Diabetes drug cuts cardiovascular and kidney problems

By Jo Carlowe

A large international trial has linked the use of the drug dulaglutide with a reduction in cardiovascular events in middle-aged and older people with type 2 diabetes.

The clinical trial* followed more than 9,900 people in 24 countries. During more than five years of follow-up, cardiovascular events like heart attacks and strokes were reduced by 12% in people taking dulaglutide compared to people taking a placebo.

This effect was seen in both men and women with or without previous cardiovascular disease. In addition, during the same period, the drug reduced the development of kidney disease by 15%.

The trial was led by the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences, Canada. Two papers describing the cardiovascular and kidney results of the trial were published in the journal The Lancet from the study called the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial.

“Compared to others, people with diabetes have twice the rate of cardiovascular events like heart attacks and strokes, and up to 40% of people with diabetes develop kidney disease,” said Hertzel Gerstein, principal investigator for the study, professor of medicine at McMaster and deputy director of the PHRI.

“The REWIND trial shows that dulaglutide can safely reduce these events while improving diabetes control and modestly lowering weight and blood pressure in middle-aged people with type 2 diabetes.”

Dulaglutide is a glucagon-like peptide-1 receptor agonist that is injected once per week.

The drug was well tolerated, modestly reduced weight, low-density lipoprotein (LDL) cholesterol and blood pressure, and modestly increased heart rate.

Oral Novo Nordisk diabetes drug poses no more heart risk than placebo: study

(Reuters) – An experimental oral form of a Novo Nordisk drug for type 2 diabetes posed no greater risk of serious heart problems or death than a placebo in patients at high risk for such complications, according to data from a large study presented on Tuesday.
Patients with type 2 diabetics and either heart disease or at high risk for heart problems who received the drug semaglutide in pill form had a combined rate of heart attack, stroke or heart-related death of 3.8% compared with 4.8% for placebo, successfully demonstrating non-inferiority.

Death from any cause occurred in 1.4% of semaglutide patients and 2.8% for placebo, according to data from the 3,183-patient trial presented at the American Diabetes Association meeting in San Francisco and published online by the New England Journal of Medicine.

While the drug led to a lower rate of death and other heart problems, the trial was not designed to show statistically significant superiority, only that semaglutide was as safe as, or non-inferior to, placebo. Similar drugs have also shown an ability to cut the risk of cardiovascular problems.

“The drug is safe,” Dr. Mansoor Husain, director of the Toronto General Hospital Research Institute who led the study, told Reuters Health in a phone interview.

“This is the first orally-available GLP-1 (glucagon-like peptide-1) receptor agonist and that’s a pretty big deal,” Husain said, noting the fear many patients have for injections. “Just being able to take a pill every day makes it much more accessible.”

Semaglutide, which stimulates insulin production, is seen as an important growth driver for Novo Nordisk, which funded the study known as Pioneer 6.
The Danish drugmaker already sells an injectable once-weekly version of the drug under the brand name Ozempic at a cost of about $800 per month, according to the website goodrx.com. The oral version is a once-a-day tablet.

Novo filed for U.S. approval for oral semaglutide in March. It is seeking priority review in hopes of getting approval within six months.

All trial participants were at high risk of cardiovascular problems because they were at least 50 years old with established heart disease or chronic kidney disease, or at least age 60 with cardiovascular risk factors. They were followed for a median of 15.9 months. The trial was designed to end after a combination of at least 122 heart attacks, strokes and deaths had accrued.

Individual cardiovascular events in the composite also showed no significant differences.

The rate of non-fatal heart attack was 2.3% with semaglutide versus 1.9% with placebo, while the rate of non-fatal stroke was 0.8% with the drug and 1.0% for placebo. The odds of death from any cardiovascular cause were 0.9% in the semaglutide group and 1.9% in the placebo group.

“We did see a 50% reduction in cardiovascular death and all-cause mortality, but these were secondary endpoints,” Husain said. The main goal of the study “was just to demonstrate safety,” he said.

He cautioned people should not to read too much into the apparent reduction in the death risk. “We urge caution because they’re small numbers and it’s a relatively short-duration study.”

The rate of patients dropping out of the trial was higher for those who received semaglutide – 11.6% compared with 6.5% for placebo – with gastrointestinal problems such as nausea and vomiting being the driving force. Those are common side effects for the GLP-1 class of diabetes medicines.

Do Adults Need a Measles Booster Shot?

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, May 8, 2019 (HealthDay News) — New York’s ongoing measles epidemic alarmed midtown Manhattan resident Deb Ivanhoe, who couldn’t remember whether she’d ever been vaccinated as a child.

So Ivanhoe, 60, sought out her long-time primary care doctor, who performed an antibody test to see whether she had any protection against measles.

To her surprise, the test revealed that Ivanhoe had no immunity to measles. Her doctor quickly gave her a measles booster shot.

“I’m a New Yorker. I’m out and about. I take the subway every day,” Ivanhoe said of her concerns. “One of the outbreak areas is in Williamsburg, Brooklyn. I have friends in Williamsburg. I go to there to visit, for dinner. It all becomes local.”

Ivanhoe is one of a growing number of adults who are worried that their immunity against measles might have lapsed, if they even received a vaccination.

The U.S. Centers for Disease Control and Prevention has downplayed these concerns, saying that only adults in high-risk groups should talk with their doctor about a measles vaccination.

But experts are divided on whether the CDC is underestimating the threat posed by possibly waning immunity in adults.

New outbreaks, new dangers

There’s good reason adults are worried. At least 764 cases of measles across 23 states have been reported so far this year, the CDC says. Most cases have occurred in unvaccinated groups living in communities located on either side of the nation, in the areas surrounding New York City and Portland, Ore.

The high-risk groups of adults who should discuss measles vaccination with their doctor include international travelers, health care workers, and folks living in communities that are in the throes of an outbreak, Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a media briefing last week.

“Most adults are protected against measles. That’s what the science says,” Messonnier said. “That includes people who were born before measles vaccine was recommended, and even folks who only got a single dose.”

Ivanhoe’s physician, Dr. Len Horovitz, said her antibody test “clearly proves that is not the case.”

Horovitz recommends his adult patients get a blood test that shows the level of antibodies they have against measles and other infectious diseases.

“By the time you reach your [childhood] pediatrician it’ll be weeks, if he’s still even alive and hasn’t retired or moved,” said Horovitz, an internist with Lenox Hill Hospital in New York City. “It’s impossible to get vaccination records for my patients. They’re tearing their hair out.”

But, Horovitz noted, “In a 24-hour turn-around time, I can offer them a blood test and have an answer.”

Waning effectiveness of early vaccine

Besides people at high risk due to their circumstances, there’s only one group of adults that really should talk with their doctor about getting the measles shot, the CDC says.

One of the first measles vaccines used a killed version of virus, and was administered between 1963 and 1967. That vaccine did not provide lasting immunity, and for decades the CDC has urged that generation of folks to undergo vaccination with the better live version of the measles vaccine.

“If you happen to be someone 50 years ago that got this killed measles vaccine, then you’d have to get re-vaccinated with the live virus vaccine,” said Dr. Sandra Fryhofer, an internal medicine specialist in Atlanta.

People born in the United States earlier than 1957 are presumed to be immune to measles because the virus is so contagious everyone caught measles in those days.

Pediatric infectious disease specialist Dr. Matthew Zahn says the CDC is right that most adults are protected against measles.

“Our experience overwhelmingly has been that it becomes a numbers game,” said Zahn, who is on staff at the Children’s Hospital Orange County in Orange, Calif. “The vaccine seems to be about 99% effective in keeping you from getting sick, but if you have hundreds and hundreds of people who are exposed, then you will see occasional cases of persons who’ve been vaccinated previously who are getting sick anyway.”

Best use of resources

Zahn figures people who are worried about the status of their measles immunity should just go ahead and get the vaccine, rather than go through an antibody test.

“If you’re not sure you’ve had your two doses before and you want to be up to date, there’s nothing wrong with getting that additional dose,” Zahn said, noting that a person who undergoes the antibody test pays extra and faces getting stuck with a needle twice.

There’s plenty of measles vaccine on hand so there’s no concern about shortages, Zahn said. Doctors are simply trying to focus their attention on the most critical weaknesses in America’s immune protection, and waning adult immunity doesn’t seem to be contributing to the ongoing outbreaks.

“It’s more of an issue where you want to best use everybody’s time and resources,” Zahn said. “We certainly are seeing outbreaks, but those outbreaks are so weighted towards unvaccinated persons, that’s where the community is by far at risk.”

2019 Measles Outbreak: What You Should Know

Note: This story was updated April 22, 2019, with additional cases reported and April 18, 2019, with statistics on reported measles cases worldwide.

April 11, 2019 — Measles cases have been skyrocketing in the U.S. this year, with 626 reported so far, according to the CDC. Worldwide, the number of reported cases jumped 300% in the first three months of 2019 compared to the same time period in 2018, according to the World Health Organization. Learn why it’s happening and how to protect your family from this potentially deadly disease.

What is measles?

Measles is a contagious disease spread by a virus. It’s so contagious that when someone has measles, 90% of the people around them who aren’t immune will also catch it. And it’s so serious that one in four people who get measles will need to be hospitalized.

What are the symptoms of measles?

Seven to 14 days after exposure, symptoms begin with a high fever, cough, runny nose, and red, watery eyes. Several days after that, the measles rash appears.

Why has measles come back?

Measles was declared eliminated in the U.S. in 2000, 3 decades after the vaccine was introduced. But in recent years, “A critical number of parents have chosen not to vaccinate their children,” says Paul Offit, MD, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “When that happens, measles — the most contagious of vaccine-preventable illnesses — is often the first to come back.”

Where have there been measles outbreaks 2019?

The CDC defines an outbreak as three or more cases . The largest outbreak this year has been in New York City, with nearly 300 cases concentrated in an Orthodox Jewish community in the Williamsburg area of Brooklyn. New York City Mayor Bill de Blasio declared a public health emergency April 9 and said unvaccinated residents living in certain ZIP codes that had been exposed to the virus must get the vaccine to help prevent further spread of the disease. Residents who refuse may face a violation and possible fine of $1,000. A group of parents is suing the city’s public health department to block the order.

Rockland County, north of the city, also had a sizable outbreak, as did counties in Washington state, Michigan, New Jersey, and California. Individual cases have been confirmed in 14 other states.

How dangerous is it?

For some people, measles brings far more than just a fever and a rash. There is no treatment, and it can cause serious health complications, especially in small children. Currently, five patients in New York City have been admitted to the intensive care unit. In general, one out of every 10 children with measles get an ear infection, which can lead to permanent hearing loss. And one or two out of every 1,000 will die.

Who’s most at risk of measles?

About 500,000 people in the U.S. can’t be vaccinated because of severe allergies or a weakened immune system, says. Offit. Those people rely on everyone else’s vaccinations to protect them, in a concept known as community (or herd) immunity. Community immunity also keeps infants safe, since the vaccine isn’t given until a child is a year old.

How is measles spread?

People with measles can spread the disease up to 4 days before their symptoms appear. When an infected person coughs or sneezes, the virus sprays into the air, where it lingers or lands on surfaces. The virus can live outside a human body for up to 2 hours — so even if you enter an empty room, if you don’t have immunity, you can become infected.

What is the chance that measles will spread more widely?

If more parents refuse to vaccinate their children, the disease could become a constant threat.

When is the measles vaccine given?

The vaccine is usually given to children between the ages of 1 and 6. To be most effective, they’ll get two doses: the first at 12 to 15 months, and the second between ages 4 and 6. That second dose can be given as soon as 28 days after the first dose, if necessary.

If every unvaccinated person got vaccinated, would it stop the spread?

Absolutely, says Offit. “Measles is back because we haven’t learned from history. And it’s the children who suffer for our ignorance.”

Are measles parties safe?

Before there was a vaccine for chickenpox, parents would bring children to the home of a child who had the pox to expose them on purpose. (Chickenpox can become more serious in adults.) Now, some parents who refuse vaccinations for their children are doing the same with measles. Offit says this is extremely dangerous. “Why risk a natural infection, knowing it could mean your life?”

Does the vaccination I got as a child still protect me?

In most cases, yes. Only about three people out of every 100 who get both doses of the vaccine will still get measles after exposure. One caveat: If you received the vaccine in its early days, between 1963 and 1967, you may need to be re-vaccinated. Certain vaccines given in those years were not effective.

What should you do if you think your child has been exposed?

Call your pediatrician right away, Offit says. The risk will depend on several things, which your doctor will assess. Do not wait for symptoms.

Moderate muscle strength may lower risk for type 2 diabetes

Of the 30 million Americans with diabetes, 90 to 95 percent have type 2, according to the Centers for Disease Control and Prevention.

New research shows building muscle strength may be one way to lower risk for the disease. The study of more than 4,500 adults found moderate muscle mass reduced the risk for type 2 diabetes by 32 percent. The benefits were independent of cardiorespiratory fitness, and higher levels of muscle strength did not provide additional protection. The findings are published in the journal Mayo Clinic Proceedings.

DC (Duck-chul) Lee, associate professor of kinesiology at Iowa State University and corresponding author of the study, says the results are encouraging because even small amounts of resistance exercise may be helpful in preventing type 2 diabetes by improving muscle strength. However, it is difficult to recommend an optimal level as there are no standardized measurements for muscle strength, he said.

“Naturally, people will want to know how often to lift weights or how much muscle mass they need, but it’s not that simple,” Lee said. “As researchers, we have several ways to measure muscle strength, such as grip strength or bench press. More work is needed to determine the proper dose of resistance exercise, which may vary for different health outcomes and populations.”

Study participants completed chest and leg presses to measure muscle strength. Those measurements were adjusted for age, gender and body weight as potential confounders, which is an example of why researchers say it is complicated to provide general recommendations.

Building strength with resistance exercise

Lee, Yuehan Wang, lead author and former research assistant in Lee’s lab; Angelique Brellenthin, an ISU postdoctoral researcher in kinesiology; along with researchers from the University of South Carolina; Pennington Biomedical Research Center; and Ochsner Clinical School-University of Queensland School of Medicine, analyzed data from the Aerobics Center Longitudinal Study, collected at the Cooper Clinic in Dallas.

The current study is one of the first to look at the risk of type 2 diabetes and muscle strength, separate from cardiorespiratory fitness. Participants ranged in age from 20 to 100 years old. All were required to complete initial and follow-up exams. Brellenthin says moderate strength reduced the risk of type 2 diabetes regardless of lifestyle choices such as smoking and drinking, or health issues such as obesity and high blood pressure.

While several factors contribute to muscle strength, Brellenthin says resistance exercise is important. Information on resistance exercise was not available for most participants, with the exception of a small group, which showed a moderate correlation between muscle strength and frequency or days per week of resistance exercise. Other research has found resistance training improves glucose levels and reduces waist circumference — an indicator of excess fat associated with type 2 diabetes and other health issues, Brellenthin said.

“You’re not necessarily going to see the results of resistance training on your bathroom scale, but there are several health benefits,” Brellenthin said. “It may help lower your risk for type 2 diabetes even though you do not lose body weight, and we know maintaining muscle mass helps us stay functional and independent throughout life.”

Start small, keep it simple

Based on self-reports, Brellenthin says only 20 percent of Americans meet the guidelines (two days a week of muscle-strengthening activities) for resistance exercise. While data for the study are not sufficient to provide suggestions for weight training, she says some is better than none. Getting started does not require a gym membership or expensive equipment. In fact, you can start at home by doing body-weight exercises.

“We want to encourage small amounts of resistance training and it doesn’t need to be complicated,” Brellenthin said. “You can get a good resistance workout with squats, planks or lunges. Then, as you build strength, you can consider adding free weights or weight machines.”

Could Diet Sodas Raise Older Women’s Stroke Risk?

By Alan Mozes

HealthDay Reporter

THURSDAY, Feb. 14, 2019 (HealthDay News) — Older women, beware: New research warns that drinking a lot of diet sodas or artificially sweetened fruit juices may increase your risk for stroke.

In a study that tracked nearly 82,000 postmenopausal women, those who drank two or more diet drinks per day saw their overall stroke risk rise by 23 percent, compared with those who consumed diet drinks less than once a week.

Blocked arteries were often the main culprit, with heavy diet drink consumption linked to a 31 percent greater risk for an ischemic stroke, which is triggered by a clot, the study findings showed.

Study author Yasmin Mossavar-Rahmani acknowledged that an “association does not imply causation.” But she stressed that the findings held up even after taking into account the nutritional value of each participant’s overall diet.

So, “we can’t assume these diet drinks are harmless, particularly when consumed at high levels,” Mossavar-Rahmani said.

“The take-home message is that these findings give us pause,” she added. “We need to do more research on why we are seeing these associations. What are the scientific mechanisms? Is there something about the artificial sweeteners, for example, that affect the bacteria in the gut and lead to health issues?”

Mossavar-Rahmani is an associate professor in the department of epidemiology and population health’s division of health promotion and nutrition research at Albert Einstein College of Medicine, in New York City.

The study authors pointed out that the American Heart Association (AHA) has recently underscored the lack of sufficient research into the cardiovascular impact of diet sodas. Until more work is done, the AHA says the jury remains out on whether artificially sweetened beverages do or do not hasten heart disease.

Women in the latest study were between 50 and 79 when they first enrolled in the Women’s Health Initiative trial between 1993 and 1998.

Investigators tracked the general health of all the enrollees for an average of nearly 12 years. During that time — at the three-year mark — all the women were asked to indicate how frequently they consumed diet sodas and diet fruit drinks over a three-month period.

The researchers did not take note of which brands of artificially sweetened drinks the women drank, and so did not know which artificial sweeteners were being consumed.

That said, nearly two-thirds of the women consumed diet sodas or drinks very infrequently, meaning less than once a week or never. Only about 5 percent were found to be “heavy” consumers of artificially sweetened drinks.

After taking into consideration a variety of stroke risk factors — including blood pressure status, smoking history and age — the study team concluded that heavy consumption of diet drinks did appear to be tied to cardiovascular risks in a number of ways.

For example, those women who drank two or more diet beverages a day saw their overall risk for developing heart disease increase by 29 percent. They were also 16 percent more likely to die prematurely from any cause.

Certain groups fared even worse: Among obese women and black women with no history of heart disease or diabetes, a diet drink habit pushed clot-driven stroke risk up by roughly twofold and fourfold, respectively, the researchers reported.

Whether or not the findings would apply to either men or younger women remains unclear, the study authors noted.

The findings were published online Feb. 14 in the journal Stroke.

Lona Sandon is program director of the department of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas.

She agreed that more research is needed to further explore a possible diet drink-heart disease connection. But for now Sandon offered simple advice: diet or regular, sodas offer no nutritional value other than calories.

“If they replace other drinks, such as milk and 100 percent fruit or vegetable drinks, then these women miss out on valuable nutrition for protecting the heart and vascular system,” Sandon warned.

“The nutrition you are missing because you are drinking artificially sweetened beverages instead may be the real problem,” she said.

A group representing the artificial sweetener industry offered another caveat about the findings — that many women who drink diet drinks are already struggling with weight issues.

“It is likely study subjects were already at a greater health risk and chose low-calorie sweetened beverages to manage their calorie and sugar intake as these products are proven safe and beneficial for those managing their weight and blood glucose levels,” said Robert Rankin, president of the Calorie Control Council.

“The contribution of reverse causality, meaning that individuals already at a greater risk of stroke and cardiovascular events chose low-calorie sweetened beverages, is very likely the cause of the associations presented by these researchers,” the council added in a statement.

How music motivates the brain to learn

Humans have been making, listening, and dancing to music since time immemorial, and this art can easily soothe or amplify our emotions. New research explains what “chords” music strikes in the brain, and how it relates to certain cognitive processes, particularly learning.

In recent years, researchers have shown more interest in how listening to music can pragmatically benefit us in numerous ways.

For instance, studies such as this one, which Medical News Today covered last spring, have suggested that people with Alzheimer’s disease who face anxiety and other stressful emotions cope better when they listen to music.

Listening to certain types of music may even alter our perception and change the way we see potential partners, while happy songs can help boost our creativity.

In a new study, the findings of which feature in the journal PNAS, researchers from McGill University in Montreal, Canada have now shown that we can use music to activate the brain’s reward center and motivate learning in an error prediction model.

“Although many authors have proposed that the intense emotions and pleasures of music result from expectancies, predictions, and their outcomes […], direct evidence for this proposition has been lacking,” the researchers write.

The current research finally gets to the bottom of this proposition, using a musical reward learning task and functional MRI to understand how pleasurable music motivates the brain to learn and to strive for its reward.

Music as a reward that ‘supports learning’

The team worked with 20 participants aged between 18 and 27 years, whom they asked to take part in a musical reward experiment. Each person had to choose a combination of colors and directions, and each combination had a different probability of the participant hearing either pleasant music or a dissonant, unpleasant audio track.

After a few attempts, the participants learned which combinations they should choose in order to increase their chances of accessing the enjoyable music reward.

While the volunteers were participating in this task, the researchers used functional MRI to measure their brain activity. Then, using a special algorithm, the investigators calculated the difference between how often the participants expected to receive their reward and the number of times they actually received it.

On further comparing this data with the functional MRI scans, the team found that correct predictions correlated with heightened activity in a brain area called the nucleus accumbens, which previous research has tied to the experience of pleasure when listening to music.

This finding indicates that music is, in itself, a viable reward and one that can provide enough motivation to the brain to learn new information that will allow it to access this source of pleasure more easily.

Furthermore, the participants who found the right combinations and made the correct predictions the most often, which correlated with heightened activity in the nucleus accumbens each time, also made the most learning progress throughout the tasks.

“This study adds to our understanding of how abstract stimuli like music activate the pleasure centers of our brains,” explains study author Benjamin Gold.

Sleep Patterns May Offer Clues to Alzheimer’s

HealthDay Reporter

WEDNESDAY, Jan. 9, 2019 (HealthDay News) — Poor sleep is common among Alzheimer’s patients, and researchers say they’re beginning to understand why.

Scientists studied 119 people aged 60 and older. Eighty percent had no thinking or memory problems, while the rest had only mild problems.

The researchers found that participants with less slow-wave sleep — deep sleep that’s needed to preserve memories and to wake up feeling refreshed — had higher levels of the brain protein tau.

Elevated tau levels are a possible sign of Alzheimer’s disease and have been linked to brain damage and mental decline, the scientists said.

The findings suggest that poor sleep among older adults could be a warning sign of declining brain health, according to the researchers at Washington University School of Medicine in St. Louis.

“We saw this inverse relationship between decreased slow-wave sleep and more tau protein in people who were either cognitively normal or very mildly impaired, meaning that reduced slow-wave activity may be a marker for the transition between normal and impaired,” said first author Dr. Brendan Lucey. He’s an assistant professor of neurology and director of the Washington University Sleep Medicine Center.

“Measuring how people sleep may be a noninvasive way to screen for Alzheimer’s disease before or just as people begin to develop problems with memory and thinking,” Lucey said in a university news release.

He noted that the people with increased tau levels “were actually sleeping more at night and napping more in the day, but they weren’t getting as good quality sleep.”

Lucey doesn’t expect sleep monitoring to replace brain scans or cerebrospinal fluid analysis for identifying early signs of Alzheimer’s disease. “But it could supplement them,” he said. The study only found an association between sleep quality and tau levels.

“It’s something that could be easily followed over time, and if someone’s sleep habits start changing, that could be a sign for doctors to take a closer look at what might be going on in their brains,” Lucey said.

About 5.7 million Americans have Alzheimer’s disease. Brain changes associated with the disease can begin up to two decades before symptoms such as memory loss and confusion appear.

The study findings were published Jan. 9 in the journal Science Translational Medicine.

Diabetes: Can we teach the body to heal itself?

In diabetes, the pancreas is unable to produce enough insulin, the hormone that is key to regulating levels of blood sugar. New research now asks if we can teach pancreatic cells to address this problem on their own.

The pancreas contains three different types of cells, each of which produces different hormones that contribute to the regulation of blood sugar levels, one way or another.

These cells are alpha-cells that produce glucagon to boost blood sugar, beta-cells that produce insulin to lower levels of glucagon, and delta-cells that produce somatostatin, a hormone that regulates alpha- and beta-cell activity.

In both type 1 and type 2 diabetes, research has linked the lack of insulin with problems in pancreatic beta-cells.

However, a new study by researchers from the University of Bergen in Norway suggests that, with just a small “push,” we may be able to train the body to start producing adequate levels of insulin once more, on its own.

More specifically, the investigators explain, some alpha-cells could turn into beta-cells and release insulin.

“We are possibly facing the start of a totally new form of treatment for diabetes, where the body can produce its own insulin, with some start-up help,” says study co-author Luiza Ghila from the Raeder Research Lab in the Department of Clinical Science at the University of Bergen.

The researchers explain their findings in detail in a study paper in the journal Nature Cell Biology.

Higher risk of blood clots associated with some HRT tablets

Thursday, 10 January 2019

Some hormone replacement therapy (HRT) tablets appear to be associated with a higher risk of rare but serious venous thromboembolism (VTE), suggests a large study* published today in The BMJ.

However, the study found no increased risk of VTE for HRT skin patches, gels or creams, although the vast majority of women choosing HRT are prescribed oral preparations.

Different treatments of HRT used to relieve menopausal symptoms are available depending on the symptoms, such as tablets containing oestrogen only or a combination of oestrogen and progestogen, as well as ‘transdermal’ treatments, such as patches, gels and creams.

Previous trials have shown increased risks of blood clots in menopausal women using HRT, but there is a lack of information on risks associated with different types of HRT.

Therefore, Yana Vinogradova, a member of an epidemiological team at the University of Nottingham led by Julia Hippisley-Cox, set out to assess the association between VTE risk and all available types of HRT in the UK between 1998 and 2017.

The research team used two UK primary care databases (QResearch and CPRD) and compared HRT prescription records of 80,396 women aged 40-79 years who developed blood clots (cases) with those of over 391,494 women who did not (controls).

Other relevant factors, such as lifestyle, family history of blood clots, and underlying conditions linked to blood clots were taken into account.

Analysis showed that most HRT tablets were found to be associated with increased VTE risk (nine extra cases per 10,000 women per year) compared with no HRT.

Tablets containing equine oestrogen, including single and combined preparations, were consistently associated with higher risks than tablets containing synthetic oestrogen.

In addition, higher doses of oestrogen were also associated with higher VTE risk, but there was no increased VTE risk found for skin patches, gels and creams.

This was an observational study so it could not establish cause and the researchers acknowledged some limitations that may have influenced the results.

Nevertheless, they said: “This study has provided a more detailed picture of the VTE risks for different HRT preparations and can help clinicians and women make treatment choices.”

They suggested clinicians should give greater consideration to transdermal HRT, particularly for women already at an increased VTE risk and in line with recent guidelines.

Royal College of General Practitioners chair Professor Helen Stokes-Lampard said the study was interesting but stressed that it showed association and not causation.

“The menopause is a transition stage for every woman and can cause difficulties for many – and for some specific symptoms, such as hot flushes and night sweats, HRT is the only medical treatment that has good evidence of benefit,” she said.

“While this study is certainly interesting and important, as the authors themselves acknowledge, the findings do not prove that tablets cause more DVTs [Deep vein thrombosis] than patches, just that there is an association. As such, it is essential that more research is conducted in this area and taken into account as new clinical guidelines are updated and developed.

“It’s important that patients don’t panic or stop taking HRT as a result of reading about this study, but instead discuss their concerns at their next routine GP appointment, or seek advice from a reputable website like NHS Choices.”