ABE JEROME BLOG

A global phase 3 trial is underway to assess the potential of dapagliflozin as a treatment to reduce COVID-19 progression among adults with cardiovascular, metabolic or renal risk factors. It was the top story last week in endocrinology.

Another top story was about a review that concluded there is insufficient evidence to recommend DPP-IV inhibitor treatment for patients with type 2 diabetes and COVID-19.

Read these and more of last week's top stories in endocrinology below:

Clinical trial investigates dapagliflozin for COVID-19 treatment

Recruitment for a global phase 3 trial is now underway to assess the potential of the SGLT2 inhibitor dapagliflozin (Farxiga, AstraZeneca) as a treatment to reduce COVID-19 progression, complications and death among adults with cardiovascular, metabolic or renal risk factors. Read more.

'Insufficient evidence' to recommend DPP-IV inhibitor treatment in type 2 diabetes with COVID-19

Insulin — not DPP-IV inhibitors or GLP-1 receptor agonists — should be the agent of choice for the management of severely ill patients with diabetes and coronavirus infections; this position is supported by extensive historical experience and the increased adoption of continuous glucose monitoring, according to a literature review published in Endocrine Reviews. Read more.

 

Insulin — not DPP-IV inhibitors or GLP-1 receptor agonists — should be the agent of choice for the management of severely ill patients with diabetes and coronavirus infections, according to a recent review.

Source: Adobe Stock

Beyond COVID-19: The future of telehealth in endocrinology

As clinicians around the country rapidly transition from in-person to telehealth visits, many changes must be managed at once. Endocrinologists in particular are working to find new ways to support people with diabetes who rely on data-driven care and multiple in-person visits each year, and the shift has left many wondering what may come next now that certain telehealth regulations have been temporarily loosened. Read more.

'We knew we needed to get creative': Inside Mount Sinai's effort to make glucose management safer during COVID-19

The risk for severe COVID-19 complications is significantly higher for people with diabetes, and glucose management may play a vital role in disease outcomes. At the same time, careful monitoring of inpatient glucose can prove unsafe for clinicians and nurses, who must repeatedly put themselves at risk to perform routine fingersticks for glucose monitoring. Read more.

Preoperative metformin reduces mortality, readmission risks for patients with type 2 diabetes

Patients with type 2 diabetes who were prescribed metformin prior to a major surgery had reduced risks for mortality and readmission in the 90 days following the procedure, according to a retrospective cohort study published in JAMA Surgery. Read more.

SALT LAKE CITY (AP) — A federal judge ordered a Utah man to stop selling silver products marketed as cures for the coronavirus.

U.S. District Judge David Barlow issued a temporary restraining order Wednesday against 60-year-old Gordon Pedersen and his companies, My Doctor Suggests LLC and GP Silver LLC, The Deseret News reported.

U.S. Attorney for Utah John Huber filed a civil complaint against Pedersen Monday saying he fraudulently markets silver products as a cure for COVID-19.

"The defendants have made a wide variety of false and misleading claims touting silver products as a preventative for COVID-19," a statement from Huber's office said.

The misrepresentations include claims that "having silver in the bloodstream will 'usher' any coronavirus out of the body and that 'it has been proven that alkaline structured silver will destroy all forms of viruses, (and) it will protect people from the coronavirus,'" the statement said.

Pedersen and his companies have promoted silver products as a treatment for various diseases including arthritis, diabetes, influenza, and pneumonia since about 2014, the civil complaint said.

Prosecutors said in court documents that prices on the My Doctor Suggests website go up to $299.95 for a gallon (3.79 liters) of the silver solution, a mix of water, extract from silver wire and sodium bicarbonate, commonly known as baking soda.

Court documents did not list an attorney for Pederson and he did not immediately return an email message from The Associated Press seeking comment.

Simon Dawson | Bloomberg | Getty Images

AstraZeneca said on Thursday it has started a late-stage trial testing its diabetes drug Farxiga to reduce the risk of serious complications and organ failure in Covid-19 patients with existing heart and kidney problems.

This is the British drugmaker's second trial investigating an existing therapy to help treat the highly contagious respiratory illness caused by the novel coronavirus.

The goal is to assess if Farxiga can cut the risk of disease progression, clinical complications, and death in such patients, AstraZeneca said.

Some studies have shown that patients with existing heart conditions are at a high risk of developing COVID-19 complications, including heart failure, it added.

Farxiga, approved as a treatment for the common type-2 diabetes, is part of the SGLT2-inhibitor class of antidiabetic medication that causes the kidneys to expel blood sugar through urine and has shown promise in various heart and kidney condition trials.

AstraZeneca is partnering with the Saint Luke's Mid America Heart Institute for the trial.

The company said last week it would start a trial of its cancer drug Calquence to assess its potential to control the exaggerated immune system response associated with Covid-19 infection in severely ill patients.

(HealthDay)—Pharmacologic treatment for type 2 diabetes increased from 2003 to 2016, according to a study published online March 31 in Diabetes Care.

Phuc Le, Ph.D., from the Cleveland Clinic in Ohio, and colleagues used data from the 2003 to 2016 National Health and Nutrition Examination Survey to identify 6,323 adults who had ever been told they had diabetes, had a hemoglobin A1c (HbA1c) >6.4 percent, or had a fasting plasma glucose >125 mg/dL. Trends in diabetes medication use were assessed.

The researchers found that the proportion taking any medication increased from 58 percent in 2003 to 2004 to 67 percent in 2015 to 2016 (P < 0.001). Specifically, use of metformin and insulin analogs increased, while use of sulfonylureas, thiazolidinediones, and human insulin decreased. The choice of drug did not vary significantly by older age, weight, or presence of cardiovascular disease following the 2012 American Diabetes Association (ADA) recommendation. Hypoglycemia-inducing medications were less likely to be received by patients with low HbA1c (<6 percent) and those aged ≥65 years, while older patients with comorbidities were more likely to receive these medications. Higher-cost medication use was associated with insurance but not income.

"Following ADA recommendations, the use of metformin increased, but physicians generally did not individualize treatment according to patients' characteristics," the authors write. "Substantial opportunities exist to improve pharmacologic management of diabetes."

Two authors disclosed ties to the pharmaceutical industry.

Copyright © 2020 HealthDay. All rights reserved.

Citation: Diabetes medication prescribing increased 2003 to 2016 (2020, April 28) retrieved 28 April 2020 from https://medicalxpress.com/news/2020-04-diabetes-medication.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

IMAGE: Relative mRNA expression levels of thioredoxin-interacting protein (TXNIP) (A), and glial fibrillary acidic protein (GFAP) (B) based on the average expression levels of the nondiabetic mice group (db/dm) (set as... view more 

Credit: The American Journal of Pathology

Philadelphia, April 27, 2020 - Diabetic retinopathy is one of the main vascular complications of type 2 diabetes, and the most common cause of visual deterioration in adults. A new study in The American Journal of Pathology, published by Elsevier, reports on the efficacy of a possible treatment candidate that showed anti-inflammatory and neuroprotective effects on the retina and optic nerve head in early type 2 diabetic retinopathy using a diabetic mouse model.

Diabetic retinopathy is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye. The cause is usually attributed to high blood sugar (hyperglycemia), but several studies have shown that inflammation is also an important factor in the progression of the disorder.

"Inflammation causes neurodegeneration as well as microvascular abnormalities in the retina," explained lead investigator Jin A. Choi, PhD, Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. "Diabetic retinal neurodegeneration can occur before the onset of clinical diabetic retinal microvascular abnormalities. Therefore, therapeutics for neurodegeneration may provide a novel interventional strategy in the window period between the diagnosis of type 2 diabetes and the onset of clinically manifested diabetic retinopathy."

Investigators analyzed and compared the anti-inflammatory and neuroprotective effects of the glucagon-like peptide-1 receptor agonist (GLP-1RA) lixisenatide in the retina and the optic nerve head with those of insulin in a mouse model of type 2 diabetes. They divided diabetic mice into three groups; GLP-1RA (LIX); insulin (INS) with controlled hyperglycemia based on the glucose concentration of LIX; and a control group (D-CON). Nondiabetic control mice were also characterized for comparison.

After eight weeks of treatment, neuroinflammation caused by type 2 diabetes was significantly reduced in GLP-1RA-treated retinas and optic nerve heads compared with untreated or even insulin-treated retinas of early type 2 diabetic mice, showing that the outcomes are independent of the glucose-lowering effect of GLP-1RA.

"This study can provide a possible therapeutic strategy to prevent visual deterioration by using GLP-1RA in early type 2 diabetic retinopathy," noted first author Yeon Woong Chung, MD, Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. "GLP-1RA significantly suppressed neuroinflammation in the early diabetic retinopathy, whereas insulin had little or no suppressive effect in this study."

"Retinal ganglion cells start to die even before clinical changes such as hemorrhages in diabetic retinopathy occur," commented Dr. Choi. "Thus, for better visual prognosis, we need to focus on the treatment of the retina in early type 2 diabetes before the clinical onset of diabetic retinopathy. The diabetic mouse group in our study who were treated with GLP-1RA showed significantly decreased cell death compared to those with insulin treatment."

###

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

© Provided by The Motley Fool To Help High-Risk COVID-19 Patients, AstraZeneca's Testing a Diabetes Treatment

AstraZeneca (NYSE: AZN) and Saint Luke's Mid America Heart Institute in Kansas City have begun a clinical trial in which they are giving hospitalized COVID-19 patients Farxiga, which is actually a diabetes treatment. While the blood-sugar-lowering drug won't do anything to combat the coronavirus itself, the investigators are looking for signs that it can reduce the risk of some of its potentially lethal complications. 

Farxiga helps patients with type 2 diabetes control their blood sugar by promoting the passage of glucose from the bloodstream to the bladder. It's approved to reduce the risk of heart failure for high-risk diabetes patients.

The DARE-19 trial will be enrolling hospitalized COVID-19 patients who also have cardiovascular, metabolic, or kidney problems. The risks of serious complications such as organ failure make this group extremely vulnerable to the coronavirus. And since it is already known that Farxiga reduces risks of lethal complications over the long run for these patients, there's a pretty good chance it can provide some benefit to them while they are struggling with the additional health threats that come with a severe case of COVID-19.

CONSTELLATION BRANDS, INC.

Fighting viruses is not one of AstraZeneca's major areas of focus, but the company is trying to assist the global COVID-19 response in any way it can. Earlier this month, it started a randomized trial in which severely ill coronavirus patients were treated with Calquence, a Bruton's tyrosine kinase (BTK) inhibitor normally used to treat blood cancer patients.

Some COVID-19 patients experience an immune-system response so frenzied that their body's efforts to fight off the virus become more dangerous to them than the virus itself. Calquence assists leukemia and lymphoma patients by limiting out-of-control immune cell activity, which could also be helpful for patients having severe reactions to the coronavirus.

Cory Renauer has no position in any of the stocks mentioned. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.

SPONSORED:

10 stocks we like better than AstraZeneca

When investing geniuses David and Tom Gardner have a stock tip, it can pay to listen. After all, the newsletter they have run for over a decade, Motley Fool Stock Advisor, has tripled the market.*

David and Tom just revealed what they believe are the ten best stocks for investors to buy right now... and AstraZeneca wasn't one of them! That's right -- they think these 10 stocks are even better buys.

See the 10 stocks

 

*Stock Advisor returns as of April 16, 2020

 

In the 21st century, the search for methods of treating noncommunicable diseases, such as obesity, metabolic syndrome, and diabetes are among the top priorities. Prevention and treatment of these diseases include changing and controlling lifestyle, diet, and the use of pharmaceuticals.

Despite the progress in medicine and pharmacology (developing new solutions for correcting metabolism) and biotechnologies, new effective approaches are still on demand in treating obesity, metabolic syndrome, and diabetes.

Researchers note that adipose tissue is one of the key players in the development of obesity and diabetes. Adipose tissue is classified both by anatomical location and by function (white and brown fat). So, the main functions of white adipose tissue are to save energy in the form of lipids, and it also has an endocrine function—the secretion of hormones, growth factors, cytokines, chemokines, etc.

The function of brown adipose tissue is to generate heat during adaptive thermogenesis (the process of generating heat in response to cold stimulation). In humans, unlike rodents (laboratory animals most widely used in medical experiments, including modeling of obesity, metabolic syndrome and diabetes), brown adipose tissue is present in significant numbers only in newborns and infants. Recently, the existence of active thermogenic adipose tissue in adults has been shown, but this adipose tissue differs from classical brown adipose tissue in several aspects (development, morphology, gene expression, adipokine production, etc.). This adipose tissue is called "brown."

All types of adipocytes (cells that make up adipose tissue mainly) arise from adipose stem cells during differentiation. Currently, the question of the origin of brown adipocytes (from the same stem cell as white adipocytes, or from the same stem cell as brown adipocytes, or from its own stem cell), as well as the ability of white adipose tissue to differentiate into brown adipose tissue.

The ability to control the formation of new adipose tissue, turn white adipose tissue into brown one, or determine the direction of adipocyte stem cell differentiation into a specific subtype is an attractive goal for the development of new pharmacological substances for the treatment of obesity, metabolic syndrome and diabetes.

In addition to the search for new pharmacological substances designed to control the functions of adipose tissue or various other biochemical aspects of energy homeostasis, it is also important to study the role of water in human health, metabolism and the pathogenesis of various diseases. Water is the most abundant chemical substance on Earth and makes up the largest mass fraction in living organisms as a percentage. Water is also a universal solvent in which the basic biochemical processes of living organisms occur.

An important component of a healthy diet is drinking water instead of sugar and soda. So, the modulation of the biological and physico-chemical properties of water is also a promising opportunity to increase the effectiveness of the treatment of said diseases.

Dr. Larisa Litvinova, Ph.D. in Medicine, Head of the Immunology and Cell Biotechnologies Laboratory, states "One of the focuses of modern medicine is the development of deuterium-containing drugs. Another direction relates to the role of the D/H ratio of isotopology and its change in water, which will be used as an adjuvant in the treatment of cancer. A different D/H ratio manifests itself in the form of a kinetic isotope effect, which is characterized by a change in the rates of biotransformation and excretion of drugs. Moreover, methodological approaches to the quality control of medicines based on isotopology of water could reduce the toxic load on the body."

IKBFU Scientists Larisa Litvinova and Maria Wulf were conducting the research in cooperation with colleagues from Moscow and Kiev, and the goal of the research was to find out whether deuterium is engaged in differentiation of adipose tissue stem cells regulation. Adipogenic differentiation of mesenchymal stem cells was chosen as an in vitro model, where the efficiency of the formation of mature fat cells from precursor cells in media with different deuterium contents was evaluated.

The data on the effect of various concentrations of deuterium on the efficiency and direction (formation of brown/beige or white adipocytes) of differentiation of mesenchymal stem cells in an in vitro model system were obtained in the study. Naturally for the possible practical application of these results, additional studies are needed that would allow a more detailed description of the molecular mechanisms of the influence of various concentrations of deuterium at the cellular level, as well as studies at the body level.

The results of the study are published in the article "The influence of deuterium on the effectiveness and type of adipogenic differentiation of stem cells of human adipose tissue in vitro" in the Scientific Reports journal. The results can serve as the basis for the development of new approaches in the treatment of obesity, metabolic syndrome and diabetes, by regulating the differentiation of fat stem cells and adipocyte functions.

More information: Alona V. Zlatska et al, Effect of the deuterium on efficiency and type of adipogenic differentiation of human adipose-derived stem cells in vitro, Scientific Reports (2020). DOI: 10.1038/s41598-020-61983-3

Provided by Immanuel Kant Baltic Federal University

Citation: New approaches to treating obesity, metabolic syndrome and diabetes (2020, April 23) retrieved 25 April 2020 from https://medicalxpress.com/news/2020-04-approaches-obesity-metabolic-syndrome-diabetes.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.