India, world failed to meet World Health Organization’s End-TB milestone 2020: Lancet study

GBD study is the largest and most comprehensive effort to quantify health loss across places and over time

India’s tuberculosis (TB) incidence dropped marginally by 0.5 per cent between 2015 and 2020 and failed to meet the World Health Organization’s (WHO’s) End-TB milestone for 2020, according to new global research published in The Lancet Infectious Diseases journal.

The WHO End-TB strategy aims for a 90 per cent reduction in TB deaths and an 80 per cent reduction in the incidence rate by 2030, compared to the baseline figures of 2015. The 2020 milestones include a 20 per cent reduction in the TB incidence rate and a 35 per cent reduction in deaths.

The latest study estimated that the incidence of TB across all ages in India was 213 cases per one lakh population in 2020, well above the WHO’s milestone figure (for India) of 171 per one lakh population. Deaths due to the bacterial infectious disease in the same year were estimated to be between 3.5-5 lakh, again much above the mortality milestone of 2.7-3.2 lakh set for India.

The study comes ahead of World Tuberculosis Day on March 24.

Despite accelerated progress in reducing TB burden over the past decade, the world failed to attain the first interim milestones of the WHO End-TB strategy in 2020, said the researchers forming the Global Burden Disease (GBD) 2021 Tuberculosis Collaborators. The pace of decline has also differed across age groups, with adults aged 50 years and above having the slowest progress.

Of the 204 countries analysed by the team, 15 met the 2020 TB incidence milestone, while 17 met the mortality milestone. Of the 15, 11 were in sub-Saharan Africa, the researchers said.

Novel case-finding interventions in countries like Nigeria, Tanzania, Cameroon and Kenya helped reduce incidence, and were further supported by improved drug coverage in treating HIV across many countries in the sub-Saharan African region, they said.

Only 17 countries achieved the 2020 End-TB mortality milestone and drug resistance could be an important factor, according to the researchers.

An ‘efficacious, safe, and shorter’ regimen for treating drug-resistant TB, endorsed by WHO, could have helped reduce deaths, they said. They were referring to the WHO’s updated recommendations on treating drug-resistant TB issued in 2020, amidst antibacterial resistance emerging as a major public health threat.

The team also acknowledged the efforts of national social protection interventions in Moldova and Ecuador - two of the 17 countries - that ‘markedly increased treatment adherence’ and ‘potentially prevented drug resistance’.

Around the world, children under 15 years of age were seen to have the largest reductions in TB burden, with incidence falling by 16 per cent and deaths by 34 per cent between 2015 and 2020, even as the burden still remains high in children, according to the authors.

Citing evidence from recent research, they said most of the bacterial disease’s transmission occurs outdoors and hence, integrating contact-tracing with community-based strategies of screening and prevention will be ‘particularly important for continued progress’.

Globally, adults aged 50 years and above were found to make up 37 per cent of all TB incident cases and 58 per cent of all TB deaths in 2020, and targeting these age groups would be required to meet End-TB targets, the researchers said.

Screening and treating older adults for latent tuberculosis - where symptoms do not present themselves - would be essential. Further, given their high chances of adverse reactions to treatment, the researchers highlighted the importance of developing shorter, less toxic treatments, along with early diagnosis, for achieving the End-TB targets.

About the COVID-19 pandemic’s impact on the global TB burden, the researchers cited limited empirical data and underscored the need for continued research, even as they acknowledged many models to have predicted hundreds of thousands of additional TB deaths due to the pandemic.

The GBD study is the largest and most comprehensive effort to quantify health loss across places and over time, according to the Institute for Health Metrics and Evaluation at University of Washington in the US, which coordinates it.

https://www.tribuneindia.com/news/health/india-world-failed-to-meet-world-health-organizations-end-tb-milestone-2020-lancet-study-602583

Renal failure cases are on the rise

Unhealthy lifestyle is causing many ailments, most of which impact renal health

As life expectancy rises with advancement in healthcare and improvement in living standards, there has been a parallel increase in lifestyle-related diseases, including diabetes, hypertension and obesity. All these ailments impact kidney health, causing rise in kidney-related disorders and complications. Kidneys are vital organs responsible for filtering blood, eliminating waste products through urine, and maintaining electrolyte balance of the body.

As faulty lifestyle habits increase across all age groups, so do the related ailments, most of which impact renal health. As a result, chronic kidney disease (CKD) is not limited to the elderly any more and there is an alarming increase in kidney disease among young individuals. It is among the leading causes of deaths worldwide.

Kidney diseases can present as acute (lasting less than two weeks), subacute (2-12 weeks), or chronic (lasting over 12 weeks). Acute and subacute cases often arise as secondary conditions to other medical issues. CKD, the most prevalent form, in most cases remains hidden, with a significant portion of cases being asymptomatic or mildly symptomatic. In South Asia, CKD’s prevalence stands at 14 per cent. A cross-sectional study in India involving over 50,000 participants revealed diabetes as the cause of one-third of CKD cases, followed by CKD of unknown origin (CKDu), diseases affecting kidney filtration apparatus and high blood pressure. Sadly, half of the patients are diagnosed at an advanced stage, hindering successful intervention or treatment.

Chronic kidney disease

Up to one-fifth of individuals with diabetes can develop kidney disease, contributing to the escalating CKD incidence in India. Another common aetiology of CKD is CKDu, which is reported from various regions in India. Its exact cause remains unclear but is loosely associated with environmental and occupational exposures, such as heat stress, dehydration, agrochemicals, heavy metals, complementary medicines and infections. The relationship between hypertension and kidney disease is often likened to a chicken-and-egg situation, with CKD causing hypertension and vice versa.

Another common cause of CKD is the misuse or abuse of over-the-counter medications (OTCs), consumption of complementary and alternative medications (CAM) and misuse of recreational drugs. Certain medications, particularly painkillers, can have harmful effects on kidneys if used without proper supervision or in excessive amounts.

Additionally, kidney disease often has a hereditary component, underscoring the importance of identifying familial patterns. Early detection allows for the implementation of optimal remedial measures.

Symptoms and prevention

Common symptoms of CKD include swelling (oedema), hypertension, haematuria (blood in urine), proteinuria (high protein levels in urine) in initial stages, decreased appetite, nausea/vomiting, disrupted sleep patterns, pruritus (itching), and dyspnoea (shortness of breath) in advanced stages.

CKD presents a significant public health challenge, urging us to prioritise disease prevention and promote healthy lifestyles. With one-third of CKD cases linked to diabetes, a major preventive factor is promoting lifestyle improvements. This includes steering clear of junk food, reducing salt intake, maintaining regular exercise habits, and quitting smoking. Furthermore, vigilant monitoring of blood pressure and urine and kidney function tests play a pivotal role in averting the onset of kidney disease.

Even among diabetics, effective management of blood glucose levels and BP can forestall the development of kidney disease in the long run. Certain medications for diabetes and hypertension have also shown promise in slowing the progression of kidney disease, reducing likelihood of reliance on dialysis. Another preventive measure involves avoiding the use of OTCs and CAM. By adopting these preventive strategies, we can significantly mitigate the risk of CKD.

When patients do not respond to medications and progress to end-stage kidney disease (ESKD), kidney replacement therapy becomes necessary, such as dialysis or kidney transplant. The quality of dialysis has significantly improved, leading to improved life expectancy in these patients. However, kidney transplant remains the best treatment for ESKD patients.

Kidney disease is potentially preventable. Emphasising on healthy lifestyles, glycaemic and blood pressure control, and cautious medication usage through public education can effectively prevent and check the progression of kidney disease.

https://www.tribuneindia.com/news/features/renal-failure-cases-are-on-the-rise-601161

Lack of vitamin D may not be associated with lower back pain, study finds

Scientists have looked into the link between lower back pain and vitamin D.

• Lower back pain is considered the leading cause of disability worldwide.
• Past studies have linked a vitamin D deficiency to lower back pain.
• A new study from researchers at the University of Heidelberg in Germany says there is no correlation between vitamin D deficiency and lower back pain.

Researchers estimate that about 619 million people around the world live with lower back pain.

This condition is also considered to be the leading cause of disability worldwide.

There are a number of reasons why a person may experience lower back pain, including strained or injured muscles, spinal damage, or underlying conditions like arthritis and osteoporosis.

Depending on the situation, a person’s lower back pain may be treated with a combination of medications, physical therapy, and/or surgery.

Previous research shows between 5%-10% of low back pain becomes chronic low back pain lasting for more than 12 weeks, and 50% of people treated for low back pain have recurring episodes within one year.

Past studies have linked a deficiency in vitamin D to lower back pain as this hormone is essential for healthy bones and regulating inflammation. Plus signs of vitamin D deficiency include pain in the bones, joints, and muscles.

Now, researchers from the University of Heidelberg in Germany report the opposite to be true — they say there is no correlation between vitamin D deficiency and lower back pain.

The study was recently published in the journal Nutrients.

No vitamin D, lower back pain link found

For this study, researchers analyzed information from the UK Biobank. They used data from 135,934 participants between the ages of 40 and 69 years.

For this study, researchers analyzed data from the UK Biobank of over 500,000 people. All study participants were between the ages of 40 and 69 years old.

Scientists had access to vitamin D information on all participants, including their levels and whether or not they took a vitamin D or multivitamin supplement. They also collected information on any lower back pain diagnoses.

Scientists reported about 21.6% of all study participants had a vitamin D deficiency and about 4% regularly took a vitamin D supplement.

About 3.8% of study participants reported lower back pain the month before the study started. Another 3.3% were diagnosed with lower back pain for the first time during a median follow-up time of 8.5 years.

Upon analysis, researchers found that vitamin D deficiency and vitamin D supplementation were not associated with lower back pain. They believe this is partially due to the multifactorial nature of lower back pain.

Mixed results from previous research

Past studies examining a potential link between vitamin D deficiency and lower back pain have been mixed.

A study published in July 2018 found that low back pain severity increased in people deficient in vitamin D, while another study published in January 2019 reported that treating vitamin D deficiency may improve back pain in people who are overweight or obese.

Another study published in August 2019 discovered vitamin D deficiency and insufficiency can cause or worsen neck and back pain.

Research published in February 2021 indicated a high probability of vitamin D deficiency in the nonspecific chronic lower back pain population and also found a negative correlation between vitamin D status and pain severity.

However, there have been other studies reporting no link between vitamin D and lower back pain.

A study published in December 2020 concluded there was no relationship between chronic lower back pain and vitamin D levels, and research published in March 2018 reported vitamin D supplementation was not more effective than placebo, no intervention, or other conservative/pharmacological interventions for lower back pain.

Vitamin D may not prevent chronic pain

After reviewing this study, Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, told Medical News Today he was not surprised by its findings.

“Treating patients with chronic or low back pain for a long time, we haven’t really (found) a link to prove that patients on supplemental vitamin D have prevented low back pain,” Dr. Mikhael explained. “We have a lot of patients on vitamin D supplements, but they have chronic low back pain.”

“The case is a little bit different for people that are in their advanced age or they are menopausal and they have (a) higher risk of osteoporosis and compression fracture and then they have a low level of vitamin D,” he continued.

“This is where we ask them to take the supplement to get adequate mineralization of their bone and keep their bone healthy. But low vitamin D or supplemental vitamin D did not prevent the development of low back pain,” he said.

For future research in this area, Dr. Mikhael said he would like to see if people who are premenopausal or have a genetic predisposition for bone loss would be helped if treated with vitamin D early on.

“I (want) to see if these patients (that) have been preemptively or early on treated adequately for any vitamin D deficiency if they can prevent the progress of bone loss and prevent the development of full-blown osteoporosis and become high risk for compression fractures,” he added.

90% of people will experience low back pain

Dr. Dante Implicito, department chair of Orthopedic Surgery and chief of Orthopedic Spinal Surgery at Hackensack University Medical Center in New Jersey, provided similar comments after reviewing this research.

“As is the case with the vast majority of vitamins and supplements, there is no underlying proven connection for the ailments they are heavily marketed as addressing,” Dr. Implicito told MNT. “This is the essence of the difference between stringent FDA drug safety and efficacy process and ‘nutritional supplements‘ which are evaluated as foods and not at all refereed regarding their ‘medicinal or therapeutic’ claims.”

“Low back pain is ubiquitous. On the order of 90% of humans will experience low back pain in their lifetime. The symptom of low back pain is seen in a large multitude of conditions such as muscle strains, muscle deconditioning, cancer, disc injuries, arthritis, kidney stones, endometriosis, stress, etc. — the list goes on and on.”— Dr. Dante Implicito

Dr. Implicito said many varied factors are important in making these actual underlying diagnoses and the presence of low back pain is only one consideration.

“Vitamin D is known to play an important role in bone health and is especially important in the treatment of osteopenia and osteoporosis,” he added. “It has not been shown, to my knowledge, to actually be ‘anti-inflammatory’ by any peer-reviewed scientific journal.”

https://www.medicalnewstoday.com/articles/lack-vitamin-d-may-not-be-associated-lower-back-pain-study#90%-of-people-will-experience-low-back-pain

Tobacco exposure before birth and in childhood can increase type 2 diabetes risk

Experts say tobacco exposure before birth can raise type 2 diabetes risk later in life.

A new analysis shows a strong correlation between tobacco exposure early in life and the development of type 2 diabetes later in life.

Researchers report that people with preexisting genetic risk factors for type 2 diabetes face an even higher risk if they smoke.

They say that adopting a healthy lifestyle later in life helped lower the risk.

New research shows that early exposure to tobacco – whether in the womb or during childhood and adolescence – has a strong correlation with the development of type 2 diabetes later in life.

The large-scale observational analysis pulled records of about 476,000 adults in the UK Biobank.

The findings, which have not been published yet in a peer-reviewed journal, were presented this week at the annual American Heart Association’s Epidemiology and Prevention/Lifestyle and Cardiometabolic Scientific Sessions in Chicago.

While the data only shows correlation and not causation, it adds to the body of evidence that correlates tobacco exposure with poor health – particularly for those who are exposed early in life.

“This emphasizes the importance of preventing tobacco exposures in early life stages including during pregnancy, especially for people with high genetic risk for type 2 diabetes,” Victor Wenze Zhong, a senior study author and a professor and chair of the department of epidemiology and biostatistics at Shanghai Jiao Tong University School of Medicine in China, told Medical News Today.

“Adopting a healthy lifestyle later in adulthood could lower the risk of type 2 diabetes among people who have had tobacco exposure in utero, childhood, or adolescence,” he added.

How tobacco exposure affects type 2 diabetes risk

It’s already been established that smoking and tobacco exposure are associated with a host of negative health outcomes such as cancer, heart disease, stroke, and diabetes.

The study authors reported that people who started smoking in childhood had double the risk of type 2 diabetes. In addition, those who started smoking as adolescents had a 57% higher risk while those who started smoking as adults had a 33% higher risk of developing type 2 diabetes compared to those who never smoked.

The study categorized childhood as ages 5 to 14 and adolescence as ages 15 to 17. Those with a genetic predisposition for type 2 diabetes faced a higher risk.

Dr. Robert Eckel, an endocrinologist and past president of the American Heart Association who was not involved in the study, told Medical News Today that while the research carries some caveats in terms of being observational, it could help physicians better understand the association between tobacco and type 2 diabetes.

“I think we’ve known for some time that tobacco utilization is associated with all kinds of adverse effects – type 2 diabetes, cancer, hypertension, and many others that affect the cardio metabolic space,” he explained. “So the idea that tobacco is potentially insightful for the diagnosis of type 2 diabetes is really important.”

While the correlation is established, proving causation is more elusive. Eckel said that a clue could lie in the fact that tobacco exposure is associated with insulin resistance – but there are many factors, genetic and otherwise, at play.

The analysis also found that adopting a healthy lifestyle later in adulthood could lower the risk of developing type 2 diabetes, even for those who were exposed to tobacco early in life.

Tobacco’s downward trend

Smoking is still commonplace, but its prevalence has been on a downward trajectory for decades.

About 42% of U.S. adults were smokers in 1965, while under 14% were smokers in 2018. The U.S. Centers for Disease Control and Prevention (CDC) estimates that the number fell to less than 12% in 2021.

“There’s been a concerted effort made to curb smoking, from labeling products that contain tobacco to public education and public regulations,” Eckel explained.

While numbers are lower, they’re still nowhere near zero. The number of U.S. adults who smoke still amounts to 28 million people and cigarette smoking is still the leading cause of preventable disease and death in the United States.

Eckel said that for those who might need one more reason to quit smoking, it’s worth considering that their polygenic risk for type 2 diabetes could make them even more susceptible to developing the condition if they smoke – adding that many people have no idea what their risk factor may be.

“I think type 2 diabetes is something we don’t want in addition to all the other risks that relate to tobacco utilization,” he said. “So the take-home message is that if you’ve been exposed to tobacco when you were young, it’s time to get your lifestyle activated in a way that would prevent excess body weight gain and understand what your risk factors may be.”

https://www.medicalnewstoday.com/articles/tobacco-exposure-before-birth-and-in-childhood-can-increase-type-2-diabetes-risk

Researchers developing an inhalable screening test for lung cancer

A new screening test could help diagnose lung cancer earlier than traditional CT scans.

• About 1.8 million deaths each year are attributable to lung cancer, making it the leading cause of cancer death around the world.
• Only 16% of people with lung cancer receive an early diagnosis, which offers a much higher survival rate.
• Researchers say they have developed a new way to detect lung cancer at its earliest stages using an inhaler and a simple urine test.

About 1.8 million deaths each year are attributable to lung cancer, making it the leading cause of cancer death globally.

 

Previous research reports that only 16% of people receive a lung cancer diagnosis at an early stage.

 

However, as with any type of cancer, an early diagnosis of lung cancer offers better outcomes. Studies show that the average 5-year lung cancer survival rate in the U.S. is as low as 18%, but that rate jumps as high as 55% when caught at an early stage.

 

Now, researchers from the Massachusetts Institute of Technology (MIT) say they have developed a new way to detect lung cancer at its earliest stages using an inhaler and a simple urine test.

 

The study was recently published in the journal Science Advances.

 

Why is lung cancer hard to detect early? 

Current guidelines recommend anyone between the ages of 55 and 80 years old who has a history of heavy smoking should be screened for lung cancer.

 

Right now, the gold standard for lung cancer screening is the low-dose computed tomography (CT) scan. However, CT scans can sometimes produce false positives or negatives.

 

Past research shows that the majority of lung cancer cases are diagnosed at an advanced stage because most people do not have any symptoms in the earliest stages.

 

“Lung cancer is such a difficult diagnosis for many patients because it doesn’t give us many warning signs before it’s at an advanced stage,” explained Dr. Michael Spallone, a thoracic surgeon with Hackensack University Medical Center in New Jersey who was not involved in this study. “In fact, many of the lung cancers we diagnose on a day-to-day basis is based off of incidental findings; in other words, the patient has had imaging done for another reason, i.e. chest pain or cough, that just so happened to pick up an unrelated finding of a lung nodule or mass.”

 

“Many lung cancers can be cured if detected early, particularly with surgical resection,” Spallone told Medical News Today. “However, surgery is an available option only before the cancer has spread or become too invasive to resect. Therefore, anything that gives us an earlier warning that something may be going on, is an advantage to us and patients alike.”

 

Lung cancer screening in 20 minutes

For this study, researchers used a new technology using nanoparticle sensors that are breathed in through the use of an inhaler or nebulizer.

 

The nanoparticle sensors are coated with a reporter, such as a DNA barcode, making them into “nano-detectives” for lung cancer screening, said Qian Zhong, a research scientist at MIT and co-lead author of this study.

 

“Upon inhalation, these DNA-barcoded nanoparticles patrol the lungs in search of cancer-associated protease signatures,” Zhong told Medical News Today. “The nanoparticles are engineered to be activated by disease signals in the tumor microenvironment, releasing the DNA barcodes into the bloodstream, which are then filtered into the urine.”

 

“We analyze these urinary ‘fingerprints’ using a multiplexed quantitative lateral flow assay,” he added. “Results can be obtained at room temperature from the paper test within 20 minutes.”

 

Could new lung cancer inhaler test replace CT scans? 

As access to CT scans is limited in certain parts of the world, scientists believe this inhaler screening test may provide another option.

 

“CT remains one of the best imaging modalities with high resolution to visualize malignant nodules when substantial respiratory symptoms associated with lung cancer have been spotted or developed,” Dr. Edward Tan, a former postdoctoral research fellow at MIT and co-lead author of this study, explained to Medical News Today. “However, up to 95 percent of CT-positive patients are false positive. For those early nodules that cannot be confirmed benign or malignant in a single visit or are located in deep lung areas, one or more CT scans in (the) following months or years are needed for confirmation. Unfortunately, many patients in reality don’t follow the recommendations or miss the follow-up appointments.”

 

“The whole process is costly and always completed in several visits, which is definitely [a burden] to low-income households which live pay check by pay check,” Tan added. “Therefore, many at-risk people from low-income households have limited/no access to this lung cancer program even in the U.S., not to mention in other low-income countries. So we believe that the accessibility to this kind of screening could have a big impact in those contexts.”

 

Future lung cancer research steps

This new lung cancer screening test was tested on a mouse model during this study. The mice were genetically engineered to develop lung tumors similar to those seen in humans.

 

Through various experiments, scientists measured the levels of 20 different sensors, ultimately identifying four required sensors for diagnostic results. These four sensors were tested again in the mouse model and researchers reported it could accurately detect early-stage lung cancer tumors.

 

The research team reportedly plans to next test the sensors on human biopsy samples and eventually perform clinical trials on humans.

 

“We are actively exploring the platform’s utility for detecting other pulmonary diseases, such as infections,” Tan said. “Another exciting application of the PATROL platform is therapeutic monitoring. For instance, it could serve as a tool to assess patients’ responses to specific treatments. Regarding translation to clinical use, further optimization of the nanosensor probes and extensive preclinical studies are required.”

 

‘Exciting’ technology and innovation in lung cancer diagnosis

After reviewing this study, Spallone told MNT that this type of technology and innovation is so exciting to see.

 

“It’s part of the reason that many of us choose to go into medicine in the first place,” he said. “Medicine is constantly changing, adapting, and improving. In the cancer world, particularly lung cancer, the name of the game is early detection. Anything that gets us an earlier diagnosis has the potential to improve outcomes for patients.”

 

“The other aspect that I love is the ease of the proposed test,” Spallone added. “Many patients are familiar with using an inhaler and a urine test is one of simplest diagnostic tools available for patients. It doesn’t involve needles or radiation such as an X-ray or CT scan. Any time you can simplify testing and make it safe, patients tend to be more comfortable taking advantage of it.”

 

Spallone commented that the obvious next step for this type of research is to test its effectiveness in humans.

 

“The article highlights the fact that human lung cancer is more complicated than the mouse models it was initially tested on,” he explained. “You want to make sure the test is sensitive — it knows when cancer is there — and you want it to be specific — it knows that it’s cancer and not something else. This often takes time and meticulous effort on the part of the research team. That being said, I have a lot of optimism that it could become a more attractive and available option to those appropriate for lung cancer screening in (the) future.”

https://www.medicalnewstoday.com/articles/researchers-developing-an-inhalable-screening-test-for-lung-cancer#Exciting-technology-and-innovation-in-lung-cancer-diagnosis

Vitamin D2 may help delay symptoms, extend honeymoon phase of diabetes

Research has linked higher doses of vitamin D to an extended honeymoon phase in diabetes.

• Type 1 diabetes occurs when β cells in the pancreas stop producing insulin, the hormone that controls blood glucose.

• This autoimmune condition may develop at any age but commonly starts during childhood and adolescence.

• Following diagnosis, people often experience a ‘honeymoon phase’, during which some β cells continue to function and produce insulin.

• A study has now found that high doses of vitamin D2 may extend this honeymoon phase and delay the symptoms of diabetes.

Type 1 diabetes is an autoimmune disorder in which β cells in the pancreas are destroyed and stop producing insulin. A person who is diagnosed with type 1 diabetes must take insulin for the rest of their life to control their blood glucose levels and prevent complications.
 
The condition often develops in childhood or early adulthood, although it can occur later in life. Symptoms that indicate type 1 diabetes may include:

• increased thirst and urination

• increased hunger

• blurred vision

• fatigue

• unexplained weight loss

• a life-threatening condition called diabetic ketoacidosis (DKA).

 
Soon after diagnosis, people with type 1 diabetes will often experience a lessening of symptoms, known as the honeymoon phase, or partial clinical remission. This occurs in around 50% of children who are diagnosed with type 1 diabetes.
 
In the honeymoon phase, people often have an increase in insulin production, and become less reliant on insulin therapy, because some β cells continue to function and produce insulin. Around 50% of children and 60% of adults experience this after diagnosis, and it generally lasts 3-12 months, although some β cells may keep functioning for more than 5 years.
 
The longer the honeymoon phase, the lower the likelihood of developing complications from type 1 diabetes.
 
Now, a study has found that vitamin D2 can help maintain the functioning of β cells, which could extend the honeymoon phase.
 
The findings are published in JAMA Network Open.
“The study suggests that vitamin D2 may help preserve beta cell function, which are the cells responsible for insulin production. The exact mechanisms aren’t fully understood, but vitamin D2 may play a role in regulating the immune system and reducing inflammation, which could contribute to beta cell health.”
— Dr. Daniel Ganjian, board certified pediatrician at Providence Saint John’s Health Center in Santa Monica, CA, speaking to Medical News Today, welcomed the findings.
 
However, Dr. Robert Gabbay, M.D., Ph.D., chief scientific and medical officer at the American Diabetes Association, cautioned:
 
“The study is a secondary analysis of another study, and it has some limitations as a result of that.”
 
Health effects of vitamin D
Vitamin D is essential for good health, as it helps the body absorb calcium, which is used for building, maintaining and repairing bones. It is also vital for muscle movement, and for the functioning of the nervous system and the immune system.
 
There are two forms of vitamin D — D2, also known as ergocalciferol, and D3, or cholecalciferol. We make vitamin D when we expose our skin to the sun, but can also get it in some foods or take it as a supplement. Both forms have the same effect on the body, although there is some evidence that D3 may be slightly more effective in raising levels of vitamin D in the blood.
 
Most vitamin D2 is made by sun exposure, but mushrooms and yeast also make D2 when exposed to the sun, so keeping your mushrooms somewhere sunny before eating them will increase their D2 content. Some manufacturers fortify products such as dairy and plant milks, orange juice and cereals with vitamin D2.
 
Oily fish, such as trout, salmon, tuna, and mackerel, and fish oils are the best sources of vitamin D3, so people who do not eat fish must get it from fortified foods or supplements.
 
Testing vitamin D2 in children and adolescents
In this trial, the researchers recruited 48 children and adolescents, aged between 10 and 21 years, who had been diagnosed with type 1 diabetes no more than 3 months before the start of the trial. After initial testing, they excluded 12 children from the trial.
 
They then randomly allocated the remaining 36 to two groups of 18. By dividing each group into those of normal-weight (BMI below 85th centile) and overweight/obese (BMI on or above 85th centile), they created 4 groups of 9 participants.
 
For the double-blind trial, they gave one group (9 normal-weight and 9 overweight/obese) 50 000 international units (IU) of ergocalciferol orally once weekly for 2 months, and then once every other week for 10 months. They gave the control group similar-appearing placebo pills and pill-counting dosettes.
 
Vitamin D2 extends the activity of β cells
The researchers carried out a number of tests at three, six, nine, and 12 months after the participants had fasted overnight.
 
From these, they calculated proinsulin to C-peptide (PI:C) ratio. This ratio increases as β cells stop functioning. In the treatment group, PI:C decreased significantly compared with the placebo group.
 
For the first 3 months, both groups had similar percent change from baseline in the area under the curve (%∆AUC) of C-peptide — the gold standard measure of β cell loss in Type 1 diabetes — but this decreased slower in the vitamin D2 group than the placebo group over the following 9 months, showing that they retained more active β cells.
 
Both measures showed that vitamin D2 was extending the activity of β cells compared with placebo, as Dr. Ganjian explained to Medical News Today:
“The study observed an improvement in the proinsulin-to-C-peptide ratio (PI:C) in the vitamin D2 group. PI:C is an indicator of beta cell function. A lower ratio suggests more efficient insulin production.”
 
“Vitamin D2 supplementation shows promise in extending the honeymoon phase and potentially benefiting beta cell function in newly diagnosed T1D patients,” he added.
 
What might this mean for people with type 1 diabetes?
“This adds to the body of evidence of agents that may preserve beta cell function in early type 1 diabetes. It is an encouraging initial study, and we look forward to further research in the area.”— Dr. Robert Gabbay
 
Preserving β cell function for as long as possible is a key goal in treating type 1 diabetes, and this research indicates another potential way of doing this, as Dr. Gabbay told MNT:
 
“This is early evidence suggesting that vitamin D may be effective in preserving beta cell function in early type I diabetes. This comes on the heels of other agents showing similar effects.”
 
“What would be really exciting is to see some combination of these agents dramatically affect and prolong the period of time in early type 1 diabetes during which insulin is still produced,” he added.

https://www.medicalnewstoday.com/articles/vitamin-d2-may-help-delay-symptoms-extend-honeymoon-phase-type-1-diabetes

New weight loss pill amycretin more effective than semaglutide in early trial

Novo Nordisk’s new weight loss pill, amycretin, has had promising results in an early clinical trial.

• Amycretin, a new weight loss drug developed by Novo Nordisk, has shown promising early results and is potentially more effective than the company’s established treatments, Ozempic and Wegovy.
• In a phase 1 trial, the drug was found to significantly reduce body weight by 13% over 3 months — a noteworthy improvement compared to the 6% reduction seen with earlier drugs.
• Despite the need for further research to fully understand amycretin’s long-term safety and effectiveness, these findings sparked an increase in Novo Nordisk’s stock prices as well as a heightened interest in GLP-1 agonist medications. 

Early findings from a phase 1 clinical trial announced by the Danish company Novo Nordisk, show that amycretin — an experimental drug they have developed to treat obesity — may be significantly more effective than Ozempic and Wegovy (semaglutide) at improving weight loss.

 

The company has not yet published the data in a peer-reviewed journal, nor has it specified when it might do so.

 

This may not come as a surprise, seeing that both Ozempic and Wegovy are primarily prescribed for adults with type 2 diabetes to help them control blood sugar levels.

 

Of the two, only Wegovy has gained Food and Drug Administration (FDA) approval for chronic weight management in adults, though all semaglutide drugs appear to be associated with weight loss.

Both medications belong to the class of glucagon-like peptide-1 (GLP-1) receptor agonists, and work by mimicking the action of a hormone that helps regulate blood sugar levels and appetite.

 

Early results suggest that amycretin led to a 13% reduction in body weight over a 3-month period.

 

Previous research demonstrated that semaglutide led to an approximate 6% reduction in body weight over a similar timeframe.

 

Pill form may make amycretin more desirable

Experts, however, have stressed the need for more comprehensive research to verify the long-term benefits and safety profile of amycretin.

 

Despite these cautions, Novo Nordisk’s stock value surged by over 8% following the drug’s presentation at an investor meeting on March 7, 2024.

 

The surging interest in a new class of medications known as GLP-1 agonists has propelled Novo Nordisk to become the most valuable company in Europe, despite facing significant supply shortages due to high demand.

 

Amycretin differentiates itself from semaglutide medications like Ozempic and Wegovy, and from Eli Lilly’s Mounjaro and Zepbound (tirazepide) by being administered orally as a pill rather than through a weekly injection.

 

How does amycretin lead to weight loss?

Like its counterparts, amycretin works by emulating the GLP-1 hormone that suppresses appetite. In addition, it also imitates another hormone, amylin.

 

The limited information available suggests this method could be quite promising, but it is important to note that much more data are required.

 

This is because amycretin has yet to be evaluated against other medications in a direct comparison trial.

 

At a recent investor event, a senior development executive from Novo Nordisk highlighted the potential for amycretin to match the effectiveness and safety profile of CagriSema, another GLP-1 agonist drug by the company, targeting amylin.

 

The company anticipates the results of a study on an injectable version of amycretin to be released next year.

 

Based on these findings, Novo Nordisk intends to initiate a comprehensive development program.

 

Weight reduction notable in participants who received amycretin

During a trial of amycretin that involved 16 participants with an average weight of 89 kilograms, those who received a placebo experienced a 1% decrease in body weight over a 12-week period.

 

Studies indicate that GLP-1 agonist medications can reduce the likelihood of cardiovascular diseases linked to obesity, yet they also increase the chance of experiencing gastrointestinal issues.

 

Importantly for patients to understand, research shows that once individuals discontinue these drugs, they tend to regain much of the weight they had previously lost.

 

What do experts think of amycretin?

Three experts, not involved in this research, spoke to Medical News Today about the findings announced by Novo Nordisk.

 

Dr Simon C. Cork, senior lecturer in the Faculty of Health, Medicine and Social Care at Anglia Ruskin University in the United Kingdom, said that “the results from this study are exciting as they demonstrate what appears to be another effective drug in the rapidly growing weight loss field.”

 

“However we must await peer-reviewed published clinical trials before we can say for certain how this drug compares with others,” he cautioned.

 

“What is particularly notable with this drug is that it is taken orally, rather than via injection — as [with] Ozempic and Wegovy — which will undoubtedly be more appealing to patients,” Dr. Cork noted.

 

“Any drugs which demonstrate effective weight loss are welcomed in what has historically been a very difficult disease to manage. The addition of more drugs on the market will also relieve shortages of GLP-1 agonists, which are relied on by millions of people for the treatment of their type 2 diabetes.”

– Dr Simon C. Cork

Dr. Mir Ali, M.D., bariatric surgeon and medical director of Memorial Care Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, agreed.

 

“This is exciting news that another medication that appears more effective than the ones currently available is in development,” Dr. Ali said.

 

However, “a phase 1 trial is the initial trial to show clinical effectiveness and safety in human subjects,” he explained. “Typically, additional research is then conducted to look more closely at long term side effects and effectiveness.”

 

Speaking of the mechanisms involved, Dr. Ali noted that: “The mechanisms are similar in that GLP-1 and amycretin both target specific receptors; GLP-1 agonists at this time are only available in an injectable form. Having a pill available that is just as effective (or more effective) would certainly make using these medications easier for the patient.”

 

Dr. Jared Ross, a professor and medical director at the Henry Ford College Paramedic Program and the medical director for Trauma Services at Bothwell Regional Health Center in Missouri also explained that:

 

“Amycretin is an analog to amylin, a hormone secreted by the pancreas that is involved in appetite, weight, and blood sugar levels. This has large-scale implications as it represents the first oral hormonal medication for obesity, unlike GLP-1 analogs like semaglutide and tirzepatide which are both injections […]”

“Amylin analogs stimulate both the GLP-1 receptors in the gut and the amylin receptors in the pancreas,” Dr. Ross added.

 

“Another amylin analog, an injected medication called cagrilintide, in combination with semaglutide (a GLP-1 analog) has been shown in two small studies to have greater weight loss and better blood sugar control than with semaglutide alone,” he further noted.

 

However, Dr. Ross highlighted that “the long-term benefits of these medications have yet to be determined as have the adverse effects.”

 

“One of the major concerns with these hormone medications is that the effects appear to reverse once the medication is stopped, making life-long use necessary,” he emphasized.

https://www.medicalnewstoday.com/articles/new-weight-loss-pill-amycretin-more-effective-than-semaglutide-in-early-trial