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In the Netherlands, where the healthcare system grapples with the staggering burden of over one million patients combating type 2 diabetes (T2D), a significant breakthrough has emerged. A study evaluating the cost-effectiveness of integrating finerenone, a promising therapeutic addition to standard care, offers hope for patients with advanced chronic kidney disease (CKD) and T2D. The study results were published in the journal Cardiovascular Diabetology. 

T2D often brings along the ominous companion of CKD, affecting approximately 36% of patients in the Netherlands. The annual medical costs associated with T2D and CKD are a considerable financial strain, totaling around €1.3 billion and €805 million, respectively. The FIDELIO-DKD trial, a landmark investigation, showcased that the inclusion of finerenone in the standard of care (SoC) regimen significantly reduces the risk of CKD progression and cardiovascular (CV) events in patients dealing with CKD stages 2–4 linked to T2D.

Also Read: Indoco Remedies Canagliflozin Tablets for type 2 diabetes adults get USFDA tentative okay

To delve deeper into the potential impact of finerenone on healthcare economics, the study employed the validated FINE-CKD model. This Markov cohort model simulates the lifelong journey of patients, focusing on outcomes related to CV events and renal replacement therapy. The researchers tailored the model to reflect the Dutch societal perspective, considering both clinical effectiveness and economic implications.

Findings: 

• Results from the study paint a promising picture. When finerenone is integrated into the SoC, patients experience an extension in the time free from CV events and renal replacement therapy, translating to 0.20 additional quality-adjusted life years (QALYs).
• Perhaps even more compelling is the cost-saving aspect: finerenone led to a €6136 decrease in total lifetime costs per patient compared to SoC alone.
• This financial benefit stems from the significant reduction in renal and CV events, showcasing finerenone as a dominant treatment option.
• The study found that finerenone, when added to SoC, has an 83% probability of being a dominant strategy and a 93% probability of being cost-effective, particularly at a willingness-to-pay threshold of €20,000.

Also Read: Stem cell-based treatment for type 1 diabetes can control blood sugar and reduce need for insulin injections: Study

The implications of this study are groundbreaking, not just for patients facing the challenging intersection of T2D and advanced CKD but also for the broader healthcare system. By demonstrating that the integration of finerenone not only improves patient outcomes but also yields substantial cost savings, this research paves the way for more widespread adoption of this innovative treatment approach. In essence, the study offers a glimmer of hope for those navigating the complexities of diabetes and advanced kidney disease, showcasing that cutting-edge treatments can not only enhance lives but also contribute to the economic sustainability of healthcare systems. 

Further reading: 

Quist, S.W., van Schoonhoven, A.V., Bakker, S.J.L. et al. Cost-effectiveness of finerenone in chronic kidney disease associated with type 2 diabetes in The Netherlands. Cardiovasc Diabetol 22, 328 (2023). https://doi.org/10.1186/s12933-023-02053-6

A recent double-blind, placebo-controlled randomized clinical trial conducted across three teaching hospitals in China evaluated the efficacy of low-dose esketamine as an adjuvant to propofol-based sedation during same-visit bidirectional endoscopy. The study aimed to explore whether the addition of esketamine could potentially reduce the occurrence of adverse events such as desaturation and hypotension.

Sweden: A recent study carried out at the University of Gothenburg has shown the advantages of a moderately low-carbohydrate diet for adults with type 1 diabetes over a traditional diet. The study published in The Lancet Regional Health – Europe is the largest of its kind to date. 

The researchers revealed that the average blood sugar level is reduced and the time with good values during 24 hours is increased, without any negative health impact. 

Participants were for different periods randomly assigned in a crossover manner to eat a traditional diet with 50% of the energy from carbohydrates, or a moderate low-carbohydrate diet with 30% of the energy from carbohydrates.

This is a moderate reduction in carbohydrates, with 24-hour monitoring of all participants via continuous glucose monitoring (CGM). Blood glucose levels were recorded at least every 15 minutes during the 16 weeks of the study, and were followed up by a dietitian and diabetes nurse.

The researchers emphasize that for safety reasons, major changes in carbohydrate intake in type 1 diabetes should always be made in consultation with the healthcare provider. Individuals should not make these dietary changes on their own, especially not for children with type 1 diabetes. The current study concerns only adults.

Several benefits of a moderate low-carbohydrate diet

The 50 participants all had type 1 diabetes with elevated mean glucose, long-term blood sugar, and injection therapy with insulin or an insulin pump. Half were women, half men. The average age was 48 years.

Both diets tested were healthy in terms of fat and carbohydrate quality. They included vegetables, fiber-rich carbohydrate sources, unsaturated fats, nuts, seeds and legumes, and were individualized by a dietitian.

Participants on a moderate low-carbohydrate diet were found to spend more time in what is known as the target range, the range within which people with type 1 diabetes should be in terms of glucose levels. The increase in time within the target range was an average of 68 minutes per day compared to the traditional diet, while the time with elevated values ​​was reduced by 85 minutes per day. Overall clinical important changes.

The first author of the study is Sofia Sterner Isaksson, a doctoral student at the Sahlgrenska Academy at the University of Gothenburg and a dietitian in the NU Hospital Group.

“The study shows that a moderate low-carbohydrate diet lowers the average blood sugar level and that more patients can keep their blood sugar within the target range, which is considered beneficial in reducing the risk of organ damage for people with type 1 diabetes,” she says.

No adverse effects of the diet

The researchers saw no evidence of adverse effects. Cholesterol and blood pressure levels were similar for both diets, and participants also felt a bit more satisfied with the moderate low-carbohydrate diet. It has been discussed whether a form of acids, ketones, can become too high when carbohydrates are reduced in type 1 diabetes, but these were also kept at reasonable levels.

“A moderate low-carbohydrate diet can be a good treatment option for adults with type 1 diabetes with elevated glucose levels. However, it is important that the diet is healthy with a particular focus on fat and carbohydrate quality, and that the amount of carbohydrates is not too low so it can be considered safe. Healthcare providers should therefore offer help and monitoring of the diet,” says Sofia Sterner Isaksson.

Responsible for the study is Marcus Lind, professor of diabetology at the University of Gothenburg and senior physician at the research units for diabetes at Sahlgrenska University Hospital and the NU Hospital Group.

“All patients should find the diet that suits them, in consultation with their healthcare professionals, but there has been a lack of sufficiently large studies randomizing participants to different experimental treatments of this kind. It is therefore important that we can present data showing that a moderate low-carbohydrate diet is effective and safe for adults with type 1 diabetes,” he says.

Reference:

Sofia Sterner Isaksson, Arndís F. Ólafsdóttir, Simon Ivarsson, Henrik Imberg, Eva Toft, Sara Hallström, Ulf Rosenqvist, Marie Ekström, Marcus Lind, The effect of carbohydrate intake on glycaemic control in individuals with type 1 diabetes: a randomised, open-label, crossover trial, The Lancet Regional Health – Europe, 2023, https://doi.org/10.1016/j.lanepe.2023.100799.

Weight loss is a biggest concern for all. An increasing number of people are choosing Ozempic as the latest solution for weight loss and now many of them are considering whether to pause the medication to more comfortably enjoy food-filled holiday festivities. But is that advisable and safe to do?

According to the U.S. Food and Drug Administration, Ozempic is a drug that improves blood sugar control in adults with Type 2 diabetes when used alongside diet and exercise. The most common side effects of this medication include nausea, vomiting, diarrhea, abdominal pain, and constipation. Despite these side effects, the medication has gained popularity due to the significant weight loss experienced by many on Ozempic.

However, experts are discovering that pausing the medication might potentially result in prolonged side effects.

In the following Q&A, UCLA Health Clinical Nutrition expert Mopelola Adeyemo, MD, MPH addresses some of the most common questions regarding taking Ozempic during the holiday season and stresses the importance of not skipping doses to indulge in excessive eating during this festive period.

Dr. Adeyemo says when people start Ozempic they may experience symptoms such as nausea, vomiting, diarrhea and constipation which may resolve as their body gets used to the medication. However, when you skip Ozempic, there is risk, on restarting the medication, you may experience these symptoms again. The concern is greater if you have skipped the medication for several weeks and restart at a higher dose.

Furthermore, depending on how long you have skipped your Ozempic you may need to start on a lower dose when restarting. If you are taking Ozempic for weight loss this could delay you achieving your weight loss goals. If you have skipped your Ozempic for two weeks or more, I would recommend discussing with your physician the plan for restarting.

It is important to get the adequate amount of nutrients your body needs while taking Ozempic. Thus, the food recommendations while taking Ozempic are the same we recommend for every adult, which is to maintain a healthy well-balanced diet. We continue to recommend a diet consisting of lean protein sources, whole grains, fruits, plenty of vegetables, low-fat dairy, and healthy fat sources such as olive oil and avocados, while limiting saturated fats. I would recommend limiting fatty foods as they can trigger symptoms of abdominal pain, nausea, and/or diarrhea in some individuals which mirrors potential side effects of Ozempic he added.

One of the ways that Ozempic promotes weight loss is by increasing the sensation of feeling full sooner after starting a meal in part by slowing the emptying of the stomach. Thus, eating in excess can cause symptoms of nausea and vomiting due to the slowed emptying of the stomach. That’s why, while taking Ozempic, it is important to practice mindful eating including paying attention to portion sizes or focusing on multiple small meals during the day, if needed.

For people taking Ozempic for Type 2 diabetes, pausing the medication may cause blood sugar to be uncontrolled during these times. This becomes even more concerning if you stop the medication so that you can overindulge in high-carbohydrate foods during the holidays which will increase your blood sugar even further. Amongst individuals with diabetes, sugar levels being severely elevated can lead to feeling very ill with severe nausea and vomiting, requiring hospitalization.

Further, frequent pausing and restarting your Ozempic might make it challenging for your physician to find a medication regimen to control your diabetes. If for any reason you are considering pausing a medication prescribed by your physician for your diabetes, such as Ozempic, it is important to discuss this with your physician before doing so.

The long-term risk to pausing and restarting Ozempic when used for weight loss solely is limited to potentially slowing weight loss results.

To limit overindulging during the holidays, focus on practicing mindful eating behaviors. Practice chewing slowly and putting your fork on the table after each bite, so you give yourself time to assess your fullness level while eating. Try to avoid distractions while eating such as looking at the TV or your phone – this will improve your awareness of how much you are eating. When there is an option, choose the smaller plate. This will help you with portion control – sometimes seeing less on your plate can help you crave less.

Lastly, remember to start the plate off right, by first filling at least half of your plate with non-starchy vegetables, which can be very filling, but often lower in calories and packed with many needed nutrients and vitamins. Then move on to the protein and whole grains.

He ended, If you begin to experience adverse symptoms due to pausing Ozempic, contact the physician who prescribed your Ozempic right away. If you experience uncontrollable abdominal pain, vomiting or diarrhea, or inability to keep water down, seek medical attention right away by going to your local emergency room or urgent ca