Category Archives: Diabetes

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Join us for a discussion on the critical intersection of diabetes and liver disease. Our guest, Sarah Bauer, a pediatrician, shares her personal journey and insights into the recent screening guidelines released by the American Diabetes Association. From the importance of early detection to bridging the gap between research and practice, we explore actionable steps for improved patient care and advocacy.

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A story of liver cancer and diabetes [PODCAST] - Kevin MD

The following is a summary of A Plasma Metabolite Score Related to Psychological Distress and Diabetes Risk: A Nested Case-control Study in US Women, published in the June 2024 issue of Endocrinology by Huang, et al.

For a study, researchers sought to investigate the association between a metabolomic signature for psychological distress and the risk of developing diabetes.

A nested case-control study was conducted within the Nurses Health Study, involving 728 women with incident diabetes and 728 matched controls. Plasma metabolomics data were collected between 1989 and 1990, and incident diabetes was diagnosed between 1992 and 2008. Based on prior research, a weighted plasma metabolite-based distress score (MDS) comprised of 19 metabolites was calculated. Conditional logistic regression was used to estimate odds ratios (OR) and 95% CI for diabetes risk according to MDS, adjusting for matching and other diabetes risk factors.

After adjustment for sociodemographic factors, family history of diabetes, and health behaviors, the OR for diabetes risk across quintiles of MDS ranged from 1.00 (reference) for the lowest quintile to 2.47 for the highest quintile. Each standard deviation increase in MDS was associated with a 36% higher diabetes risk (95% CI: 1.21, 1.54; P-trend <.0001). This association was moderately attenuated after additional adjustment for body mass index (comparable OR: 1.17; 95% CI: 1.02, 1.35; P-trend = .02). The MDS explained 17.6% of the association between self-reported psychological distress and diabetes risk (P = .04).

The MDS showed a significant association with diabetes risk in women. The findings suggested that differences in lipid and amino acid metabolites may contribute to the link between psychological distress and diabetes risk.

Reference: academic.oup.com/jcem/article-abstract/109/6/e1434/7471893

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Plasma Metabolite Score Associated with Diabetes Risk and Psychological Distress - Physician's Weekly

AstraZenecas (LSE: AZN) Farxiga (dapagliflozin) has received approval from the US Food and Drug Administration to improve glycemic control in children with type-2 diabetes (T2D).

The FDA's decision was based on positive results from the Phase III T2NOW trial.

Previously, Farxiga was approved in the USA for adults with T2D as an adjunct to diet and exercise.

Ruud Dobber, executive vice president of AstraZeneca's biopharmaceuticals business unit,

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New approval brings Farxiga to children with diabetes in the USA - The Pharma Letter

Grammy-winning performer Usher visited the U.S. Capitol Wednesday to meet with lawmakers about treatments for type 1 diabetes one week after meeting with Apple CEO Tim Cook to discuss the topic.

Ushers son was diagnosed with the disease at age 6, and the R&B singer is an outspoken advocate for those afflicted with the disease.

Hes also a spokesman for Sanofi, a French drugmaker and one of the largest producers of insulin.

Ushers trip to the Capitol included a meeting with House Minority Leader Hakeem Jeffries, New York Democrat, and other lawmakers to discuss health care policy, a legislative aide told The Washington Times.

According to Fortune, Sanofi executives were to join the meetings to discuss the importance of early screening for the disease.

Usher entered the Capitol through the Senate basement and was escorted by Sen. Raphael Warnock, Georgia Democrat, to a small meeting room on the House side.

Donning a casual brown suit and dark sunglasses, the superstar made his way across the Capitol mostly unnoticed by throngs of tourists. He was protected by a pack of security personnel and legislative aides.

Usher declined to comment when asked by a reporter about the purpose of his visit but provided a charming grin.

Mr. Warnock and Usher stopped briefly on the first floor to view a civil rights exhibit in the hallway, then ducked into an office dedicated to Rep. Joseph Rainey, a former slave and South Carolina Republican who in 1870 was the first Black American elected to the House.

According to Fortune, Usher brainstormed type 1 diabetes awareness ideas with Apples CEO Cook last week and said he planned to take his ideas to Capitol Hill.

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Usher visits U.S. Capitol with pharmaceutical executives to talk about diabetes treatments - Washington Times

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People Are Living Longer With Type 1 Diabetes | Health | shelbynews.com - Shelbynews

Mother Jones; Getty

Since May 2021, Rebecca Dotson has navigated type II diabetes with the help of mutual aid. Without the right resourcesmonitoring devices, insulin, and other medicationsunmanaged diabetes can, at worst, kill people; it can also lead to expensive hospital stays and complications including amputations. Insulin is seven to 10 times more expensive in the United States than abroad, on average, which can be disastrous for uninsured and underinsured people.

A few months after she was first diagnosed, Dotson, a former registered nurse, reached out to a group called Mutual Aid Diabetes, which distributes funds and supplies like insulin pens around the US to those who need themlike Dotson, who now receives insulin and funds to help with insurance co-pays from the group as often as twice a month.

Dotson, who lives in Pennsylvania, has also been battling advanced bone cancer, which leaves her in a lot of pain. Knowing that she has a place to turn for help managing her diabetes takes some weight off her back, though not all.

My diabetic medications are some of the most expensive and hard to get sometimes, Dotson said.

An estimated one in six Americans on insulin have rationed it due to cost, which can lead to death.

Mutual Aid Diabetes, or MAD, is entirely volunteer-run. It came to fruition earlier in the Covid-19 pandemic through diabetics who wanted to help others in their communitiesnearly 40 million Americans have a form of diabetessurvive to the next day when they couldnt access insulin, or other diabetes medications and supplies. Unlike many patient-focused groups, they do not accept money from pharmaceutical companies.

An estimated one in six Americans on insulin have rationed it due to cost, which can lead to death. Rationing insulin, research shows, is more common among Black, middle-income, underinsured and uninsured people. Allie Marotta, one of MADs co-founders, knows what thats like. At 26, Marotta, who lives in New York, was kicked off her parents health insurance plan. Marotta was an independent contractor working in theater, meaning she didnt receive health insurance through her jobs.

I was uninsured for a period of time, where I was rationing insulin, Marotta said. I was receiving black market donations for myself to use.

Marotta then transitioned to helping others obtain the supplies they needed through such donations, often through direct messages on X/Twitter. Marotta and others wanted to make the process of asking for donations more accessible, which led them to create MAD.

An essential part of MADs work is community involvement from diabetics. The group has community partners, donors of insulin and other goods who MAD connects with diabetics in need who donate insulin and other goods and send it directly to a diabetic in need, as well as distributing funds directly to diabetics who need it as soon as possible. Its modelmostly diabetics helping others with diabetesalso aligns with the disability rights motto Nothing about us without us, involving people with the condition on both sides of the process.

Requests to MAD for both insulin and continuous glucose (blood sugar) monitoring devices, which cost from $100 to $300 per month, have increased. This past April, MAD received 52 aid form requests for help (where people could request multiple supplies at once), up from 7 in April 2021.

MAD wants its intake process to add as little stress as possible, Marotta says, as people are often in a crisis by the time they reach out. After a diabetic in need fills out a short form, a volunteer texts or emails to help get them medicine both directly and, if possible, through their insurancethough the wait is at least 48 hours, and its not a replacement for emergency care.

We always recommend, go straight to the ER if you need direct medical care, Marotta said.

Its a common misconception that people with type II diabetes do not need or benefit from using insulin, despite the fact that type II diabetes often starts with insulin resistance. Fatphobia, anti-Blackness, and classism often contribute to that idea, according to MADs manifesto.

Fatphobia has also impacted the experience of getting care for people like Dotson, who put off seeing an endocrinologist for that reason: I was afraid of just being told it was my fault because I was fat, she said.

Some pharmaceutical companies do have programs for low-cost insulin, but many limit it to people with type I diabetes, leaving those with type II and other forms, including cystic fibrosisrelated diabetes and latent autoimmune diabetes, in the dust.

Donating was not only a cool mutual aid moment, but just a cool relationship-building interaction with a fellow diabetic moment.

Almost every manufacturers patient assistance program requires you to have type I diabetes, Marotta said. Sometimes theyll phrase it as insulin-dependent diabetes, which does open a loophole for people with type II.

Its not just Big Pharma that makes problematic policy decisions around diabetes treatment. Insurance companies have similar clauses where they wont cover a continuous glucose monitor for someonewhich type II diabetics also needunless they have type I diabetes, Marotta said. To have to test your blood sugar instead of having a continuous glucose monitor is pretty archaic.

The United States has moved to make insulin more affordable under the Inflation Reduction Act, capping its monthly cost at $35 for people enrolled in Medicare. However, some forms of insulin and other supplieslike injectable insulin, which isnt used with a traditional insulin pumpare only covered by Medicare Part D, which patients have to pay more for.

Earlier this year, Dora Mendelson switched to a newer model of insulin pumps. When she saw a social media post from MAD about someone looking for the older ones she now had lying around, it was a no-brainer for Mendelson, who has since joined MAD as a volunteer, to redistribute her supplies.

The person I actually sent the supplies to sent me a letter saying thank you, and that it was really a lifesaver, Mendelson said. It was not only a cool mutual aid moment, but just a cool relationship-building interaction with a fellow diabetic moment.

Mendelson, who lives in Washington, D.C., felt drawn to mutual aid work because of hurdles she encountered seeking treatment as a graduate student in Canada, like longer wait times to see specialists and pressure to switch pumps.

Sully Carmona, who found out about MAD through a disability activist, saw the group highlighting the GoFundMes of diabetics in Gaza trying to leave the region in part to get insulin and other diabetes supplies, as well as raising awareness about the challenges these diabetics face on its social media. As the Guardian reported in February, though some aid trucks with insulin are getting into Gaza, Doctors Without Borders medical coordinator for the region says that patients cant get to the places where it is stocked because of the airstrikes.

As a person who has had the privilege of good health insurance throughout my life, Carmona said, I need to do all I can to support others who have been denied what they need for diabetes care, and to advocate for access for all.

Read more from the original source:
Insulin Prices Are Deadly HighBut Mutual Aid Is Keeping Diabetics Alive Mother Jones - Mother Jones

Treatment for type-1 diabetes insulin injections several times daily has been known and used since it was invented by University of Toronto scientists 103 years ago. But during all this time, the dynamics of the chronic, lifelong disease have not been known,

Now, researchers at the Hebrew University of Jerusalem (HU) have revealed important clues. Their new study found that aging human pancreatic beta cells display features of senescence (aging) while keeping elevated levels of genes vital for their function.

Despite their aging status, these cells therefore exhibit an ability to release insulin in response to glucose, aiding in blood sugar regulation. In addition, these aged cells show increased activity of genes that can stimulate the immune system.

This information sheds light on the potential role of aging beta cells in immune regulation and their relevance to autoimmune reactions in type- 1 diabetes.

The research led by Dr. Milan Patra together with Profs Ittai Ben-Porath and Prof. Yuval Dor from HUs Faculty of Medicine has revealed that senescent human pancreatic beta offer enhanced functional maturation through chromatin reorganization.

The research paper has just been published in the journal Nucleic Acids Researchunder the title Senescence of human pancreatic beta cells enhances functional maturation through chromatin reorganization and promotes interferon responsiveness.

Diabetes, characterized by a total lack of insulin or resistance to what there is, hinges on dysfunctional pancreatic beta cells whose function is to secrete the hormone and take glucose from the blood. Enhancing or preserving the function of these cells is pivotal for developing diabetes treatments.

Around the world there are some 463 million adults, or roughly one in 11, who suffer from the genetic type -1 (a minority of diabetes) and from type-2 that is caused by overweight, lack of exercise, a sedentary lifestyle, urbanization, poor diets, sedentary lifestyles, overprocessed foods and poor diets. By 2045, over 700 million could be afflicted, posing overwhelming challenges to healthcare, economies, and public health efforts.

Healthcare systems agree that urgent action is needed to stem this tide, via effective prevention strategies, better access to care, and innovative treatments.

The main role of adult human pancreatic beta cells is to activate a gene called p16 that means they are in an aging-like state called cellular senescence. Instead of showing signs of dysfunctionality, these cells present high levels of genes that are vital for their function so they appear to have a higher level of functionality and maturity compared to their non-aged neighbors. This is surprising because previously identified senescent cells in other tissues are usually regarded as dysfunctional and having harmful effects.

By analyzing the gene organization of senescent beta cells, the researchers discovered that they change the packaging of the genes the chromatin, generating a reprogrammed organization that allows activation of functionality. Because of this, it seems that the aging beta cells have the ability to release insulin in response to glucose in even larger amounts, which helps regulate blood sugar levels effectively.

The team also found that senescent beta cells have elevated levels of genes that communicate with the immune system. This response called the interferon response, normally reacts to a viral infection, calling on immune cells to attack the invader, but the senescence beta cells activate this pathway in the absence of such infection: it is molecular changes in the cells themselves simulate this response. The potential consequence is increased stimulation of immune cells to attack beta cells, the fundamental process that drives type I diabetes.

This means that aging beta cells could help regulate immune responses and be important for understanding autoimmune reactions in type-1 diabetes. Potentially, blocking this response or the process of senescence, could be used to prevent the progression of type-I diabetes in its early stages.

The discovery that aging pancreatic beta cells can remain very functional and respond to immune signals counters the traditional view that senescent cells are purely detrimental. This new understanding opens the door to potential therapies aimed at preserving or enhancing the insulin-secreting function of beta cells in diabetic patients.

These key findings suggest that senescent beta cells are not a liability, but may act, in a pre-designed manner, to improve insulin production as we age, countering other detrimental effects, said Ben Porath. If it is proven in the future that senescence of beta cells is a prominent feature of the early stages of type-1 diabetes, targeting of these cells through drug treatment could represent a novel approach for preventing autoimmune attack of beta cells.

The team plan in the future to dig deeper into the mechanisms driving the increased activity of functional-maturation programs in aging beta cells, influenced by chromatin dynamics. A comprehensive understanding of these processes holds promise for the development of targeted therapies aimed at enhancing beta-cell functionality and lifespan and improve the quality of life for type-1 diabetes patients, understand how senescence affects the interaction of immune cells with beta cells, and whether this is indeed associated with diabetes, may open the door for new treatment approaches.

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Israeli university publishes novel findings on insulin and diabetes - The Jerusalem Post

This means that even more people living with the disease will be able to use this life-changing app. For the first time, the FDA authorised the use of the artificial pancreas system in pregnancy.

CamAPS FX, produced by Cambridge spinout company CamDiab (www.camdiab.com), is an Android app that can be used to help manage glucose levels in people with type 1 diabetes, including during pregnancy.

The app allows a compatible insulin pump and a compatible continuous glucose monitor to talk to each other, creating an artificial pancreas.

The CamAPS FX closed loop algorithm was given FDA authorisation on Thursday 23 May. It had already been CE-marked for use in the UK and the EU.

CamAPS FX creator Roman Hovorka is Professor of Metabolic Technology at the Institute of Metabolic Science and Department of Paediatrics at the University of Cambridge, where the technology was developed.

He said: "We set out to help people with type 1 diabetes and their families live better lives and were delighted that the FDA has reviewed the safety and effectiveness of CamAPS FX and has given the technology its approval."

"It has been extensively tested and were proud that it is considered by many to be the best algorithm out there."

CamAPS FX is already used by more than 27,000 people in 15 countries across Europe and Australia. Artificial pancreas systems such as CamAPS FX have been granted approval for wide use by the NHS in November 2023 by the National Institute for Health and Care Excellence (NICE).

Read more about the device here

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US Food and Drug Administration approves Cambridge-developed artificial pancreas - University of Cambridge news

After years of anticipation, the FLOW trial has brought forth a conclusion many had expected but had no clinical trial data to prove: semaglutide 1.0 mg provides renoprotective benefit in patients with type 2 diabetes and chronic kidney disease (CKD).

With topline data announced in March 2024, the medical community waited with bated breath to learn about the full results of the trial, which were presented at the 61st European Renal Association Congress and offered insight into the effects beyond the trials primary composite endpoint by detailing the impact of semaglutide 1.0 mg across a myriad of kidney-specific and cardiovascular-based outcomes from the trial.

Aninternational, double-blind, randomized, placebo-controlled trial, FLOW randomized 3533 patients in a 1:1 ratio to semaglutide 1.0 mg or placebo therapy. For inclusion in the trial, patients were required to have type 2 diabetes and chronic kidney disease, which was defined as an eGFR of 50 to 75 ml/min/1.73m2of body-surface area and a UACR greater than 300 andless than5000 or an eGFR of 25 to less than 50 ml/min/1.73m2and a UACR greater than 100 and less than 5000.

The trials primary outcome of interest was a composite of major kidney disease events, which included dialysis, transplantation, or an eGFR of less than15 ml/min/1.73m2, at least a 50% reduction in the eGFR from baseline, or death from kidney-related or cardiovascular causes.

Results suggested use of semaglutide was associated with a 24% relative risk reduction for the trials primary outcome of major kidney disease events compared to placebo therapy (Hazard Ratio [HR], 0.76; 95% Confidence Interval [CI], 0.66 to 0.88;P= .0003). Analysis of kidney-specific components of the primary outcome indicated semaglutide use was associated with a 21% reduction in risk relative to placebo therapy (HR, 0.79; 95% CI, 0.66 to 0.94). Further analysis demonstrated risk of death from cardiovascular causes was reduced by 29% relative to placebo therapy (HR, 0.71; 95% CI, 0.56 to 0.89).

To celebrate the trial and break down what it means for people with type 2 diabetes and CKD, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, recorded a special edition episode ofDiabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives.Check out the episode to learn more about the clinical application of this trial, unmet need in CKD management, the future of incretin therapies, and more!

Relevant disclosures for Dr. Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Dr. Bellini include Abbott Diabetes Care, MannKind, Sanofi, and others.

References:

Perkovic V, Tuttle K, Rossing P, et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes.New England Journal of Medicine. Published online May 24, 2024. doi:10.1056/NEJMoa2403347

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Diabetes Dialogue: FLOW Trial and Semaglutide's Benefit in Chronic Kidney Disease - MD Magazine

Novo Nordisks Ozempic cut the risk of death in a trial of patients with type 2 diabetes and chronic kidney disease, suggesting it may offer some added benefits over other classes of drugs approved to treat this population.

Specifically, the diabetes drug cut the risk of cardiovascular-related deaths by 29% and all-cause deaths by 20%. Given the study parameters, this implies that over three years, 39 people would need to be treated to prevent one death from any cause, according to new results presented Friday at a meeting of the European Renal Association and published in the New England Journal of Medicine.

Ozempic also lowered the risk of major heart complications including cardiovascular-related death, heart attack, or stroke by 18%, driven primarily by the reduced rate of heart-linked death.

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Ozempic cut risk of death in diabetes patients with chronic kidney disease - STAT