Saturday, December 21, 2019

Prediabetes Plus Other Conditions as Risk Factors for Other Chronic Conditions

Because prediabetes is a risk factor for type 2 diabetes, the condition is gaining in importance in healthcare. Prediabetes is an abnormally high blood glucose condition, but not high enough to be called diabetes. And this abnormally high glucose state, along with other disorders, can raise the risk for other diseases. In fact, when a person has prediabetes, plus overweight, obesity, or central obesity, the risk for cardiovascular diseases and other morbidities can be heightened. Therefore, gaining more insight into ailments that can combine with prediabetes to increase the risk for diabetes and other morbidities becomes extremely important.

The CDC offers a program called the National Diabetes Prevention Program or NDPP. And Medicare offers the Medicare DPP, which is built on the NDPP. In both programs, individuals must have a BMI greater than or equal to 25 (greater than or equal to 23 for Asians) as part of the eligibility requirements, again, because excess body fat increases the risk for type 2 diabetes.

One study has shown that for men, having prediabetes plus a high BMI and belly fat can raise the risk of cardiovascular (CV) disease. The investigators concluded that “Among men with prediabetes, both BMI and waist circumference should be included when evaluating the risks of major CV events and mortality. Measurement of adiposity constitutes a simple and cost-effective strategy to identify those at high-risk population in prediabetes.”

Another study has shown that the hormone, cortisol, can be an important marker for a person with prediabetes. Cortisol is called the stress hormone, because the level of cortisol typically rises in our body during stressful situations. And this rise can lead to glucose elevation in our blood stream. While more glucose in our blood stream can be helpful in stressful situations -- giving us focus and energy -- too much glucose in the blood stream, for too long, can be harmful. Since a high level of cortisol can lead to an increase in glucose in the blood stream, being able to evaluate the cortisol in our body could be helpful.
And in the above referenced study, it was found that the cortisol in the saliva for persons who are prediabetic is not as high as the cortisol in the saliva for people with type 2 diabetes. So looking at the cortisol level in saliva for persons with prediabetes, and taking actions to lower the cortisol, like lowering the stress, may one day be helpful in delaying or preventing type 2 diabetes.

At any rate, evaluating a person for prediabetes is beneficial. And healthcare providers should make a point of including prediabetes considerations in patient evaluations. Further, the providers should include, risk-increasing conditions in the  evaluations. These inclusions may help prevent or delay type 2 diabetes and other chronic conditions.

Friday, December 20, 2019

The Combination Drug Phentermine-Topiramate May be Useful in Treating Childhood Obesity

The weight loss drug, Qsymia, is one of the five anti-obesity drugs approved by the Federal Drug Administration or the FDA for long term use. The other drugs given FDA approval are Xenical, Saxenda, Contrave and Belviq. Qsymia was developed by a company based in California called Vivus. The anti-obesity drug gained FDA approval in 2012. Qsymia is a combination of two other drugs. They are phentermine and topiramate.
The combination-drug is approved for adults with a BMI greater than or equal to 30, or for adults with a BMI greater than or equal to 27, when the adults have at least one comorbidity such as high blood pressure type 2 diabetes or high cholesterol. However, at least one study indicates that the combination of phentermine and topiramate may be appropriate for the treatment of childhood obesity.

The study was a multicenter randomized control study consisting of obese adolescents 12 to 17 years of age. For the study, 42 adolescents were randomly assigned to a placebo group and two other phentermine-topiramate groups. One of the phentermine-topiramate groups was given a low dose of the phentermine-topiramate combination. The dose was 7.5 mg of phentermine and 46 mg of topiramate. The other phentermine-topiramate group was given 15 mg of phentermine and 92 mg of topiramate for the combination dose.

The investigators concluded that: "Treatment of adolescents with obesity using a fixed-dose combination of phentermine/topiramate for 8 weeks resulted in exposure to [phentermine and topiramate] that was comparable to that observed in adults, statistically significant weight loss, and a tolerable safety profile. These data indicate that both mid- and top-doses  are appropriate for longer term safety and efficacy studies in adolescents.”

Since obesity is a problem for children as well as adults, perhaps some consideration should be given to making the combination drug, phentermine-topiramate, available for adolescent use. The drug could only add to the arsenal of tools that are now being used to fight childhood obesity.
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