, yet good dental health is an easy and important target for improving health, Rivier said.
“It’s rather inexpensive. It’s pretty easy to improve oral health on a population level,” Rivier said.
The study authors say older adults who have poor dental health and diabetes would benefit from cognitive screenings from their primary care providers.
The study findings were published March 12 in the Journal of Dental Research.
More information
The U.S. National Institute on Aging has more on cognitive health and older adults.
SOURCES: Bei Wu, PhD, vice dean for research, New York University Rory Meyers College of Nursing and co-director, NYU Aging Incubator, New York City; Cyprien Rivier, MD, MSc, postdoctoral fellow, neurology, Yale School of Medicine, New Haven, Conn.; Journal of Dental Research, March 12, 2023
Newswise — Individuals with Type 1 diabetes have a smaller pancreas than people without diabetes. This is surprising because insulin-producing beta cells account for just a small fraction of the pancreas, so the loss of beta cells in Type 1 diabetes would not be expected to reduce pancreas size.
Now, a study of one family from Alabama has led Vanderbilt University Medical Center researchers to discover that insulin deficiency, independent of the autoimmunity associated with Type 1 diabetes, is the principal factor leading to a markedly smaller pancreas.
Four members of this family of eight have monogenic diabetes from a rare mutation in the insulin gene, leading to insulin deficiency without autoimmunity. Magnetic resonance imaging (MRI) of the pancreas showed a reduced size and altered shape in the individuals with diabetes. This was similar to what had previously been observed in individuals with Type 1 diabetes. These new findings are published in Diabetes Care, a journal of the American Diabetes Association.
“This is a wonderful story about the power of a single family to inform us about the process of a disease that affects millions of people,” said Daniel Moore, MD, PhD, associate professor of Pediatrics in the Ian Burr Division of Pediatric Endocrinology and Diabetes. “There are not many families, especially not large families, who are known to have exactly this form of diabetes, who could come forward to help us answer this question. But they responded to the call, and they’ve provided a really clear answer to a fundamental biologic question.”
About two decades ago, David Pursell and his wife, Ellen, agreed that he and three of their six children who were diagnosed with diabetes would participate in research with the hope more could be learned about the disease. It was as simple as giving a little blood.
They were surprised years later when a researcher from the University of Chicago’s Kovler Diabetes Center called to tell them that advances in science had revealed that the four actually had monogenic diabetes due to a mutation in the insulin gene instead of Type 1 diabetes.
Last year, the Pursells were contacted by VUMC researchers who were collaborating with Siri Greeley, MD, PhD, and colleagues at the Kovler Diabetes Center’s Monogenic Diabetes Registry. The Vanderbilt research team asked if the family could travel to Nashville to have precise measurements of their pancreas taken at the Medical Center.
The VUMC research team, which includes Moore, Jordan Wright, MD, PhD, Jon Williams, PhD, Melissa Hilmes, MD, and Alvin C. Powers, MD, along with colleague Jack Virostko, PhD, at The University of Texas at Austin, had previously found the reduction in pancreas size was present at the time of Type 1 diabetes diagnosis. The Vanderbilt investigators had also organized an international team, the Multicenter Assessment of the Pancreas in Type 1 Diabetes (MAP-T1D), to develop a standardized MRI imaging protocol to assess pancreas volume and microarchitecture.
“We know the pancreas is much smaller in individuals with Type 1 diabetes, but there haven’t been good models to understand exactly what’s going on,” said Wright, an instructor in the Division of Diabetes, Endocrinology and Metabolism and first author on the manuscript. “This is the first time we can actually demonstrate in humans that insulin is a major factor in determining pancreas size and the loss of it leads to a much smaller pancreas.”
David and Ellen and their now adult children, Peggy Rice, Vaughan Spanjer, Chrissy Adolf, Ramsey Nuss, and twin sons Parker and Martin Pursell, each had their pancreas size measured using the standardized Vanderbilt MRI protocol. David, Chrissy, Parker and Martin have monogenic diabetes.
“When we talked to the doctors at Kovler, they asked if we’d be interested in participating in some trials or research and we said, ‘Of course, anything we can do,’” said David Pursell. “When we learned our diabetes was not caused by an immune response due to our islet cells being attacked by antibodies, then we thought maybe we’ve got the chance of getting an islet cell transplant.
“But also, we’re obviously all in this together. If, by virtue of our family volunteering for this research we can help anyone else, we felt like it would be worth it.”
This research was performed with assistance from the Vanderbilt University Institute of Imaging Sciences (National Institutes of Health [NIH] project 1S10OD021771-01), the Vanderbilt Institute for Clinical and Translational Research (UL1-TR000445) and the Institute for Translational Medicine (UL1-TR000430) and with the support of the Leona M. and Harry B. Helmsley Charitable Trust, the Juvenile Diabetes Research Foundation, the Doris Duke Charitable Foundation, the NIH (DK104942, DK129979) and the Vanderbilt and Chicago Diabetes Research and Training Centers (DK20593, DK20595).
March 7, 2023 — If you think the biggest risk factor to good health is smoking or genetics, think again.
According to Stephen Kopecky, MD, a preventive cardiologist at the Mayo Clinic, “nutrition is now the number one cause of early death and early disease in our country and the world.” Moreover, he says that while having genes for disease will increase your risk by 30% to 40%, having a bad lifestyle for disease will increase your risk by 300% to 400%.
About 20 years ago, Kopecky says, the cause of death worldwide changed from infection to non-infection (like non-communicable diseases). “In those last 20 years, that’s grown in terms of what kills us and what gets us sick,” he says. “The three big non-communicable diseases are heart disease, cancer, and rapidly rising is Alzheimer’s. But there’s also diabetes, obesity, and high blood pressure — all those things are also related to diet.”
Forty-eight-year-old James, of Fredericksburg, VA, knows this all too well. James asked that his last name not be printed, to protect his privacy. For the last 30 years, he’s been managing type 1 diabetes and complications of insulin resistance, along with high blood pressure, high cholesterol, thyroid disease, and low testosterone. As a former Division 1 college athlete, James exercised regularly and ate what he believed to be a responsible diet.
“Those weirdos in the gym at 5 a.m. who eat chicken salads for every lunch? Yeah, that’s me,” says James.
But he went from a playing weight of 202 pounds to 320 pounds, despite continuing to lift weights and do cardiovascular exercise at least 5 days a week. “Whenever I went to the doctor and stepped on the scale, I got skeptical looks when I made claims of ‘exercising and eating right.’ In all honesty, I thought I was,” says James, noting he followed a low-carb, high-protein diet. “But I didn’t count calories or consider the impact of fat on my already insulin-resistant body,” he says.
After visiting many health professionals, James finally found success with Nancy Farrell Allen, a registered dietitian nutritionist.
Previous doctors applauded his diet, but Allen explained that his insulin resistance was linked to the amount of fat James consumed. “The more fat in my system, the more insulin I needed to inject,” he says. “The more insulin I injected, the more weight I’d gain. The more weight I’d gain, the more insulin I’d inject, continuing this regrettable cycle.”
Allen suggested he shift his diet to a more balanced approach, with a strict eye on fat. “She completely changed my way of thinking about food, broke my belief that all carbs are bad, helped me identify my daily caloric needs, and focused me on eating a balanced diet enriched with fiber,” says James, who then lost 45 pounds in 3 months. “I found myself having more energy, sleeping better, focusing better, and taking less insulin than I had in nearly 20 years,” he says.
Another patient, Sheila Jalili of Miami, took a proactive approach to her health when she turned 40, getting some tests and lab work done for a baseline comparison. “My BMI was around 20, I exercise every day, and I don’t have any diseases in my family,” Jalili says, noting everything checked out fine.
She continued her annual checkups and tests, noticing her triglycerides and cholesterol numbers increasing. When her cholesterol reached alarming levels and her triglycerides skyrocketed to 1,230, she met with Kopecky, the Mayo Clinic cardiologist, who prescribed fish oil and asked about her diet. Jalili started tracking what she ate and did an exhaustive review of her fridge contents, noting the sodium levels, cholesterol levels, and fat levels in the foods.
To her surprise, she discovered she ate a lot of unhealthy carbs and fats. “I went into overload. I changed everything. I did so much research,” she says. After 42 days of eating extremely healthy, she dropped her total cholesterol by about 100, halved her HDL, and reduced her triglycerides from 1,238 to 176.
A bad lifestyle often starts with what you eat — and what you don’t. Even if you think you’re eating healthy, you might want to revisit your diet. In particular, reconsider ultra-processed foods (like doughnuts, hot dogs, and fast-food burgers). Though convenient and affordable, they’re inflammatory and, over time, can cause many health issues.
“It bothers our tissues, our heart, our arteries, our brains, our pancreas, our liver, and our lungs, and that leads to disease,” Kopecky says. “It could be in the brain with Alzheimer’s, the heart with coronary artery disease, or cancers elsewhere.”
Ideally, you’d immediately overhaul an unhealthy diet. But that’s not a reality for most people. Making sweeping changes all at once can feel overwhelming. Take small steps instead.
Baby-Step Your Way to a Healthier Diet
Before making any dietary changes, Selvi Rajagopal, MD, MPH, advises having a conversation with your health care provider to figure out your specific health status. Rajagopal, assistant professor of medicine at Johns Hopkins University, says that, generally speaking, everyone will benefit from eating a balanced, healthy diet filled with a variety of nutrient-rich foods.
That includes fruits, vegetables, whole grains, lean protein, low-fat/fat-free dairy, and healthy fats. However, talking with your doctor can help you identify any specific nutrient deficiencies, health issues, and lifestyle factors that need to be addressed. Then you can devise a healthy eating plan that works specifically for your needs.
Revamp how you organize your refrigerator. Most refrigerators put two opaque drawers labeled “Fruits” and “Vegetables” at the bottom, where you’re least likely to see them. Kopecky advises moving your produce to eye level and put the less-healthy options in those bottom drawers. “When we open the fridge, that’s what we see, and that’s what we tend to eat,” he says.
Change your perspective. “There isn’t one healthy weight or one healthy size,” says Rajagopal. Don’t aim for a number on the scale or a certain BMI or certain clothing size. Every body is different, not only in shape and size, but in health risk factors. Also, many people feel really overwhelmed trying to “be healthy.” Rajagopal says, “Healthy is just trying to do something to improve your health, and that improvement can be really small.”
Understand how to read food labels. Allen takes every patient to the grocery store to read and understand food labeling and to highlight different foods. She shares the guidelines below with her patients.
Fat: Low-fat foods contain 3 grams of fat or less per serving.
Sugar: Four grams equal 1 teaspoon. When a serving of sugar lists 12 grams of sugar in a 2/3-cup serving, that means it contains roughly 3teaspoonsof sugar.
Fiber: A naturally high-fiber food can contain about 5 grams of fiber per serving.
Sodium: A low-sodium food contains less than or equal to 140 milligrams of sodium per serving.
Protein: Seven grams of protein equal about 1 ounce of protein.
This approach is particularly important as the FDA is exploring a change in which foods can be labeled as healthy. The agency in September unveiled a proposed rule to try and counter the fact that, as the agency claims, more than 80% of people in the U.S. aren’t eating enough vegetables, fruit, and dairy. And most people consume too much added sugars, saturated fat, and sodium.
Under the proposed rule, in order to be labeled “healthy” on food packaging, products must contain “a certain meaningful amount” of food from at least one of the food groups or subgroups (e.g., fruit, vegetable, dairy, etc.) recommended by the agency’s dietary guidelines.
They must also stick to specific limits for certain nutrients, such as saturated fat, sodium, and added sugars.
Breakfast cereals, for example, would need to contain 0.75 ounces of whole grains and contain no more than 1 gram of saturated fat, 230 milligrams of sodium, and 2.5 grams of added sugars to qualify, the agency said.
Don’t fear carbs or fat! Your body needs both to survive, as carbs help fuel your body and fat helps your body absorb fat-soluble nutrients like vitamins A, D, and E. But not all carbs or fats are equal. Choose complex carbohydrates found naturally in plant-based foods (like fruits, vegetables, and whole grains) over simple carbohydrates often found in processed foods (like white bread, enriched pasta, and white rice).
Similarly, strive to include healthy, unsaturated fats (including polyunsaturated and monounsaturated fats) found in foods such as fatty fish, vegetable oils, avocadoes, and some seeds and nuts. Avoid foods with unhealthy saturated and trans fats found primarily in animal products (such as meat, eggs, high-fat dairy) and highly processed foods (frozen pizza and microwave popcorn). “Having a baseline understanding of what this means makes you a much savvier consumer,” says Rajagopal, who suggests going to the U.S. Department of Agriculture’s website to learn about these food components.
Adopt healthier cooking methods. Maybe you’re buying healthy foods but preparing them in unhealthy ways. That lean, skinless chicken breast just got a lot less healthy once you breaded it, deep-fried it, and smothered it with cheese. Allen suggests lighter, leaner techniques such as baking, roasting, grilling, and steaming. “Frying, sautéing, breading, au gratin, buttery, and Alfredo all add additional calories to burn off,” says Allen.
Start small. Eliminate the all-or-nothing thinking, such as, “I want to cut out all sugar” or “I want to cook all my meals at home.”
If you’ve been eating sugar your whole life or eating dinner out 5 nights a week, eliminating this bad habit at once is a huge undertaking. Instead, start small. For instance, reduce one sugary food item you frequently eat.
“Maybe it’s soda,” says Rajagopal. “Maybe you go from four cans of soda a day to two cans. Make one change and see how it goes for a week or two.”
Ditto for cooking — aim to add one more home-cooked meal a week rather than trying to cook at home 7 days a week. She also advises bringing in an accountability buddy to help you stay on track.
Take one bite. “If you take a bite of a ground meat or sausage and replace that with a bite of something that’s a little healthier — like black beans or a vegetable — then, after doing this for a couple of years, that actually reduces your risk of heart attack and reduces your risk in the long-term of cancers and Alzheimer’s,” advises Kopecky. “Literally one bite difference.”
By making small, consistent changes, they can have a big impact over time. Pick one tip that resonates most, implement it, and stick to it until it becomes second nature. Once mastered, move on to another tip, building on that foundation of success.
March 6, 2023 — More than 80% of U.S. adults with type 2 diabetes meet the criteria to use new treatment drugs, such as semaglutide, which is marketed as Ozempic, according to a new study published in the Annals of Internal Medicine.
However, only about 1 in 10 of those who meet the criteria used the drugs in recent years, the study found. In addition, the high prices for some of the drugs means they may put them out of reach as the first drug treatment for these patients. Most people with type 2 diabetes are prescribed metformin initially, but generally have other medications added on, but some of the newer drugs are now recommended as first-line treatment for some.
“It’s critical that we continue to study the best ways to manage type 2 diabetes (including medications and lifestyle changes), but it’s also important to examine how available these methods are to people,” says lead author Shichao Tang, PhD, a researcher with the Division of Diabetes Translation at the CDC’s National Center for Chronic Disease Prevention.
“This includes researching how many people are using certain tools or medications and how many people are eligible for them, which was the aim of this study,” Tang says.
A 2022 report from the American Diabetes Association and European Association for the Study of Diabetes recommended the use of certain drugs, such as Ozempic, which is given as a weekly injection, with other similar drugs available as daily injections, and oral tablets, for patients with type 2 diabetes.
This is because, as well as lowering blood sugar, these new drugs have been found to reduce the risks of complications of diabetes, such as heart disease and kidney disease, and they also result in weight loss, compared with older drugs.
The researchers estimated that, for the 22.4 million U.S. adults with diagnosed type 2 diabetes, about 82.3% would meet the recommended criteria to use drugs from these two new classes. About 94.5% of Medicare recipients with type 2 would be recommended to use them as well.
However, only 3.7% of those who met the criteria used them during the study period and just 5.3% of those eligible for the oral tablets used them.
About 9.1% used either of them before the most recent 2022 guidelines, which opened up the medications as first-line treatment for patients with type 2 diabetes.
Based on retail prices listed on a US-based website, a 30-day supply of an oral tablet drug can cost about $550-$600/month, while common injected drugs can run from a few hundred dollars for a daily injection or close to $1,000 for a version given weekly.
Prior studies suggest that the two drug types could be cost-effective as second-line treatments, the authors note. However, the current costs would need to drop by 70% for them to be cost-effective as first-line treatments.
Additional studies are needed to understand if the new treatments are cost-effective for certain patient subgroups as first-line medications.
Newswise — As a popular diabetes drug takes social media by storm as a quick fix for weight loss, experts warn, not only is there no magic pill when it comes to losing weight, but this off-label use can actually backfire, possibly doubling the weight that was lost, once the medication is stopped.
According to the National Institute of Health, more than 2 in 5 adults are obese. With obesity linked to a number of diseases, including diabetes, heart disease, stroke, and cancers including breast and colorectal, these statistics are a major cause for concern.
But there is hope according to a new study published in the journal Obesity that found people with severe obesity, who underwent bariatric surgery, were significantly less likely to die from heart disease, diabetes, or cancer, compared with people with severe obesity who didn’t have the surgery.
“Bariatric surgery alters the digestive system to help people lose weight,” explains Dr. Hans Schmidt, chief, Bariatric Surgery at Hackensack University Medical Center. “The benefits of bariatric surgery can far outweigh the possibility of any complications.”
Dr. Schmidt says when multiple attempts at weight loss fail, bariatric surgery is often the best option because it actually reduces the stomach’s storage capacity, limiting food intake to help people feel full, faster.
Nobody knows this better than 38 year old Alex Monteleone, a detective with the Palisades Park Police Department, who underwent bariatric surgery in 2018. Alex not only lost nearly 100 pounds, he’s also no longer on the verge of diabetes or high blood pressure.
Alex Monteleone
For more information on this life saving procedure or to book interviews with Dr. Schmidt and his patients, contact .
Pharmaceutical giant Eli Lilly announced that it will cut insulin prices by up to 70% and cap out-of-pocket costs at $35. Lilia Luciano has the details.
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Newswise — The National Institutes of Health has awarded Rutgers a $3.5 million grant to conduct a five-year study exploring the impact medications have on older adults with multiple medical conditions.
The goal of researchers from Rutgers Center for Pharmacoepidemiology and Treatment Science (PETS) is to provide patients with multiple chronic conditions, caregivers and health care providers with information needed to make informed treatment decisions.
“Unfortunately, most clinical trials of medications do not include patients with multimorbidity, which means that there is little data available about the risks and benefits of medications in this population,” said Chintan Dave, assistant director at PETS and the principal investigator of the National Heart, Lung and Blood Institute grant-backed project. “This lack of information makes it difficult for health care providers to make informed decisions about treating patients with multiple medical conditions.”
“With over 36 million older adults in the U.S. affected by multimorbidity, this is a pressing issue that requires immediate attention,” said Dave, who also is a core faculty member of the Rutgers Institute for Health, Health Care Policy and Aging Research (IFH) and an assistant professor with Rutgers Ernest Mario School of Pharmacy.
Dave and his colleagues will use data from more than 23 million patients to learn how having multiple conditions affects the benefits and risks of medications, representing the first effort to systematically evaluate the impact of multimorbidity on medication related outcomes. Specifically, researchers will examine medication use and outcomes in three highly prevalent chronic conditions: Type 2 diabetes, atrial fibrillation and atherosclerotic cardiovascular disease.
Coinvestigators involved in the study include Brian Strom, the chancellor of Rutgers Biomedical and Health Sciences; Tobias Gerhard, interim director of IFH and director of PETS; Jason Roy, a professor of biostatistics and chair of the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health; Soko Setoguchi, a core faculty member at PETS and IFH, professor of medicine at Rutgers Robert Wood Johnson Medical School and professor of epidemiology at Rutgers School of Public Health; and Melissa Wei, an assistant professor of medicine in residence at the David Geffen School of Medicine at University of California, Los Angeles.
The grant was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL163163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Hannah Crabtree got active on Twitter in 2016 to find more people like herself: those with Type 1 diabetes who’d hacked their insulin pumps to automatically adjust the amount of insulin delivered.
Soon, though, Crabtree found a more critical diabetes-related conversation happening on Twitter: rising insulin prices.
Crabtree’s mother, who also had diabetes, died in 2006 of complications from rationing expensive insulin. Most people naturally produce the hormone, which helps the body convert carbohydrates into energy. People with Type 1 diabetes don’t produce enough, so they need injectable insulin to stay alive.
But the medication has become increasingly expensive. One version rose in price from $21 to $255 per vial between 1996 and 2016, for example, and Crabtree had often wondered in the years after her mother died why more people weren’t talking about the issue. On Twitter, she found the people who were doing just that.
Crabtree, a 32-year-old accountant in the Virginia suburbs of Washington, D.C., became part of a small group of patient activists who have managed to turn U.S. insulin prices into a kitchen table issue in part through their use of Twitter.
But these activists have long called for caps on insulin prices, not just copays, and Biden’s measure is unlikely to gain traction in the current Congress, let alone address the broader concerns about the high prices of many other types of medications that patients struggle to afford. The political intransigence reveals the limitations of Twitter as a platform for patient advocacy, despite recent successes. Some advocates now say they have scaled back their use of the platform, as trolls grow bolder with Elon Musk now in charge of Twitter and journalists and politicians eyeing other platforms.
“Twitter is a lifeline for a lot of diabetics,” said Nicole Smith-Holt, an activist in Minnesota, pointing to the insulin sharing that happens via the platform. “I fear we’re going to lose a main resource for a lot of people.”
Like others seeking change, such as disability rights advocates and the Black Lives Matter movement, diabetes activists have used social media hashtags to find one another, build momentum, and change the public conversation.
Alice Wong, a disabled activist in San Francisco who helped create the #cripthevote hashtag to give people with disabilities a voice in the 2016 election, said people downplay “armchair activism” as something frivolous and inferior to grassroots organizing.
“But effective activism has to meet people where they are,” she said. Despite Twitter’s many flaws and accessibility issues, Wong said, it has been a primary way for many people with disabilities to express themselves.
Many prominent voices on what some call Diabetes Twitter have a personal connection to high insulin prices, having struggled to afford it themselves or had family members die because of rationing. Like Crabtree, though, they often joined the online conversation through happenstance, with an everyday gripe about living with diabetes blowing up after strangers retweeted it with the hashtag #insulin4all.
The hashtag was created in part by T1 International, a nonprofit that advocates for people with Type 1 diabetes and doesn’t take donations from pharmaceutical companies. The organization was founded in 2014 by Elizabeth Pfiester, who saw a need for an organization directly addressing insulin affordability.
Diabetes activists have sometimes been wary of the standard-bearer organizations, such as the American Diabetes Association and JDRF, formerly the Juvenile Diabetes Research Federation, because they receive money from drugmakers. ADA spokesperson Rebecca Fisher said the organization has supportedstate and federalefforts to cap out-of-pocket insulin costs. Chelsea-Lyn Rudder, a JDRF spokesperson, said the organization has spent years lobbying Congress and calling on insulin manufacturers, health plans, employers, and the government to take action to lower the cost of insulin.
“Less than one percent of JDRF’s funding comes from companies that manufacture insulin,” Rudder said, “and these companies have no role in decisions about advocacy and research priorities.”
The online conversation inspired one advocate, a Washington, D.C., attorney named Laura Marston, to tell her own story about struggling to afford insulin to The Washington Post in 2016. When Sen. Bernie Sanders (I-Vt.) tweeted a chart from the article and suggested that “the drug industry’s greed” was to blame for insulin’s rising cost, the stock price of one of the big three insulin manufacturers, Eli Lilly, took a tumble.
Laura Marston speaks at a 2018 rally in Washington, D.C., against high medical costs. She is among a group of activists who have been using Twitter and on-the-ground protests to fight high insulin prices.
Providence Auditore
A similar scenario played out in November when the company’s stock sank 4% the day after a tweet from a parody Eli Lilly account claimed the pharmaceutical giant was making insulin free. Eli Lilly CEO David Ricks told a summit that the prank showed more work needs to be done to lower insulin costs for patients. In both cases, the company’s stock price quickly recovered. Eli Lilly stock is trading around 300% higher now than in 2017.
Eli Lilly did not respond to requests for comment about the role of social media in the national conversation about insulin prices.
Smith-Holt became an insulin activist after she lost her son Alec, at age 26, in 2017 because he couldn’t afford his insulin. She started speaking out about insulin affordability to local media, but her advocacy really took off once she joined Twitter.
“There’s just no stopping a tweet,” Smith-Holt said. “It goes out into the universe and God only knows how many thousands or millions of people see.”
Smith-Holt was among a group of activists who traveled to Canada in 2019 to purchase insulin over the counter to showcase the disproportionately high cost Americans pay. During the first trip, dubbed the “#CaravanToCanada,” they garnered attention by tweeting about their journey. Sanders later joined them on an excursion to Windsor, Ontario, ahead of a Democratic presidential primary debate in next-door Detroit.
Pfiester pointed to real-world successes the movement has had beyond the copay caps: Since the #insulin4all campaign started, all three major insulin manufacturers have new patient assistance programs to help people get insulin if they are struggling to afford it. Another offline success came in 2020 in Minnesota, where Smith-Holt championed the Alec Smith Insulin Affordability Act, which created an insulin safety net that made insulin available for as little as $35 for a 30-day supply to people with an urgent need. The program is in place despite a legal challenge from the pharmaceutical industry.
But social media takes a toll on activists. Health misinformation and speculation abound. The open nature of Twitter creates a powerful tool for spreading a message but also an invitation for backlash, trolling, and vitriol.
“I can’t tell you how many times I’ve been told that I should be in prison because I actually caused the death of my son,” Smith-Holt said.
Such venom already gave activists pause about the platform even before Musk bought it and began to remove restraints. Fears it could get worse have led some to leave the platform.
Smith-Holt said she has pared down her own online activism. It could be because of recent changes on Twitter, she said, but she also might just be running out of bandwidth. She works two jobs — for an airline and as a financial aid administrator at a community college.
She’s proud of Alec’s law, and showing the country that insulin affordability is an issue for people like her son. But, she said, it never seems to be enough.
“I don’t know what it’s going to take,” she said.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
