March Medication News – Updates on pharma science news to keep people with diabetes in the know!
The last couple of months have brought a lot of interesting study updates in the world of medications that people with diabetes use. It’s always to good to have an ear to the ground on pharma studies because they can give us guidance on medication choices from blood sugar management, to complication risk, and also possible side benefits.
When deciding whether to use a medication we always do a risk/benefit analysis. Is the benefit (direct and immediate or indirect and potential) worth the risk (side effects and costs) The info on the product label is only the beginning of this decision-making for patients and prescribers in the know. As we have written in the past, off-label medication use can be a highly effective tool in the management of diabetes and a host of other diseases. So knowing the full range of what a medication CAN do, not just what the FDA says it is approved to do can give us a BIG leg up on medication decision-making. So let’s take a look at some medications common in the life of people with diabetes that hit the press this winter that we should know about!
In February the results of the CLVr study were released at ATTD (Advanced Technology and Treatments for Diabetes) in Berlin. The goal of this study was to investigate methods of preventing beta cell function following insulin initiation in newly diagnosed PWD. Participants were started either on a hybrid closed loop insulin pump with aggressive insulin therapy, and/or verapamil and standard insulin therapy. Surprisingly verapamil proved to be effective, not only at preventing beta cell loss but at improving beta cell function over the year following diagnosis!
Verapamil is a blood pressure medication that has been safely and effectively used for decades. Perhaps best of all, it’s extremely cheap! Its main side effect is the unwanted lowering of blood pressure. This study was done in children and teens and the medication was tolerated well with only 17% of participants on verapamil having non-serious side effects, while 20% of those on placebo reported non-serious side effects.
This is a very exciting step toward further delay of beta cell function loss in early diagnosis and reinforces the need for early screening for those at risk for type 1 diabetes. With such a low cost and low side effect treatment option available it may even increase the viability for population-wide screening efforts to gain traction.
Vitamin D & dementia
One of the hottest supplements in recent years has been vitamin D! In fact, you can check this link for articles we’ve written about the benefits of vitamin D for people with diabetes: https://integrateddiabetes.com/?s=Vitamin+D&lang=en
Another recent study of over 12,000 participants in the UK and Canada over a 40-year period, showed that participants who took routine Vitamin D supplements were 40% less likely to develop dementia when corrected for age and gender vs the population that did not take Vitamin D. This is a promising real-world finding because, while doses of Vitamin D and blood levels of Vitamin D are unknown, these patients were not recorded to have been taking part in studies or treatments using higher than typical doses of Vitamin D. Until now many studies that have shown great benefits of Vitamin D use have either been at doses in excess of 8 times the normal dietary recommendation and or via IV or injection rather than oral routes. This study shows that even under non-study, real-world Vitamin D supplementing conditions there is a marked benefit. One major shortfall of this study was that the participants were 80% caucasian. Further studies of more diverse populations are needed.
At IDS we do recommend everyone with diabetes talk with their prescriber about the benefits for them of supplementing with vitamin D and what dose would be appropriate for their individual needs.
More info on dementia and vitamin D
TZD’s and Dementia
“Glitazones”, also known as TZDs are a class of diabetes medications that are seldom discussed these days. With many blood sugar-lowering medications with fewer unwanted side effect risks ( Edema, weight gain, heart failure, hypoglycemia, increased risk of fracture, decreased hematocrit and hemoglobin along with a nasty 2010 ban on Avandia in many countries).
However, we have seen studies for years that TZDs have been linked to lower rates of dementia. Some studies show up to a 50% reduction in Alzheimer’s risk. A recent update published in February’s Neurology found not only a lower risk of dementia in patients with type 2 diabetes who were on pioglitazone, but also a reduction in overall stroke risk. The dementia risks were lowest in patients with a previous history of prior ischemia or stroke, a population that would typically be at a higher risk for dementia. This study out of Korea brings up more reasons to continue researching these medications rather than relegating them to the dust of diabetes past.
Metformin &Covid Viral Load
Metformin has been shown to not always be the best first-line medication in type 2 diabetes. This is largely because it reduces hepatic (liver) glucose release, but does very little to reduce blood sugar directly. But it has been linked to everything from, to improving Cancer survival rates and reducing rates of other cancers!
Metformin has been used for decades in the treatment of Polycystic Ovary symdrome (PCOS) and has even been shown to reduce rates of miscarriage in women both with and without preexisting diabetes.
It has been tied to slowing rates of macular degeneration and reduced rates of DVT (veinous thromboembolism) in adults with type 2. Metformin has even been shown to reduce rates of dementia in older adults and rates of cognitive loss related to Parkinson’s and Alzheimer’s. It is of significant note that in all of these cases, the impact is decoupled from glycemic control. There seems to be something about what metformin is, and how it works in the body that has a lot of benefits.
In February 2023 a study called COVID-OUT, a stage 3 clinical trial on the impacts of metformin on Covid infection, severity and post diagnosis prognosis wrapped. While it did not reach its primary endpoint, (That of using Metformin as a treatment for Covid itself to prevent severe disease resulting in hospitalization or death) the study DID show a 42% reduction in the hospitalization of those with a covid infection of 14 days duration, and a 58% reduction in those with a symptomatic infection lasting 28 days. It also demonstrated that patients on metformin showed a 4.4x greater decrease in post-infection viral load on days 1, 5, and 10 of Covid (of all variants) than placebo regardless of the vaccination status of the individual.
Importantly this antiviral effect was shown both for those who were on metformin in advance of infection and those who were metformin naieve and given metformin upon diagnosis. Again this demonstrates that it is not the glycemic control of the metformin responsible for the impacts on viral load. The anti Viral effect was actually as strong or stronger than that of a standard anti-viral treatment for Covid nirmatrelvir (paxlovid) Research continues, but the many benefits of metformin continue to make it a good medication option where the benefits keep mounting and the side effect profile continues to remain relatively unchanged. (Metformin Linked to Reductions in COVID-19 Viral Load – Medscape – Feb 21, 2023.)
The pharmaceutical world is always evolving, and medications used for one purpose are often found to have entirely unintended benefits in other areas.
We keep our eyes and minds open to innovation and the possibilities to help educate and empower our patients to work with their healthcare team to stay at the leading edge of medical possibilities. Being aware of what your medication options are and what secondary benefits those medications present can help us make not only the best choices for our blood sugar management but our overall long-term health.
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