Diabetes Pill Might Replace Injection to Control Blood Sugar

Serena Gordon wrote . . . . . .

An injectable class of diabetes medication — called glucagon-like peptide-1 or GLP-1 — might one day be available in pill form, research suggests.

Based on the results of a global phase 2 clinical trial, the study authors reported a significant drop in blood sugar levels for people on the oral medication, and no significant increase in low blood sugar levels (hypoglycemia) compared to a placebo over six months.

The findings also showed that people taking the highest dose of the pill lost a large amount of weight — about 15 pounds — compared to a weight loss of fewer than 3 pounds for people on the inactive placebo pill.

The research was funded by Novo Nordisk, the company that makes the drug, called oral semaglutide.

“Semaglutide could transform diabetes treatment,” said Dr. Robert Courgi, an endocrinologist at Southside Hospital in Bay Shore, N.Y.

“Glucagon-like peptide receptor agonists are agents that are highly recommended according to diabetes guidelines, but rarely used because they require injection. Most patients prefer a pill,” Courgi explained.

Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City, agreed that these new findings were exciting.

“This medication looks pretty good. The high dose matched the [injection] version. There was low hypoglycemia. It controls blood glucose. There was weight loss and it’s not an injection. This is the same molecule that’s been shown [as an injection] to decrease cardiovascular mortality,” Zonszein said.

“It has all the ingredients for an excellent medication. If this comes to market, it would be very good for people with type 2 diabetes,” he added.

Zonszein and Courgi were not involved in the current study.

The study included just over 1,100 people with type 2 diabetes recruited from 100 centers in 14 countries around the world.

The volunteers’ average age was 57. The average time they’d had type 2 diabetes was six years. On average, they were considered obese.

The participants’ average hemoglobin (HbA1C) levels were between 7 and 9.5 percent. HbA1C — also called A1C — is a measure of average blood sugar control over two to three months. The American Diabetes Association generally recommends an HbA1C of less than 7 percent for most people with type 2 diabetes.

The study volunteers were randomly placed into treatment groups that lasted 26 weeks. One group was given a once-weekly injection containing 1.0 milligram (mg) of semaglutide. Five groups were given one of five doses of oral semaglutide — 2.5, 5, 10, 20 or 40 mg. Another group was given escalating doses of the pill version, starting with the smallest dose and ending at 40 mg. The final group was given an oral placebo.

The highest dose of the pill performed similarly to the injectable form as far as blood sugar control and weight loss. Those on the 40-mg oral dose and those who got the injection saw an average drop in their HbA1C of 1.9 percent, the study showed. More than 70 percent of those who took the pill saw a weight loss of at least 5 percent.

According to the study’s lead author, Dr. Melanie Davies, “The A1C reductions and weight loss were very impressive and similar to what we’ve seen with the weekly injection of semaglutide.” Davies is a professor of diabetes medicine at the Diabetes Research Centre at the University of Leicester in England.

The two forms of the drug were also similar in the reported side effects, which affected up to around 80 percent of those taking both forms of the drug. The most common side effects were mild to moderate digestive concerns that tended to go away with time. Nausea was less common in people who started on the lowest dose and then were given stronger doses.

There were three reported cases of pancreatitis — inflammation of the pancreas — a potentially serious condition that has been linked to this class of medication in previous studies. One person was taking the injectable form of the drug. The other two were on the oral drug — 20 mg and 40 mg.

Zonszein noted that “pancreatitis was a bit more in those who took the drug. This may be an issue we have to pay attention to, and it may help to start with a lower dose.”

He also added that GLP-1 drugs, whether by injection or by mouth, should be given in combination with the standard first line type 2 diabetes drug metformin.

“We get more mileage from combining drugs and patients really do much better,” Zonszein said.

Findings from the study were published in the Journal of the American Medical Association. Davies said phase 3 trials of the pill are already well under way.

Source: HealthDay


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Omega-6 Could Lower Type 2 Diabetes Risk by 35 Percent

Researchers suggest that omega-6 fatty acids, which are found in soybean oil, could lower the risk of type 2 diabetes.

Eating a diet rich in omega-6 polyunsaturated fatty acids could reduce the risk of type 2 diabetes by more than a third, a new review concludes.

From an analysis of almost 40,000 adults across 20 studies, researchers found that people who had higher blood levels of linoleic acid — a main form of omega-6 — were less likely to develop type 2 diabetes than those with lower levels of the fatty acid.

Study co-author Dr. Jason Wu, of the George Institute for Global Health in Australia, and colleagues recently reported their findings in The Lancet Diabetes & Endocrinology.

Type 2 diabetes occurs when the body is no longer able to effectively use insulin — the hormone that regulates blood glucose — or when the pancreas does not produce enough insulin. As a result, blood glucose levels become too high.

According to the Centers for Disease Control and Prevention (CDC), around 30.3 million people in the United States have diabetes, and the majority of cases are type 2.

Following a healthful diet is deemed one of the best ways to prevent type 2 diabetes.

Polyunsaturated fats (PUFAs) such as omega-3 and omega-6 should form a part of a healthful diet, albeit in moderation. The new review, however, suggests that we might want to consider increasing our intake of omega-6 to protect against type 2 diabetes.

Omega-6: A help or hindrance?

Omega-6 fatty acids are considered to be essential for health; not only do they aid brain function, but they also play an important role in skin and hair growth, and they help to regulate metabolism and support bone health.

However, since the body is unable to produce omega-6, we can only get these fatty acids from certain foods, including soybean oil, sunflower oil, corn oil, and some nuts and seeds.

Current guidelines from the American Heart Association (AHA) recommend that omega-6 fatty acids should make up no more than 5–10 percent of our daily total energy intake, as they have been linked to increased inflammation and heart disease.

“Based on concerns for harm, some countries recommend even lower intakes,” says Dr. Wu.

However, Dr. Wu and team note that while there are an array of studies that have investigated the effects of omega-6 on heart health, little is known about how omega-6 influences the risk of type 2 diabetes.

“[…] only a handful of prospective studies have evaluated associations between linoleic acid or arachidonic acid biomarkers and type 2 diabetes,” write the study authors, “resulting in potential limitations of publication bias and inadequate power to assess interactions by demographic, medical, or genetic characteristics.”

“Thus,” they add, “the potential effects of omega-6 PUFAs, including linoleic acid and its metabolite arachidonic acid, on type 2 diabetes remain unresolved and are of considerable clinical, scientific, and public health importance.”

‘Striking evidence’

To find out more about the link between omega-6 and type 2 diabetes, the researchers conducted an analysis of 20 prospective cohort studies on the subject.

The studies included a total of 39,740 adults aged 49–76 years from 10 countries, including the U.S., the United Kingdom, Germany, France, Finland, Australia, Iceland, the Netherlands, Taiwan, and Sweden.

All study participants were free of type 2 diabetes at study baseline. During a follow-up period of 366,073 person years, 4,347 new cases of type 2 diabetes occurred.

As part of the studies, participants’ blood was assessed for levels of linoleic acid and arachidonic acid, and the team looked at whether or not these levels might be linked to the development of type 2 diabetes.

Compared with subjects who had low blood levels of linoleic acid, the researchers found that those who had higher levels of the omega-6 fatty acid were 35 percent less likely to develop type 2 diabetes.

“This is striking evidence,” says senior author Prof. Dariush Mozaffarian, of the Friedman School of Nutrition Science and Policy at Tufts University in Middlesex County, MA.

“The people involved in the study were generally healthy and were not given specific guidance on what to eat. Yet those who had the highest levels of blood omega-6 markers had a much lower chance of developing type 2 diabetes,” he adds.

There was no significant link between blood levels of arachidonic acid and risk of type 2 diabetes, the team reports.

These findings persisted after accounting for a number of possible confounding factors, including body mass index (BMI), age, sex, race, and levels of omega-3 fatty acids.

‘Little evidence for harms’

Interestingly, the researchers say that their findings — together with results from previous studies — “do not suggest that high levels of dietary omega-6 PUFA[s] are harmful.”

“Additionally,” the team adds, “although omega-3 and omega-6 PUFA has been hypothesized to compete, we did not identify any evidence of a physiologically relevant interaction in this large, well-powered consortium analysis.”

The researchers caution that many of the studies included in their analysis were observational, so they are unable to prove cause and effect between higher linoleic acid levels and reduced risk of type 2 diabetes.

That said, they believe that their results indicate that we may benefit from increasing our intake of omega-6.

Source: Medical News Today

Seniors with Type 2 Diabetes May Have Increased Risk for Fracture

Though seniors with type 2 diabetes (T2D) tend to have normal or higher bone density than their peers, researchers have found that they are more likely to succumb to fractures than seniors without T2D. In a new study published in the Journal of Bone and Mineral Research, researchers from Hebrew SeniorLife’s Institute for Aging Research found older adults with type 2 diabetes had deficits in cortical bone–the dense outer surface of bone that forms a protective layer around the internal cavity– compared to non-diabetics. The findings suggest that the microarchitecture of cortical bone may be altered in seniors with T2D and thereby place them at increased risk of fracture.

Participants in this study included over 1,000 member of the Framingham Study who were examined over a period of 3 years. High resolution scanning allowed researchers to determine that many older adults with diabetes had weakness specific to cortical bone microarchitecture that cannot be measured by standard bone density testing.

Osteoporotic fractures are a significant public health problem that can lead to disability, decreased quality of life, and even death – not to mention significant health care costs. Risk of fracture is even greater in adults with T2D, including a 40 – 50% increased risk of hip fracture – the most serious of osteoporotic fractures.

“Fracture in older adults with type 2 diabetes is a highly important public health problem and will only increase with the aging of the population and growing epidemic of diabetes. Our findings identify skeletal deficits that may contribute to excess fracture risk in older adults with diabetes and may ultimately lead to new approaches to improve prevention and treatment,” said Dr. Elizabeth Samelson, lead author of the study.

Researchers hope that novel studies such as this will help to revolutionize the area of bone health, especially for older adults. It is important to follow screening guidelines for bone density testing, but better understanding of all the factors that affect bone strength and the tendency to fracture is needed.

Source: EurekAlert

High Salt Intake Increased Diabetes Risk

High levels of salt consumption may increase an adult’s risk of developing diabetes, researchers say.

The new study included data from a few thousand people in Sweden. The findings showed that salt intake was associated with an average 65 percent increase in the risk of developing type 2 diabetes for each 2.5 extra grams of salt (slightly less than half a teaspoon) consumed per day.

People with the highest salt intake (about 1.25 teaspoons of salt or higher) were 72 percent more likely to develop type 2 diabetes than those with the lowest intake, the investigators found.

The study, led by Bahareh Rasouli of the Institute of Environmental Medicine at the Karolinska Institute in Stockholm, was scheduled for presentation Thursday at the annual meeting of the European Association for the Study of Diabetes (EASD) in Lisbon, Portugal.

The current study didn’t look at how salt might increase the risk of diabetes. But the researchers suggested that increasing salt intake may spur insulin resistance, a condition that can lead to type 2 diabetes. Or, it could be that salt intake was related to a higher weight.

The study can’t prove a direct cause-and-effect relationship, only an association.

High salt consumption was also associated with a significantly increased risk of latent autoimmune diabetes in adults, a form of type 1 diabetes that develops very slowly and appears in adulthood.

The study findings may prove important in efforts to prevent diabetes in adults, the researchers said in an EASD news release.

Findings presented at meetings are generally viewed as preliminary until they’ve been published in a peer-reviewed journal.

Source: HealthDay


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Eating Meat Linked to Higher Risk of Diabetes

While a plant-based diet is generally considered healthier than a meat-based diet in preventing the risk of diabetes, not all meats affect the risk equally. As Professor Koh Woon Puay of Clinical Sciences at Duke-NUS Medical School (Duke-NUS), and her team found out, higher intakes of red meat and poultry are associated with a significantly increased risk of developing diabetes, which is partially attributed to their higher content of heme iron in these meats. This study provides the foundation for evidence-based dietary recommendations to the Singapore population in mitigating diabetes risk and reducing the healthcare burden of this chronic condition.

These findings come from the Singapore Chinese Health Study, which recruited 63,257 adults aged 45–74 years between 1993 and 1998, and then followed them up for an average of about 11 years. The study found a positive association between intakes of red meat and poultry, and the risk of developing diabetes. Specifically, compared to those in the lowest quartile intake, those in the highest quartile intake of red meat and poultry had a 23 per cent and 15 per cent increase in risk of diabetes, respectively, while the intake of fish/shellfish was not associated with risk of diabetes. The increased risk associated with red meat/poultry was reduced by substituting them with fish/shellfish.

In trying to understand the underlying mechanism for the role of red meat and poultry in the development of diabetes, the study also investigated the association between dietary heme-iron content from all meats and the risk of diabetes, and found a dose-dependent positive association. After adjusting for heme-iron content in the diet, the red-meat and diabetes association was still present, suggesting that other chemicals present in red meat could be accountable for the increase in risk of diabetes. Conversely, the association between poultry intake and diabetes risk became null, suggesting that this risk was attributable to the heme-iron content in poultry.

This is one of the largest Asian studies looking at meat consumption and diabetes risk. While the findings are consistent with other Western studies that have shown that the increased intake of red meat and increase in heme-iron content of diet could increase the risk of diabetes, this study demonstrated the additional risk of red meat attributable to other possible chemicals, other than its heme-iron content. It also suggested that chicken parts with lower heme-iron contents such as breast meat, compared to thighs, could be healthier. Finally, the study also demonstrated the benefit of replacing red meat or poultry with fish/shellfish.

Describing the key take home message for the public, senior author of the study Professor Koh said, “We don’t need to remove meat from the diet entirely. Singaporeans just need to reduce the daily intake, especially for red meat, and choose chicken breast and fish/shellfish, or plant-based protein food and dairy products, to reduce the risk of diabetes. At the end of the day, we want to provide the public with information to make evidence-based choices in picking the healthier food to reduce disease risk.”

“Although a number of western studies have consistently shown that red meat consumption should be moderated, this study is highly relevant as it is based on local population and consumption patterns. The findings affirm HPB’s recommendation to consume red meat in moderation, and that a healthy and balanced diet should contain sufficient and varied protein sources, including healthier alternatives to red meat such as fish, tofu and legumes,” said Dr Annie Ling, Director, Policy, Research and Surveillance Division, Health Promotion Board.

Source: Duke-NUS Medical School


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