Category Archives: Diabetes

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People with both T2D and sarcopenia appear to be at increased risk for CVD, and they may develop CVD earlier in life than people with T2D alone.

People with both type 2 diabetes (T2D) and sarcopenia appear to be at increased risk for cardiovascular disease (CVD), and they may develop CVD earlier in life than people with T2D alone, according to research published in Diabetes, Obesity and Metabolism.

Sarcopenia in people with type 2 diabetes was associated with a higher risk of developing CVD, stroke, HF [heart failure] and MI [myocardial infarction]. Incident CVD events possibly occurred 14.5 years earlier among those with sarcopenia than those without, wrote lead author Jirapitcha Boonpor, MSc, and coauthors. Sarcopenia screening in patients with T2D may be useful to reduce the complications of CVD.

Boonpor and colleagues studied 11,974 people aged 40-70 who had T2D and enrolled in the UK Biobank prospective cohort study in England, Wales, and Scotland from 2006-2010. Because the criteria to define sarcopenia vary by ethnicity and the UK Biobank contains data from relatively few non-White participants, the researchers restricted their analyses to White Europeans.

At baseline, all participants completed touch-screen questionnaires, underwent physical measurements, and provided biological samples. The researchers used Cox proportional hazard models to adjust for sociodemographic and lifestyle factors (including age, sex, education, socioeconomic status, BMI, processed meat intake, smoking status, alcohol intake, physical activity level, and T2D duration) to analyze the links between sarcopenia (assessed by grip strength, muscle mass, and gait speed) and CVD incidence. They used the rate advancement period to estimate the time it took for patients CVD to advance due to sarcopenia.

Over a median follow-up of 10.7 years, 1,957 participants developed CVD (742 HF, 373 stroke, and 307 MI). Compared with patients with T2D without sarcopenia, those with sarcopenia had higher risks for CVD (HR, 1.89; 95% CI, 1.61-2.21), HF (HR, 2.59; 95% CI, 2.12-3.18), stroke (HR, 1.90; 95% CI, 1.38-2.63), and MI (HR, 1.56; 95% CI, 1.04-2.33) after adjusting for all covariates.

CVD, heart failure, stroke, and MI incidence rates among participants with sarcopenia matched the rates of those without sarcopenia who were 14.5, 13.7, 13.7, and 12.8 years older, respectively.

The findings intrigue Preethika Ekanayake, MD, who was not involved in the study.

Most international working groups for sarcopenia, such as the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS), predominantly define sarcopenia as an age-related muscle mass loss and recommend screening in older adults, she says.

Although we spend a lot of time evaluating, screening, and emphasizing prevention of microvascular complications like nephropathy, neuropathy, and retinopathy in patients with diabetes, we do not place much emphasis on evaluating sarcopenia, Dr. Ekanayake notes. These findings may encourage doctors to screen their patients for sarcopenia and to counsel them on undertaking weight-bearing and resistance exercises and physical therapy to improve muscle mass and help stave off CVD onset.

As the authors state, while the large sample size, long follow-up, and wide age range are strengths of the study, the lack of non-White participants limits the generalizability of the findings to other populations; UK Biobank participants having been invited, not selected, may introduce selection bias; and self-reported activity levels and diabetes duration may not be reliable.

There is no mention of the degree of diabetes control, Dr. Ekanayake adds. For example, hemoglobin A1C [HbA1C] was not mentioned. I would be curious whether the patients with sarcopenia and higher CVD risk also had higher HbA1C values, which could have confounded the results. Moreover, low muscle mass did not impart higher CVD risk in the models that were minimally and maximally adjusted for confounders, which is also curious because sarcopenia is the loss of muscle mass.

Dr. Ekanayake joins the researchers in recommending further related research. Randomized controlled trials are needed to corroborate the findings, she advises.

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Sarcopenia Screening May Reduce CVD Risk in Patients With Type 2 Diabetes - Physician's Weekly

New research published in The New England Journal of Medicine announced that semaglutide (Wegovy: Novo Nordisk) could reduce the risk of clinically important kidney outcomes and death caused by cardiovascular issues among individuals with type 2 diabetes and chronic kidney disease (CKD). The results were found in the international, double-blind, randomized, place-controlled FLOW trial, which assessed the safety and efficacy of a 1.0 mg dose of semaglutide weekly.1

Image credit: nazif | stock.adobe.com

The study authors noted that more than half a billion individuals are affected by CKD and are at high risk for kidney failure, cardiovascular events, and death with type 2 diabetes as the main cause. Treatment options like Reninangiotensin system (RAS) inhibitors, sodiumglucose cotransporter 2 (SGLT2) inhibitors, and finerenonehave been reported to protect kidneys and reduce the risk of cardiovascular outcomes. However, despite these therapies, numerous individuals continue to lose kidney function, experience kidney failure, or die.1

Semaglutide, as a glucagon-like peptide-1 (GLP-1) receptor antagonist, could offer further treatment options to improve patient outcomes.2 The FDA recently approved a new indication for the use of semaglutide to reduce the risk of cardiovascular death, heart attack, and stroke among individuals with cardiovascular disease.2

The use of GLP-1 receptor agonists in broader populations with type 2 diabetes has previously been shown to improve glycemic control, decrease body weight, and reduce cardiovascular events. However, previous dedicated trials addressing clinically important kidney outcomes, such as kidney failure or a substantial decline in the eGFR, have been lacking, said study authors in a news release.1

The FLOW trial included 3533 individuals with type 2 diabetes who were eligible for inclusion if they experienced high-risk CKD and were receiving a maximal dose of RAS inhibitors, according to study authors.1 The individuals were randomly assigned to receive semaglutide or placebo. The study authors noted that an 8-week dose escalation regimen was used, increasing from 0.25 mg per week for 4 weeks to 0.5 mg per week for 4 weeks, then continuing with a 1.0 mg maintenance dose until the end of the study. The median follow-up was 3.4 years.1

The results showed that the primary outcome of major kidney disease events, a composite of onset of kidney failure,was 24% lower among individuals treated with semaglutide compared with the placebo group(331 vs. 410 first events; HR 0.76; 95% CI, 0.66 to 0.88; P=0.0003). Additionally, semaglutide displayed favorable results over the placebo group among kidney-specific components and death from cardiovascular causes, according to study authors.1

Furthermore, confirmatory secondary outcomes were also greater among individuals in the semaglutide group with a slower decrease in the mean annual eGFR slope by 1.16 ml per minute per 1.73 m2, and a 18% lower risk of major cardiovascular events.1

Serious adverse events were reported to be fewer among individuals in the semaglutide group compared with individuals in the placebo group (877 [49.6%] vs. 950 [53.8%]).1 However, the study authors noted that this could be due to less infections or serious cardiovascular disorders in the semaglutide group.2

However, limitations in the study included limited ability of the effects of combination therapy and a lack of detecting differences between important subgroups.1

Our trial has important strengths. This trial of a GLP-1 receptor agonist in a population of patients with chronic kidney disease and type 2 diabetes assessed clinically important outcomes, and significant benefits were shown for kidney and cardiovascular outcomes and death from any cause, said study authors in the news release.1

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Study Finds Semaglutide Improves Chronic Kidney Disease in Patients With Type 2 Diabetes - Pharmacy Times

Heart disease, diabetes and kidney disease are among the most common chronic illnesses in the United States and theyre all closely connected.

Adults with diabetes are twice as likely to have heart disease or a stroke compared with those who dont have diabetes. People with diabetes Type 1 and Type 2 are also at risk of developing kidney disease. And when the kidneys dont work well, a persons heart has to work even harder to pump blood to them, which can then lead to heart disease.

The three illnesses overlap so much that last year the American Heart Association coined the term cardiovascular-kidney-metabolic syndrome to describe patients who have two or more of these diseases, or are at risk of developing them. A new study suggests that nearly 90 percent of American adults already show some early signs of these connected conditions.

While only 15 percent of Americans meet the criteria for advanced stages of C.K.M. syndrome, meaning they have been diagnosed with diabetes, heart disease or kidney disease or are at high risk of developing them, the numbers are still astronomically higher than expected, said Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Womens Hospital in Boston and co-author of the study.

The research suggests that people should pay attention to shared risk factors for these diseases early on including excess body fat, uncontrolled blood sugar, high blood pressure and high cholesterol or triglyceride levels.

Your kidneys, heart and metabolic system (which helps process the food you eat into energy and maintains your blood sugar levels) work closely together. If something goes awry with one, it can lead to problems with the others.

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What to Know About CKM, the Link Between Heart Health, Diabetes and Kidney Disease - The New York Times

Everyone deserves a fair, healthy future. But today, for many Canadians, our provincial and territorial health care systems are under strain.

One of the biggest pressures right now is affordable medication. The medications many Canadians need are often too expensive, leading to fewer visits to pharmacies, less treatment, and more frequent health scares. The cost of contraceptives, and medications for those who are diabetic, is one of the largest barriers to access.

Were making sure Canadians get the medication that they need, when they need it.

The Prime Minister, Justin Trudeau, today highlighted measures in Budget2024 to make two key forms of prescription medication free, as well as the federal governments work to make health care fairer for every generation.

Heres what were doing:

Universal coverage for a range of contraception and diabetes medications. With $1.5billion in federal investments, we are launching the first phase of a national pharmacare plan.

The Prime Minister also highlighted the federal governments work to improve dental and health care, such as:

Making dental care more affordable:

Helping provinces and territories train more doctors and nurses, reduce hospital wait times, clear backlogs, and improve primary care, with:

Affordable health care, including prescription medication, is about fairness. This means every woman will have the ability to choose a contraceptive that is best for her, regardless of cost. And it means Canadians with diabetes will have access to the life-saving medication they need.

This is part of our work to improve the health of Canadians, strengthen the social safety net, and help every generation get ahead. Thats what were investing in through Budget2024. Right alongside this, were building more homes, creating more jobs, investing in our economy, and delivering fairness for every generation.

Medications like contraceptives and insulin are too expensive. Thats why were covering the cost. By launching the first phase of universal pharmacare, were making sure Canadians get the care they need, when they need it, and without worrying about the bill. Thats what fairness is all about.

Women should have the autonomy to make their own choices about their health and their bodies. Our plan to make common contraceptives free like birth control pills, IUDs, and even emergency contraception mean that, for nine million Canadian women, freedom of choice will be truly free. And it means more Canadian women will have freedom of choice over their bodies and their lives.

Were taking steps each day to build a stronger health care system, so everyone in Canada gets the care they need. From our pharmacare plan that will help millions of people receive free contraceptives and diabetes medication to the Canadian Dental Care Plan that is making dental care more accessible right across the country, we are focused on getting Canadians better public health care.

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Making contraception and diabetes medications free for Canadians - Prime Minister of Canada

Novo Nordisk released data from a late-stage clinical trial that indicated semaglutide better known by its brand name Ozempic reduced the risk of death in diabetes patients with chronic kidney disease (CKD).

Published in theNew England Journal of Medicineon Friday morning,the multi-year study determined that the risk of a primary-outcome event such as major kidney disease events, kidney failure or death was 24% lower in the group that received Ozempic than participants in the placebo group.

Novo stated that the trial met its secondary endpoints, including a less steep mean annual estimated glomerular filtration rate as well as a lower risk of major adverse cardiovascular events (MACE) and risk of death from any cause.

Additionally, a lower percentage of serious adverse events were reported in the semaglutide group than the placebo group. More detailed data from the study was presented at the European Renal Association meeting in Stockholm.

This trial represents the promise of potential label expansion that Ozempic, which is indicated for treating type 2 diabetes, and other GLP-1 drugs could have beyond treating diabetes and obesity.

While GLP-1 drugs have taken off in popularity due to widespread off-label use for weight loss which has caused rampant, lingering shortages both Novo and rival Eli Lilly have been studying this class potential use in other therapeutic areas.

Thus far, the results have been encouraging and led to substantive insurance coverage changes.

Last August, Novo announced that its once-weekly semaglutide 2.4 mg treatment for obesity known by the brand name Wegovy cut the risk of MACE by 20% in a clinical trial. A studyreleased a few weekslater reiterated that semaglutide treatment led to large reductions in heart failure-related symptoms for adults with the condition and obesity.

Based on these clinical trials, the Food and Drug Administration approved a label expansion for Wegovy to be used as a treatment in heart disease this spring. One week after that, the Centers for Medicare and Medicaid Services announced that Medicare Part D plans could cover anti-obesity drugs like Wegovy.

Ozempic and Wegovy have also served as financial juggernauts for the Danish drugmaker, which saw sales rise 24% in Q1, thanks to diabetes and obesity care sales jumping 27% and GLP-1 diabetes products contributing 32% sales growth.

While Novos stock was trading down slightly after the studys release, it served as a boon for dialysis providers like Fresenius, DaVita and FMC.

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Novo Nordisk's Ozempic slashed risk of death in diabetes patients with CKD - MM+M Online

The trial, conducted between June 2019 and May 2021, used a lower dose of semaglutide than generally used for diabetes or weight loss treatment, with patients receiving 1.0 mg per week or a placebo. The trial was funded by pharmaceutical company Novo Nordisk, the supplier of Ozempic.

Semaglutide also slowed down loss of kidney function, lowered systolic blood pressure, and reduced body weight among participants.

Serious adverse effects were also less common, compared to those experienced by the placebo group, but were still experienced by almost 50 per cent of those on semaglutide, which Prof. Perkovic said was a function of the poor health of those involved in the trial people with high-risk chronic kidney disease.

The proven benefits prompted the trial to be cut short, based on a recommendation by an Independent Data Monitoring Committee.

Its the same chemical compound but we used a lower dose ... we did that deliberately because people with kidney disease tend to be more sensitive to the effects and side effects of drugs, Prof. Perkovic said.

Thats helpful in terms of being able to perhaps have the drug more widely used than might have otherwise been the case given the current supply limitations.

Its hoped the findings could soon help the growing number of people with kidney disease, which now affects about 850 million people worldwide, Prof. Perkovic said.

One of the most common causes of kidney disease is diabetes, particularly type 2 diabetes, which has also been growing dramatically in recent decades, he said.

Chronic kidney diseased contributed to about 20,000 deaths in Australia in 2021, about 12 per cent of all deaths that year, the latest for which figures from the Australian Institute of Health and Welfare are available.

In addition to loss of kidney function, kidney disease increases the risk of a range of other health conditions, particularly heart disease and stroke, and is associated with poorer quality of life.

People with kidney disease feel tired, weak and a bit foggy-headed, they often can't think clearly, and their quality of life is therefore dramatically reduced, Prof. Perkovic said.

If they end up on dialysis it affects not just them but their family, because they have to go off and have dialysis several times a week and ... the cost of dialysis is really expensive, it's $100,000 per person per year in Australia or more.

Prof. Perkovic said there has been an increase in treatments for chronic kidney disease in recent years, but more needed to be done.

We're really starting to dramatically improve outcomes for people with diabetes and kidney disease. But that will only happen if the results are translated into action at the clinical coalface, so that's an important next step, he said.

That will require overcoming supply shortages for semaglutide and the general lag in implementing research in clinical settings. More research is also needed to determine the optimal way to use semaglutide in combination with other existing treatments.

The challenge is to get these results into clinical practice, to get the drug used by the people who will benefit from it, who will live longer without dialysis, without heart attacks, without strokes, if they take this drug.

Novo Nordisk will need to seek regulatory approval for semaglutide to be used to treat those with chronic kidney disease. Prof. Perkovic expected this would be granted, and that semaglutide would become part of guideline-based therapy.

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'Saving kidneys, hearts and lives': Diabetes drug found to reduce risk of kidney disease and death - UNSW Sydney

In patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), semaglutide reduced the risk of clinically important kidney outcomes, major cardiovascular events, and death from any cause by 24%, according to a study published in The New England Journal of Medicine.1

To come to these findings, researchers randomly assigned 3533 patients with T2D and CKD to receive either 1.0 mg of subcutaneous semaglutide weekly (n = 1767) or placebo (n = 1766). CKD was defined by an estimated glomerular filtration rate (eGFR) of 50 to 75 mL/min/1.73 m2 with a urinary albumin-to-creatinine ratio of 300 to 5000 mg/g, or an eGFR of 25 to less than 50 mL/min/1.73 m2 with a urinary albumin-to-creatinine ratio of 100 to 5000 mg/g.

The primary outcome measured was major kidney disease events, including the onset of kidney failuredefined as dialysis, transplantation, or an eGFR of less than 15 mL/min/1.73 m2a reduction of eGFR by at least 50% from baseline, or death from kidney-related or cardiovascular causes. Hierarchical testing was used for prespecified confirmatory secondary outcomes. The median follow-up was 3.4 years, translating to about 177 weeks of semaglutide for the treatment group.

Semaglutide injections | Image credit: Patrick Bay Damsted stock.adobe.com

Compared with placebo, patients who took the weekly glucagon-like peptide 1 (GLP-1) receptor agonist experienced a 24% lower risk of primary outcome events, with 331 events in the treatment group and 410 in the placebo group (HR, 0.76; 95% CI, 0.66-0.88; P = .0003).

Specifically, these patients were 21% less likely to experience the kidney-related primary outcomes (HR, 0.79; 95% CI, 0.66-0.94) and 29% less likely to die due to cardiovascular causes (HR, 0.71; 95% CI, 0.56-0.89).

All confirmatory secondary outcomes also favored semaglutide. The mean annual eGFR slope decline was slower by 1.16 mL/min/1.73 m2 (P < .001), the risk of major cardiovascular events was 18% lower (HR, 0.82; 95% CI, 0.68-0.98; P = .029), and the risk of death from any cause was 20% lower (HR, 0.80; 95% CI, 0.67-0.95; P = .01) in the treatment arm.

These benefits reflect important clinical effects on kidney, cardiovascular, and survival outcomes among high-risk patients, particularly given the reassuring safety findings, and support a therapeutic role for semaglutide in this population, the researchers said.

Additionally, fewer participants in the semaglutide arm (49.6%) experienced serious adverse events compared with the placebo group (53.8%), although the researchers noted this was mainly because fewer participants in the semaglutide group were reported to have serious infections or infestations (17.9% vs 21.3%) or serious cardiovascular disorders (15.4% vs 18.1%). Serious eye disorders were more frequent in the semaglutide group compared with the placebo group (3.0% vs 1.7%), while the occurrence of diabetic retinopathy events was similar between the groups (22.8% vs 22.5%). Adverse events leading to the permanent discontinuation of treatment were more common with semaglutide (13.2%) than with placebo (11.9%), primarily due to gastrointestinal disorders (4.5% vs 1.1%).

Given the benefits of renin-angiotensin system (RAS) inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and mineralocorticoid-receptor antagonism with finerenone for patients with T2D and CKD, clinicians and patients must carefully prioritize the use of semaglutide and other GLP-1 receptor agonists once studied, according to the researchers. While SGLT2 inhibitors have shown significant benefits for kidney outcomes, their effects on major cardiovascular events and mortality in this population have been mixed in prior research. With a favorable safety profile, the benefits demonstrated in the new study support the consideration of semaglutide as an initial therapeutic option alongside other proven therapies for patients with T2D and CKD.

Combination therapy is likely to be important in the future, and we found no clear heterogeneity of effect among patients receiving SGLT2 inhibitors at baseline as compared with those who were not, although the statistical power of this analysis was limited, the researchers added. Further analyses of these data are planned, and studies assessing approaches to combination therapy should be a priority.

This study was funded by Novo Nordisk, a manufacturer of Wegovy (semaglutide).

This news comes a few months after the FDA added another indication for semaglutide, expanding its use to reduce the risk of cardiovascular death, heart attack, or stroke in adults who have cardiovascular disease and overweight or obesity.2 Also, recent research showed that semaglutide led to significant improvements in exercise capacity, weight loss, and a number of secondary end points in patients with heart failure with preserved ejection fraction and obesity.3 In that study, patients taking the GLP-1 receptor agonist for a year lost 2.9% more body weight compared with patients taking placebo.

Reference

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Semaglutide Lowers Risk of Major Kidney Outcomes, Cardiovascular Events, Death in Patients With Diabetes and CKD - AJMC.com Managed Markets Network

BATAVIA, Ohio A woman will spend nearly a decade in prison after her 4-year-old child died from severe malnutrition, her teeth rotted out.

A judge sentenced Tamara Banks to nine years in prison on Friday morning. Christopher Hoeb, also charged in the child's death, awaits sentencing on June 11.

Banks was convicted of one count of involuntary manslaughter after the Clermont County coroner determined the girl's cause of death was diabetic ketoacidosis, a life-threatening condition that affects people with diabetes. Prosecutors said the girl had diabetes "that was left undiagnosed and untreated over a long period of time."

According to the prosecution, the girl was found unresponsive on Jan. 21, 2022. The couple called 911 and the girl was taken to a hospital. She was eventually declared to be brain dead and ultimately taken off life support.

Prosecutors said the girl died as a direct result of neglect and abuse from her parents, Hoeb and Banks.

Diabetic ketoacidosis, or DKA, is an extreme complication of untreated diabetes, said Dr. Chris Peltier, President of the Ohio Chapter of the American Academy of Pediatrics.

Peltier said the condition is not necessarily uncommon among children. He said the onset of diabetes can come quickly and children can get sick quickly. However, left untreated, the condition can cause a coma or even death, he said.

Eventually, the body will just shut down, he said.

Prosecutors also claim Banks and Hoeb fed their daughter mostly Mountain Dew through a baby bottle. When she died, the 4-year-old girl had almost no teeth left in her mouth, because they'd rotted out, prosecutors said.

Prosecutors: Young girl died of diabetes after neglect, abuse from parents

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Woman sentenced to prison for 4-year-old's malnutrition death - WCPO 9 Cincinnati

Over 4,800 persons with suspected symptoms of diabetes, hypertension identified during screening  The Hindu

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Over 4,800 persons with suspected symptoms of diabetes, hypertension identified during screening - The Hindu

MCH to open free diabetes clinic thanks to $500,000 received from the City of Odessa  NewsWest9.com

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MCH to open free diabetes clinic thanks to $500,000 received from the City of Odessa - NewsWest9.com