New Injectable Treatment for Obesity

July 27, 2015 · Posted in Current Treatments · Comment 

injection for obesity

Liraglutide, an injectable drug used to treat Type 2 diabetes, has been approved by the Federal Drug Administration for the treatment of obesity. The drug is newly formulated in recommended doses of 3mg/day under the brand name Saxenda. Liraglutide is suggested for adults with a body mass of 30 or above, or 27 and above with other weight-related conditions such as hypertension, diabetes, or high cholesterol.

In clinical trials, out of 3,731 participants without weight-related comorbid conditions, 62% of those who received liraglutide lost at least 5% of their body weight, compared to 34% of those who received placebo. Of the 635 participants with Type 2 diabetes, 49% of those who received liraglutide lost at least 5% of their body weight, compared to 16% of those who received placebo. In the 422 participants with other weight-related comorbidities, 42% of those taking liraglutide lost 5% or more of their body weight compared to 21.7% of those on placebo.

There were also some improvements in risk factors for cardiovascular disease in people taking liraglutide.

Liraglutide affects appetite regulation, leading to reduced calorie intake that produces weight loss. The treatment is delivered in a pre-filled multidose pen that can be injected in the abdomen, thigh, or arm. Dosing begins at 0.6 mg/day to minimize unwanted gastrointestinal effects.

Diabetes Drug Pioglitazone May Improve Bipolar Depression

July 1, 2015 · Posted in Potential Treatments · Comment 

happy woman

The hypoglycemic drug pioglitazone is typically used to treat diabetes, but a 2015 study by A. Zeinoddini and colleagues shows that it may improve depressive symptoms in patients with bipolar disorder who do not have type 2 diabetes or the metabolic syndrome (characterized by high weight, cholesterol, triglycerides, and blood pressure).

Forty-four patients with bipolar disorder and a major depressive episode were randomized to receive either 30 mg/day of pioglitazone or placebo as an adjunctive treatment to lithium. Depressive symptoms were lower in the pioglitazone group at weeks 2, 4, and 6 of the six-week study.

No serious side effect occurred in the study, but pioglitazone use is associated with some risks in those using it for diabetes treatment. People taking pioglitazone for longer than a year have shown increased rates of bladder cancer. There is an increased risk of fractures of the upper arms, hands, and feet in female patients. The drug lowers blood sugar, but not enough to be a problem in people not taking other drugs that lower blood sugar. Pioglitazone can also cause fluid retention, worsening congestive heart failure. It can also cause mild weight gain, anemia, and sinus problems.

Statins Can Prevent Cardiovascular Risk in Patients with Mental Disorders

December 5, 2014 · Posted in Current Treatments, Risk Factors · Comment 

heart attackPeople with major mental disorders such as schizophrenia and bipolar disorder are at increased risk for medical symptoms including overweight, obesity, high cholesterol or triglycerides, diabetes, and the metabolic syndrome, all of which increase risk of cardiovascular disease (heart attack), cerebrovascular disease (or strokes), and other medical difficulties. In a 2013 review article in the journal Bipolar Disorders, researcher Chittaranjan Andrade discussed the use of statins to prevent cardiovascular events in people with major mental disorders.

Statins decrease lipids, and have significant benefits in decreasing cardiac events, but their use is low among psychiatric populations. Psychiatric patients often receive less cardiac care. It may be up to their psychiatrists to push for aggressive prevention of cardiac illnesses.

The most significant side effect of statins is the possibility that they can increase risk of diabetes. In a meta-analysis by Preiss et al., intensive dosing with statins increased the risk of diabetes but also lowered the risk of cardiovascular events. In a year, 1,000 patients would get two extra cases of diabetes but 6.5 fewer cases of cardiovascular events. For patients at high risk for heart attack or stroke, a cardiovascular event is more dangerous than diabetes, so it makes sense to treat these patients with statins. In patients at lower risk, there is some evidence that diabetes risk was a problem mostly in patients with other risk factors for diabetes, including metabolic syndrome, impaired fasting glucose levels, a body mass index of 30 kg/m2 or higher, or glycated haemoglobin A (1c) above 6%.

Most studies of statins are conducted on patients in middle age, but there is a rationale for treating even younger patients with statins. Patients with bipolar disorder develop cardiovascular disease more than a decade earlier than controls. There is some evidence that cholesterol deposits in arteries begin even before age 20, and are cumulative. The risk-benefit ratio for statin use improves with years of use, so starting it earlier may lead to better prevention. Long-term use may reduce the risk of Alzheimer’s disease and Parkinson’s disease and some cancers in addition to reducing heart attacks and strokes.

Despite the risk of diabetes, it is important to consider statin use in psychiatric patients, especially those who receive antipsychotic medications. Read more

Diabetes May Contribute to Low Hippocampal Volume in Bipolar Disorder

September 24, 2014 · Posted in Risk Factors · Comment 

elderly man

Type 2 diabetes can damage the brain, particularly by reducing volume of the hippocampus, and frequently occurs in patients with bipolar disorder. A recent study of patients with bipolar disorder and abnormal glucose metabolism showed that patients with bipolar disorder who also had insulin resistance, glucose intolerance, or type 2 diabetes had smaller hippocampi than both patients with bipolar disorder and normal glucose function and normal control participants without a psychiatric disorder. In those with bipolar disorder and glucose abnormalities, age was associated with lower hippocampal volume to a greater extent than in bipolar patients with normal glucose function.

In the study, published by Tomas Hajek et al. in the journal Neuropsychopharmacology, not only did diabetes or prediabetes reduce the size of the hippocampus, but also reduced gray matter in the cerebral cortex, including the insula.

The researchers hope that treating diabetes, or possibly even its initial symptoms, more effectively may prevent these gray matter losses and slow brain aging in patients with bipolar disorder.

Diabetes Drug Metformin May Impair Cognition, But Vitamin B12 May Help

February 17, 2014 · Posted in Current Treatments, Risk Factors · Comment 

Pensive man

Metformin, one of the most popular drugs to treat type 2 diabetes, interferes with uptake of vitamin B12, which can in turn lead to some neuronal dysfunction resulting in cognitive dysfunction. Several studies have sought to clarify this link, which may affect up to 30% of patients taking the drug.

Most recently, an Australian analysis of 1354 aging patients found that those with type 2 diabetes performed less well on tests of cognitive abilities, and those diabetic patients with low vitamin B12 levels (below 250 pmol/L) scored lower than those diabetic patients with adequate levels.

Because of the malabsorption problem caused by metformin, patients taking the drug may not be able to get enough B12 from a balanced diet alone and may need supplemental B12. Those who follow a vegetarian diet, have had bowel surgery, have certain complications with the stomach, or who take other medications that depress stomach acid may be at special risk.

Physicians should carefully monitor B12 levels in patients taking metformin, particularly those who have been taking the drug for more than 3 years or those who already suffer from some sort of cognitive impairment.

Cinnamon’s Positive Effects in Type II Diabetes

September 17, 2013 · Posted in Potential Treatments · Comment 

Cinnamon bark

Cinnamon has multiple positive effects that were affirmed in a meta-analysis by Robert W. Allen et al. in Annals of Family Medicine in 2013. Cinnamon lowered blood sugar, insulin levels, triglycerides, and low-density lipoproteins (“bad” cholesterol) while increasing high-density lipoproteins (“good” cholesterol). Cinnamon did not lower hemoglobin A1C, a global measure of glucose dysregulation, but that result could be explained by the short durations of some of the studies included in the meta-analysis.

Editor’s Note: Cinnamon’s role in the fight against type II diabetes remains to be determined, but a little bit may help those with diabetes or at risk for it. The researchers who produced the meta-analysis could not make a recommendation about how much cinnamon to add to one’s diet because the studies included in the meta-analysis had explored a wide range of doses.

Statin Benefits for Mood, Brain, and Heart Seem to Outweigh Diabetes Risk

September 10, 2013 · Posted in Current Treatments · Comment 

statinsStatins are a class of drugs that are the most commonly prescribed treatment for high cholesterol. They can reduce risk of heart attack and stroke in people with a history of cardiovascular disease. New research is beginning to clarify statins’ other effects, which on the negative side can include increased risk of diabetes and liver and muscle inflammation, and on the positive side can include reduced risk of cataracts and prevention of depression and dementia.

In late 2012, the American Heart Association Scientific Sessions included a discussion of five new studies suggesting that the cardiovascular benefit of taking statins is worth the slightly increased risk of diabetes. Researchers at the conference explained that cardiovascular events are much more serious than the small increase in risk of diabetes. While all five studies showed an increase in diabetes risk, the absolute increase was low and depended on the patients’ level of risk prior to treatment and how high their doses of statins were. There are strategies that can reduce diabetes risk in statins users, including using bile-acid sequestrants, reducing niacin, and monitoring glucose. Consensus at the conference was that statins’ cardiovascular benefits are so important that the drugs shouldn’t be avoided because of concerns about diabetes.

In addition, statins’ beneficial effects on mood have been reported for several years. In 2010, an epidemiological study by Pasco et al. in Psychotherapy and Psychosomatics showed that subjects without depression were less likely to develop a new onset of depression if they were treated with statins compared to those who were not. Stafford et al. reported in the Journal of Clinical Psychiatry in 2010 that patients taking statins had a 79% decreased likelihood of depression at 9 months of follow-up. Moreover, a 2012 meta-analysis by O’Neil et al. in BMC Medicine reported that overall, statins had positive effects on mood.

A recent huge Taiwanese study of statins suggests that the drugs can also prevent dementia. At the European Society of Cardiology congress in 2013, Tin-Tse Lin reported that among 58,000 people studied, those taking the highest dosage of statins had a threefold decrease in risk of developing pre-senile and senile dementia. He explained that it was the potency of statins such as atorvastatin and rosuvastatin that provided the cognitive benefit. However it is high doses that lead to less benign side effects such as liver and muscle inflammation.

A separate US study presented at the congress showed that statin use also lowered risk of developing cataracts by 19%.

Keep Your Heart and Cardiovascular System Healthy

May 7, 2012 · Posted in Risk Factors · Comment 

heartMiddle aged folks, watch your risk factors for cardiovascular disease. These include: high blood pressure, cholesterol, weight, and blood sugar (diabetes).

According to Heartwire, an article in the New England Journal of Medicine indicates that having any of these risk factors increases the likelihood of cardiovascular disease later in life.  The more risk factors one has, the greater the increase in risk.

Across the whole meta-analysis, participants with no risk factors at age 55 (total cholesterol level: <180 mg/dL;
blood pressure: <120 mm Hg systolic and 80 mm Hg diastolic; nonsmoking; nondiabetic) had drastically better odds
of avoiding death from cardiovascular disease through the age of 80 than participants with two or more major risk
factors (4.7% vs 29.6% among men and 6.4% vs 20.5% among women).

People with an optimal risk-factor profile also had lower lifetime risks of fatal coronary heart disease or nonfatal MI (Editor’s Note: myocardial infarction, or heart attack) (3.6% vs 37.5% among men, <1% vs 18.3% among women) and fatal or nonfatal stroke (2.3% vs 8.3% among men,
5.3% vs 10.7% among women), compared with those with two or more risk factors.

What this article does not mention is that depression is a risk factor for coronary artery disease, and should be treated just as aggressively and persistently as the other cardiovascular risk factors.

Also as we’ve written before in the BNN, exercise is one element of a healthy life style that can positively affect all of these risk factors.  Starting a healthy diet and exercise regimen in middle age will have long-term positive effects and reduce risks later in life.

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