Metformin could help leaky gut

In continuation of  my update on metformin

A team of researchers from University of California, San Diego, have successfully used gut organoids in their lab to show the effects of medications to treat conditions such as “leaky gut”. The study was titled, “The stress polarity signaling (SPS) pathway serves as a marker and a target in the leaky gut barrier: implications in aging and cancer,” and was published in the journal Life Science Alliance today..

The team found that they could use 3 dimensional gut cells in a Petri dish in the form of a gut organoids and test the drugs for their efficacy on leaky guts. These organoids can successfully recreate the molecular system within the lab including intestinal lining cells etc. These cells are normally sealed to prevent leakage. In certain disease conditions, the seals may be dysfunctional leading to leaky guts, wrote the researchers. These conditions are commonly seen in cancers and among the elderly, they explained. In this condition there may be leakage of microbes as well as vital molecules from the intestines into the abdominal cavities.

To create these organoids the team used donated intestinal cells from the patients. The intestines typically have crests and crypts with peaks and valleys. From the crypts they could isolate stem cells. These cells were used to create the three dimensional organoids within the labs, the team wrote. The stem cells grew to become four types of cells that normally are noted within the gut. These cells then rolled up to become mini guts within the Petri dishes they wrote. Now the organoids were capable of being tested.

University of California San Diego School of Medicine researchers thus used 3D models of human intestines in the petri dishes. These cells were donated by real patients suffering from leaky gut. The cells were created into 3D mini organoids so that they could mimic the real intestines. The team then found certain biomarkers that were characteristic of intestines that had the leakage problem. The team speculates that these markers could help researchers diagnose this condition early and also track the progression of the disease over a course of time.

For their study they used a commonly used diabetes medicine Metformin to try and plug the leaks within the intestinal walls. The study led by Pradipta Ghosh, MD, professor of cellular and molecular medicine at UC San Diego School of Medicine and Moores Cancer Center, and senior author Soumita Das, PhD, associate professor of pathology at UC San Diego School of Medicine, revealed that this commonly used drug could help patients with a leaky gut.

Ghosh and Das had earlier, in another study showed that a mechanism called the stress-polarity signaling pathway could help close the gaps between the cells and prevent the leakage. In that study they had also noted that the connections and bonds between the cells came apart due to the stress.

This new study revealed that Metformin may work to activate certain chemical reactions that could tighten these junctions and thus prevent the leakage. The team says that their success has been seen only in the Petri dishes on the mini organoids of the gut yet. They need to replicate it in humans to see if the drug could actually help patients with leaky gut conditions. They added however that the success of the drug in these organoids is a big step in proving that the drug could actually help. Metformin, they wrote raise the levels of a protein called occluding that can tighten the junctions between cells. If successful, this could help a large number of patients, they explained.

Ghosh said, “Lots of research is done in mice that are inbred so that they are genetically identical, all in the same cage, eating the same diet, in order to remove these variables from the studies. But lab mice are far more standardized than the same human from day to day, or patients we see in the clinics. Here, our model is a better representation of humanity. On the other hand, it also means that each organoid is its own unique experiment. We have to test many organoids to be able to make any claim, which we did in our study.” Das added, “I think you'd be hard pressed to find a disease in which systemic inflammation is not a driver. That's why, even though there are so many things we still don't know, we're excited about the broad potential this model and these findings open for developing personalized leaky gut therapeutics that target AMPK and the stress-polarity signaling pathway.”

There may be several disease conditions that lead to weakening of the bonds between the cells and the junctional cells between two intestinal cells, wrote the researchers. This leads to leakage of the molecules from within the intestines as well as leakage of microbes. This can trigger the immune system leading to a state of chronic inflammation. Inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease as well as other conditions such as liver damage, cancers, diabetes, atherosclerosis, arthritis and even dementia could be associated with leaky gut cells say researchers. Till date there have been no way this problem could be studied, let alone solved, wrote the researchers. This new study finally paves a way where the condition could be replicated in the lab and studied at its molecular level.

For this study the team took the mini organoids and opened up the rolled balls to expose the intestinal surface. Over these they used bacteria and other stressors to weaken the junctional cells and create leaky openings. Now they could study the molecular mechanisms as well as the drugs which could help tightening these bonds between the cells to prevent leakage.

https://www.life-science-alliance.org/content/3/3/e201900481

https://en.wikipedia.org/wiki/Metformin

Could Diabetes Drug Metformin Help Keep People Slim?

New research suggests a first-line drug for treating type 2 diabetes   'metformin'  may help people with pre-diabetes maintain long-term weight loss.

People who lost weight while taking metformin maintained a loss of about 6% of their body weight for six to 15 years. People who lost weight through lifestyle changes -- eating healthily and exercising regularly -- managed to keep off just under 4% of their initial body weight for the same period, the study found.

Metformin doesn't seem to be particularly helpful for shedding pounds in the first place, though. In fact, an earlier phase of the study found that people were much more likely to lose 5% or more of their body weight through lifestyle changes -- healthy eating and exercising -- than by using metformin.

"Although lifestyle changes were superior for inducing weight loss early on, metformin was better for long-term weight maintenance," said senior study author Dr. Kishore Gadde. He's a professor in heart disease prevention at the Pennington Biomedical Research Center in Baton Rouge, La.

Not everyone is convinced that metformin can keep you slim, however. After reviewing the findings, Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said, "This study was very well done, but it doesn't show metformin is effective for everyone. The ones on metformin who did lose weight only regained a little less weight."

He added that metformin isn't well-tolerated by a lot of people. It can cause digestive problems, such as nausea and diarrhoea.

An  effective intervention for losing weight and maintaining that loss is clearly needed. Nearly three-quarters of the American population is overweight or obese -- a major risk factor for type 2 diabetes, according to the U.S. Centers for Disease Control and Prevention.

Losing a significant amount of weight more than 5% of your body weight  seems to help prevent pre-diabetes from turning into type 2 diabetes, and can help delay the progression of type 2 diabetes.

The latest study was a continuation of the three-year diabetes prevention clinical trial that compared three different groups of people with pre-diabetes to see what type of intervention would help prevent type 2 diabetes from developing. One group was given metformin, another was coached on intensive lifestyle changes, and the third group was given a placebo.

This study found that lifestyle changes led to the greatest initial weight loss, followed by the metformin group, according to Gadde.

From the original study group -- more than 3,000 people -- just over 1,000 lost more than 5% of their body weight.

The researchers followed this group for as long as 15 years to see who maintained their weight loss.

People taking metformin had the greatest weight loss from years six to 15, according to the study. The study also found that being older and losing a greater amount of weight in the first year were consistent predictors of lasting weight loss, the study authors said.

Gadde said it's not exactly clear why the metformin group was better at maintaining weight loss. "Metformin does reduce food intake a little bit, but it's not a dramatic effect. And, from what we know, it doesn't significantly alter energy expenditure."

He said other recent research suggests that metformin may alter the body's microbiome (the healthy bacteria in your gut). It also seems that metformin may have some effects on muscle function. But Gadde said, more research is necessary to know for sure.

Could Diabetes Drug Metformin Help Keep People Slim?

Diabetes drug use during pregnancy may increase risk of obesity or overweight in children

In continuation of my update on metformin

When women take the common diabetes medication metformin during pregnancy, it may put their children at increased risk of having obesity or overweight.

A growing number of pregnant women are taking metformin to treat gestational diabetes or a condition called polycystic ovary syndrome (PCOS). PCOS is a common cause of infertility and can put women at risk of developing diabetes and other metabolic health problems. PCOS affects an estimated 7 percent to 10 percent of women of childbearing age, according to the Hormone Health Network.

When pregnant women with PCOS or gestational diabetes take metformin, the medication crosses the placenta and is passed to the fetus.

"Our findings indicate the offspring of women who took metformin for PCOS during pregnancy are more likely to meet the criteria for obesity or overweight than children whose mothers were given a placebo during pregnancy," said the study's first author, Liv Guro Engen Hanem, M.D., of the Norwegian University of Science and Technology in Trondheim, Norway. "The results were surprising, since limited past research in this area had suggested metformin would have a protective effect on the children's metabolic health."

The researchers invited parents of 292 children who participated in two previous randomized clinical trials to be part of this study. In the previous trials, pregnant women with PCOS were assigned to take either metformin or a placebo during pregnancy. The researchers wound up reviewing body mass index (BMI) and other measurements for 161 children born following the two earlier studies.

At four years of age, the children whose mothers were randomized to metformin during pregnancy tended to weigh more than the children whose mothers took the placebo. Although metformin did not appear to affect birth weight, the trend became apparent when children reached six months of age. At the age of four years, the children in the metformin group had higher BMI scores and were more likely to meet the criteria for obesity or overweight than children in the placebo group.

"Few studies have examined the long-term health of children born to women with PCOS who took metformin," Hanem said. "Our findings indicate more research is needed to determine its effects on children who were exposed in the womb."

Ref : https://www.endocrine.org/news-room/2018/diabetes-drug-use-during-pregnancy-linked-to-childs-weight

Diabetes drug use during pregnancy may increase risk of obesity or overweight in children

Combination of diabetes and hypertension drugs can effectively treat cancer

In continuation of my update on metformin

  

Syrosingopine

  

                                                                        metformin

A combination of a diabetes medication and an antihypertensive drug can effectively combat cancer cells. The team of researchers led by Prof. Michael Hall at the Biozentrum of the University of Basel has also reported that specific cancer cells respond to this combination of drugs. The results of the study have now been published in "Science Advances".

Metformin is the most widely prescribed drug for the treatment of type 2 diabetes. Besides its blood sugar lowering effect, it also displays anti-cancer properties. The usual therapeutic dose, however, is too low to effectively fight cancer. The research team led by Prof. Michael Hall, at the Biozentrum of the University of Basel, has now made an unexpected discovery: The antihypertensive drug syrosingopine potentiates the anti-cancer efficacy of metformin. Apparently, this drug combination drives cancer cells to programmed "suicide".

Drug cocktail kills tumor cells

At higher doses, the antidiabetic drug inhibits the growth of cancer cells but could also induce unwanted side effects. Therefore, the researchers screened over a thousand drugs for whether they can enhance the anticancer action of metformin. A favorite emerged from this screening: Syrosingopine, an antihypertensive drug. As the study shows, the cocktail of these two drugs is effective in a wide range of cancers.

"For example, in samples from leukemia patients, we demonstrated that almost all tumor cells were killed by this cocktail and at doses that are actually not toxic to normal cells", says the first author, Don Benjamin. "And the effect was exclusively confined to cancer cells, as the blood cells from healthy donors were insensitive to the treatment."

Drugs block "juice" supply to cancer cells

In mice with malignant liver cancer, enlargement of the liver was reduced after the therapy. Also the number of tumor nodules was less - in some animals the tumors disappeared completely. A glance at the molecular processes in the tumor cells explains the drug combination's efficacy: Metformin lowers not only the blood glucose level, but also blocks the respiratory chain in the energy factories of the cell, the mitochondria. The antihypertensive drug syrosingopine inhibits, among other things, the degradation of sugars.

Thus, the drugs interrupt the vital processes which provide energy for the cell. Due to their increased metabolic activity and rapid growth, cancer cells have a particularly high energy consumption, which makes them extremely vulnerable when the energy supply is reduced.

Groundbreaking step towards clinical application

By testing a range of other compounds with the same mode of action, the scientists could demonstrate that the inhibition of the respiratory chain in the mitochondria is a key mechanism. These also reduced cancer cell growth in combination with the antihypertensive drug.

"We have been able to show that the two known drugs lead to more profound effects on cancer cell proliferation than each drug alone," explains Benjamin. "The data from this study support the development of combination approaches for the treatment of cancer patients." This study may have implications for future clinical application of combination scenarios targeting the energy needs of tumor cells.

Oral antidiabetic drug modulates the body's nitrogen and urea metabolism

In continuation of my updates on metformin

The most frequently prescribed oral antidiabetic drug metformin significantly affects metabolic pathways. This was reported by scientists from the Helmholtz Zentrum München together with colleagues from the German Diabetes Center (DDZ) in Düsseldorf. The underlying study was conducted with further scientists of the German Center for Diabetes Research (DZD). These results have now been published in the journal 'Diabetes'.

Metformin is a widespread oral medication to increase insulin sensitivity in patients with type 2 diabetes (T2D). According to a number of studies, it additionally reduces the risk of cardiovascular complications. Last year, a team led by Dr. Rui Wang-Sattler discovered that metformin intake lowers the levels of the harmful LDL cholesterol by activating the AMPK protein complex. Dr. Wang-Sattler is head of the "Metabolism" research group in the Research Unit of Molecular Epidemiology at the Institute of Epidemiology II at the Helmholtz Zentrum München. Her group aims to understand the molecular mechanisms that underlie the activity of metformin.

Metformin intake changes metabolite profiles in population-based KORA study

In the present work, the interdisciplinary team of scientists was able to explain a further feature of the drug: "Our results show that metformin also modulates the body's nitrogen and urea metabolism," first author Jonathan Adam summarizes.

In close collaboration with Dr. Stefan Brandmaier and other colleagues, he examined the metabolite profiles (353 small molecules) of KORA participants. The researchers compared T2D patients treated with metformin (a total of 74) with those not being treated with metformin (115) and looked for differences in the distribution of metabolites in the blood. They subsequently confirmed the findings in samples of more than 1500 participants.

Amino acid levels provide a crucial hint

Changes in the amino acid citrulline concentration caused by metformin intake were particularly significant. The amino acid citrulline (named after Citrullus vulgaris, the watermelon, where it is found in large quantities) showed significantly lower levels in samples of T2D patients treated with metformin than in untreated ones. The researchers propose that this is a further consequence of metformin's AMPK activation. "Our analysis indicates that the activation of the AMPK pathway by metformin affects nitrogen and urea metabolism through a further enzyme, which thus lowers the citrulline levels", reports Rui Wang-Sattler.

Accordingly, the scientists suspect that the additional intake of citrulline could have a positive effect on the cardiovascular system in patients being treated with metformin. As a follow-up study, the team plans to analyze the metformin-associated effects on other central metabolic pathways, such as the citric acid cycle.

Diabetes drug metformin could help reduce toxic acid levels linked to MSUD

In continuation of my update on metformin 

Maple Syrup Urine Disease (MSUD) is a rare inherited metabolic disorder involving the dysfunction of an enzyme which breaks down three essential amino acids: leucine, isoleucine and valine. Left untreated, infants die from a toxic buildup of resulting keto-acids within weeks of birth. Those who are diagnosed early can live a normal life, but are forced to eat a very controlled, formula-based diet. The only proven treatment for the disease, which is characterized by sweet-smelling urine, is a liver transplant. Publishing in Scientific Reports, researchers at the Buck Institute show that the widely-used diabetes drug metformin reduces the toxic acid levels associated with MSUD in both skin cells derived from MSUD patients and in mice. The discovery offers the possibility of a new treatment for a disorder identified 1 in 180,000 births.

Senior author and Buck faculty Arvind Ramanathan, PhD, says metformin reduced the levels of toxic ketoisocaproic acid (KIC) in patient-derived fibroblasts by 20 to 50 percent and significantly reduced KIC levels in the skeletal muscle of mice bred to have the disease by 69 percent. "We think there is a clear path to a clinical trial and we are hoping that physicians who treat MSUD patients will start pushing in that direction," he said. "There is a definite need for novel interventions."

Ramanathan, who specializes in metabolomics, came to the MUSD discovery as he was studying various compounds and the enzymes they impact in the context of aging. The work could provide a mechanistic explanation for metformin's success in controlling diabetes and possibly extending healthspan in both animals and humans. The research also highlights similarities between a rare pediatric disease and normal aging - and shows how studying one can inform the other.

Researchers studied the enzyme BCKDH, which is defective in MSUD and also decreases in activity with normal aging. Ramanathan says decreased BCKDH is implicated in obesity and diabetes; he believes it may be involved in a number of other age-related conditions as well. Ramanathan also studied an enzyme upstream of BCKDH - called BCAT. He says in MSUD, BCAT converts leucine, isoleucine and valine to toxic ketones in the mitochondria of skeletal muscle -resulting in the muscle weakness and atrophy associated with MUSD. "We think the same process may be afoot with age-related sarcopenia and frailty," he said. "Interestingly, metformin interacts with BCAT and in our MSUD mice treatment with metformin significantly reduced toxic acid buildup in the skeletal muscle."

"This is a prime example how aging research can have a significant impact on people at any age and the work also highlights the value of studying drugs already approved by the FDA," said Brian Kennedy, PhD, senior co-author and Buck Institute CEO. "In this case, we hope our discovery will help those living with MUSD. We plan on building on these insights to further our research aimed at extending the healthy years of life for all of us."

Metformin along with chemotherapy/radiation improves outcomes in head and neck cancer patients

In continuation of my update on metformin

Researchers at the University of Cincinnati (UC) College of Medicine have found that adding increasing doses of an approved Type 2 diabetes drug, metformin, to a chemotherapy and radiation treatment regimen in head and neck cancer patients is not well tolerated if escalated too quickly, but allowing slower escalation could be beneficial.

These findings are being presented via poster June 4 at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting: Collective Wisdom, being held June 3-7 in Chicago.

Trisha Wise-Draper, MD, PhD, assistant professor in the Division of Hematology Oncology at the UC College of Medicine, a member of both the Cincinnati Cancer Center and UC Cancer Institute and principal investigator on this study, says retrospective studies have shown improved outcomes in tumors treated with chemotherapy and radiation if they were also on metformin for diabetes.

"In head and neck squamous cell carcinoma, which develops in the mucous membranes of the mouth, nose and throat, diabetic patients taking a medication called metformin had better overall survival compared to those not on metformin when also treated with chemotherapy and radiation," she says. "Additionally, pancreatic cancer patients treated with chemotherapy and metformin required higher doses of metformin--1,000 milligrams twice a day--to experience positive results.

"In basic science studies, metformin has been shown to stop mTOR, a molecular pathway present and active in this type of head and neck cancer, and pretreatment with metformin resulted in a decrease in the occurrence of oral cavity tumors in animal models. In this study, we wanted to see if the combination of escalating doses of metformin with the chemotherapy agent cisplatin and radiation for head and neck cancer tumors in non-diabetic patients would be effective."

Wise-Draper says that metformin, which is an approved Type 2 diabetes medication, was provided by their investigational pharmacy. Metformin was administered orally in escalating doses for 7 to 14 days prior to starting the cisplatin and radiation and continued throughout standard treatment. Blood samples were collected before and after metformin treatment as well as during chemotherapy. Flow cytometry, a technique used to count cells, was used to detect the percent of circulating immune activated cells, and clinical laboratory tests including glucose, B12 and C-peptide (an amino acid that is important for controlling insulin) were performed.

"This is part of an ongoing clinical trial," says Wise-Draper. "We found that eight patients with advanced head and neck cancer have been enrolled so far; we plan to have 30 total. Due to the relatively quick escalation of metformin, the patients' tolerance was poor with higher doses of metformin when initiated 7 days prior to their chemotherapy and radiation therapy regimen.
"Therefore, the protocol was modified to allow slower escalation over 14 days. The most common toxicities observed included nausea (71 percent of patients) and vomiting (43 percent of patients), increase in creatinine (57 percent of patients), decreased white blood cell count (43 percent of patients) and pain when swallowing (43 percent of patients) with only nausea being directly attributed to metformin and the rest attributed to cisplatin and radiation."

She adds that there wasn't a substantial change in T cell or glucose levels with administration of metformin in the small sample of patients but that there were increased C-peptide levels in response to metformin administration.

"These results show that the combination of metformin and cisplatin and radiation was poorly tolerated when metformin was escalated quickly. However, there has been no significant increase in side effects thus far with the addition of metformin," Wise-Draper says. "The trial is continuing with escalation of metformin over a longer period of time to provide more data; we will also try to increase our sample size."

Drug combination could help reduce risk of death in type 2 diabetes

In continuation of my update on metformin

People with type 2 diabetes treated with insulin plus metformin had a reduced risk of death and major cardiac events compared with people treated with insulin alone, a new study by Cardiff University shows.

Led by Professor Craig Currie of the University's School of Medicine, the retrospective research looked at people with type 2 diabetes who were treated with insulin with or without metformin from the year 2000 onwards.

12,020 people were identified from a general practice data source, and the research team tracked them for three and a half years on average, from the time they were first prescribed insulin.

The researchers found than when used in conjunction with insulin, metformin had the potential to reduce mortality and heart attacks. They also found that there was no difference in the risk of cancer between people treated with insulin as a single therapy or in combination with metformin.

Professor Currie said: "Since 1991, the rate of insulin use in type 2 diabetes increased more than six-fold in the UK. In more recent years, metformin has also been used alongside insulin as a treatment.

"Previously, our work showed that increased insulin dose is linked with mortality, cancer and heart attacks. Existing studies have also shown that metformin can attenuate the risks associated with insulin.

"In this research we examined insulin dose along with the impact of combining insulin with metformin. We found that there was a considerable reduction in deaths and heart problems when this cheap and common drug was used in conjunction with insulin.

Around 3.9m people live with diabetes in the UK, with more than 90% of those affected having type 2 diabetes.

"While this research indicates the potential of using these treatments together, further studies are needed to determine the risks and benefits of insulin in type 2 diabetes and the possible benefits associated with the administration of metformin alongside insulin," added Professor Currie.

New clinical study to evaluate inexpensive drug to prevent type 1 diabetes

 

In continuation of my update on metformin

New trial aims to prevent type 1 diabetes

A clinical study evaluating a new hypothesis that an inexpensive drug with a simple treatment regimen can prevent type 1 diabetes will be launched in Dundee tomorrow.

The autoimmune diabetes Accelerator Prevention Trial (adAPT) is led by Professor Terence Wilkin, of the University of Exeter Medical School, with support from colleagues at the University of Dundee and NHS Tayside. It will be launched at Ninewells Hospital, Dundee, on Tuesday, 19th April.

Initial funding of $1.7 million is being provided by JDRF, the leading global organisation backing type 1 diabetes research. The study aims to contact all 6,400 families in Scotland affected by the condition, with a view to expanding into England at a later date. Children aged 5 to 16 who have a sibling or parent with type 1 diabetes will be invited for a blood test to establish whether they are at high risk of developing the disease. If so, they will be invited to take part in the trial.

Researchers will then examine the impact of administering metformin, the world's most commonly prescribed diabetes medicine, to young people in the high-risk category. If successful, the large-scale trial could explain why the incidence of type 1 diabetes has risen five-fold in the last 40 years, and provide a means of preventing it.

Researchers have previously hypothesised that type 1 diabetes is an autoimmune disease caused by a faulty immune system which attacks and destroys insulin-producing beta cells in the pancreas. Clinical trials have tried drugs that supress the immune system to attempt to subdue the attack, but the results have so far been disappointing.

The Accelerator Prevention Trial is the first to test an alternative explanation for type 1 diabetes, and is based on the accelerator hypothesis, proposed in 2001 by Professor Wilkin.

This hypothesis theorises that autoimmunity occurs as a response to damaged beta cells. It believes that beta cells, stressed by being made to work too hard in a modern environment, send out signals that switch on the immune system. adAPT will test whether metformin, which is known to protect the beta cells from stress, can stop the immune response that goes on to destroy them.

Professor Wilkin said, "We still have no means of preventing type 1 diabetes, which, at all ages, results from insufficient insulin. We all lose beta cells over the course of our lives, but most of us have enough for normal function.

"However, if the rate of beta cell loss is accelerated, type 1 diabetes develops, and the faster the loss, the younger the onset of the condition. The accelerator hypothesis talks of fast and slow type 1 diabetes - beta cell loss which progresses at different rates in different people, and appears at different ages as a result."

Metformin can reduce risk of open-angle glaucoma in people with diabetes

In continuation of my update on metformin

Taking the medication metformin hydrochloride was associated with reduced risk of developing the sight-threatening disease open-angle glaucoma in people with diabetes, according to a study published online by JAMA Ophthalmology.

Medications that mimic caloric restriction such as metformin can reduce the risk of some late age-onset disease. It is unknown whether these caloric mimetic drugs affect the risk of age-associated eye diseases such as macular degeneration, diabetic retinopathy, cataract or glaucoma.

Researcher Julia E. Richards, Ph.D., of the University of Michigan, Ann Arbor, and co-authors examined metformin use and the risk of open-angle glaucoma (OAG) using data from a large U.S. managed care network from 2001 through 2010.

Of 150,016 patients with diabetes, 5,893 (3.9 percent) developed OAG. Throughout the study period, 60,214 patients (40.1 percent) filled at least one metformin prescription; 46,505 (31 percent) filled at least one sulfonylurea prescription; 35,707 (23.8 percent) filled at least one thiazolidinedione prescription; 3,663 (2.4 percent) filled at least one meglitinide prescription; and 33,948 (22.6 percent) filled at least one insulin prescription. Some patients filled prescriptions for multiple medications.

Metformin can reduce risk of open-angle glaucoma in people with diabetes

Diabetes drug can boost efficacy of TB medication without causing drug resistance

In continuation of my update on Metformin

A more effective treatment for tuberculosis (TB) could soon be available as scientists have discovered that Metformin (MET), a drug for treating diabetes, can also be used to boost the efficacy of TB medication without inducing drug resistance.

This discovery was made by a team of international scientists led by the Singapore Immunology Network (SIgN), a research institute under the Agency for Science, Technology and Research (A*STAR), Singapore.

TB is an air-borne infectious disease caused by a bacterium called Mycobacterium tuberculosis (Mtb), which often infects the lungs. Even though drugs are available to treat the disease, TB continues to be a major threat to public health, killing close to 1.5 million people every year .

Conventional drugs used to treat TB usually adopt a pathogen-targeted strategy which attacks and kills bacteria directly. This approach has caused Mtb strains to acquire drug resistance, making existing treatments become increasingly ineffective and resulting in a pressing need to design new therapeutic strategies for the disease.

MET as an adjunct treatment for TB

The team of scientists led by SIgN began searching for drugs that could control Mtb replication indirectly. They screened FDA-approved drugs and identified MET, an old anti-diabetic drug that could defend Mtb invasion without targeting the bacteria directly. Instead, MET targets the host cells to trigger the production of a chemical which then damages Mtb and stops its replication. Such indirect, host-targeted approach is less likely to engender drug resistance. The team also discovered that MET improves the efficacy of conventional anti-TB drugs when used in combination with them.

The scientists then validated the findings with patient data provided by the Tuberculosis Clinical Unit at the Tan Tock Seng Hospital, and consequently verified that the use of MET is indeed associated with improved TB control and decreased disease severity. This anti-diabetic drug is therefore a promising adjunctive therapy that could enhance the effectiveness of existing TB treatments. As it is a drug that is currently in use, another benefit of using MET as an adjunct treatment for TB is that it is likely to shorten the time required for clinical trials.

Diabetes drug can boost efficacy of TB medication without causing drug resistance

Isis Pharmaceuticals reports positive data from ISIS-GCGRRx Phase 2 study in patients with type 2 diabetes

Isis Pharmaceuticals, Inc.  announced positive data from a Phase 2 study of ISIS-GCGRRx in patients with type 2 diabetes uncontrolled on stable metformin therapy. In this study, patients in the per protocol efficacy population treated with ISIS-GCGRRx achieved statistically significant reductions in measures of glucose control. The absolute mean reductions in hemoglobin A1c (HbA1c) were greater than 2 percentage points>Rx also experienced increased plasma GLP-1 levels. Isis will present additional detail from this study as a late-breaking abstract program at the American Diabetes Association 74th Scientific Sessions. In conjunction, Isis will host an investor event on June 15, 2014 at 7:00 a.m PT. 

"These results reported today represent the potential for a major advance in diabetes therapeutics. ISIS-GCGRRx employs a unique mechanism to treat patients with type 2 diabetes. It is well known that as type 2 diabetes progresses, dysregulated glucagon action becomes a more significant contributor to the disease. The ability of ISIS-GCGRRxto improve glycemic control without causing any clinically significant increases in blood pressure or lipids offers a significant advantage for both patients and treating physicians," said Robert Henry, M.D., chief, VA endocrinology & metabolism and professor of medicine in residence, University of California, San Diego School of Medicine. "The additional effect on increasing GLP-1 means that ISIS-GCGRRx treatment could help to preserve pancreatic function and enhance insulin secretion in diabetic patients."

Isis Pharmaceuticals reports positive data from ISIS-GCGRRx Phase 2 study in patients with type 2 diabetes

Combination of metformin and rapamycin shows potential in treating aging and related diseases

A proven approach to slow the aging process is dietary restriction, but new research in the Linus Pauling Institute at Oregon State University helps explain the action of a drug that appears to mimic that process - rapamycin.

Rapamycin, an antibiotic and immunosuppressant approved for use about 15 years ago, has drawn extensive interest for its apparent ability - at least in laboratory animal tests - to emulate the ability of dietary restriction in helping animals to live both longer and healthier.

However, this medication has some drawbacks, including an increase in insulin resistance that could set the stage for diabetes. The new findings, published in the Journals of Gerontology: Biological Sciences, help to explain why that happens, and what could be done to address it.

They suggest that a combination of rapamycin and another drug to offset that increase in insulin resistance might provide the benefits of this medication without the unwanted side effect.

"This could be an important advance if it helps us find a way to gain the apparent benefits of rapamycin without increasing insulin resistance," said Viviana Perez, an assistant professor in the Department of Biochemistry and Biophysics in the OSU College of Science.

"It could provide a way not only to increase lifespan but to address some age-related diseases and improve general health," Perez said. "We might find a way for people not only to live longer, but to live better and with a higher quality of life."

Age-related diseases include many of the degenerative diseases that affect billions of people around the world and are among the leading causes of death: cardiovascular disease, diabetes, Alzheimer's disease and cancer.

Combination of metformin and rapamycin shows potential in treating aging and related diseases

Popular diabetes drug does not improve survival rates after cancer

In continuation of my update on metformin

Despite previous scientific studies that suggest diabetes drug metformin has anti-cancer properties, a new, first-of-its-kind study from Women's College Hospital has found the drug may not actually improve survival rates after breast cancer in certain patients.

The study, published in the journal Diabetes Care, failed to show an improved survival rate in older breast cancer patients with diabetes taking the drug metformin, a first-line treatment for diabetes. However, the authors caution further research is necessary to validate the study's findings.

"Metformin is a drug commonly used by diabetic patients to control the amount of glucose in their blood," said the study's lead author Dr. Iliana Lega, a research fellow at Women's College Research Institute. "Although existing scientific literature suggests that drug may prevent new cancers and death from breast cancer, our study found the drug did not significantly impact survival rates in our patients."

Scientific research has found metformin is associated with an up to 30 per cent reduction in new cancers and a reduction in tumour growth in non-diabetic breast cancer patients treated with the drug, Dr. Lega notes in the study.

To test the drug's anti-cancer properties, the authors examined 2,361 women, aged 66 or older who were treated with the drug and diagnosed with breast cancer between April 1, 1997 and March 31, 2008. The women were followed from their date of breast cancer diagnosis until their death or until March 30, 2010. The researchers found no significant statistical correlation between cumulative use of metformin and death from all causes or a significant reduction in deaths due to breast cancer.

"What makes our study so unique is that while the effects of metformin have been well documented, previous research has not examined the cumulative effects of the drug on patients, particularly breast cancer patients with diabetes," Dr. Lega said. "This is important given that diabetic patients may switch drugs over the course of their treatment."

The authors note a lack of data on body mass index, breast cancer stage and a short followup period for breast-cancer specific deaths, limit interpretation of their findings. Further research is necessary in a younger population of patients with breast cancer and diabetes.

"Understanding the effects of metformin on breast cancer patients is critical in helping address the gap in cancer outcomes in patients with and without diabetes," she added. "The findings will help physicians inform treatment plans for patients with diabetes."

Ref : http://care.diabetesjournals.org/content/early/2013/04/30/dc12-2535

Popular diabetes drug does not improve survival rates after cancer

Metformin more effective than sulfonylurea in controlling type 2 diabetes

In continuation of my update on Metformin

A Vanderbilt study examining the impact of the two most commonly prescribed oraldiabetes medications on the risk for heart attack, stroke and death has found the drug metformin has benefits over sulfonylurea drugs.

It was important to examine the cardiovascular impact of the more commonly used diabetes drugs after recent controversy surrounded another diabetes medication, rosiglitazone, because it was associated with an increased cardiac risk, said lead author, Christianne L. Roumie, M.D., MPH, assistant professor of Internal Medicine and Pediatrics. Smaller studies pointed to a potential advantage of taking the drug metformin but this study confirms this in a large population.

"We demonstrated that for every 1,000 patients who are using metformin for a year there are two fewer heart attacks, strokes or deaths compared with patients who use sulfonylureas. I think this reinforces the recommendation that metformin should be used as the first medication to treat diabetes," Roumie said.

The researchers looked at the charts of more than 250,000 veterans receiving care in Veterans Health Administration hospitals throughout the United States.

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Metformin more effective than sulfonylurea in controlling type 2 diabetes

Lilly, Boehringer Ingelheim announce results from linagliptin Phase III trial on T2D

 In continuation of my update on Linagliptin

Results of the one Phase III study presented (Poster No. 999-P) showed that linagliptin was effective as an add-on therapy to basal insulin alone or in combination with metformin and/or pioglitazone in reducing blood glucose levels in adult patients with T2D, when compared to placebo as an add-on to these background therapies. Linagliptin demonstrated a placebo-adjusted reduction in HbA1c of 0.65% (p<0.0001) from a baseline HbA1c of 8.3% at 24 weeks without weight gain or additional risk of hypoglycaemia.  HbA1c is measured in people with diabetes to provide an index of blood glucose control for the previous two to three months. 

A post-hoc analysis from a second Phase III trial (Poster No. 1044-P) found that in hyperglycaemic patients on a background of metformin randomised to add linagliptin or glimepiride, a greater proportion of patients taking linagliptin achieved target HbA1c <7% without weight gain and/or hypoglycaemia than those taking glimepiride after 104 weeks (linagliptin 54% versus glimepiride 23%) while comparably improving blood glucose levels.

Ref : http://www.boehringer-ingelheim.com/news/news_releases/press_releases/2012/09_june_2012_linagliptin1.html

New drug improves glycaemic control with minimum risk of hypoglycemia in type 2 diabetics..

TAK-875, a new treatment for type 2 diabetes, improves blood sugar control and is equally effective as glimepiride, but has a significantly lower risk of creating a dangerous drop in blood sugar, called hypoglycemia, according to a new study. TAK-875 is a novel oral medication designed to enhance insulin secretion in a glucose-dependant manner, which means that it has no effect on insulin secretion when glucose levels are normal, and as such has the potential to improve the control of blood sugar levels without the risk of hypoglycemia.

In the study, Charles Burant, M.D., Ph.D., professor of internal medicine at the University of Michigan Health System, and colleagues randomly assigned 426 patients with type 2 diabetes who were not achieving adequate glucose control through diet, exercise or metformin treatment to one of five doses of TAK-875, a placebo, or glimepiride, a conventional diabetes treatment. The primary outcome was change in hemogloblin A1c from the start of the study.

At 12 weeks, all doses of TAK-875 resulted in significant drops in HbA1c compared with placebo, a similar reduction occurred in patients given glimepiride.

At a TAK-875 dose of 25 mg or higher, about twice as many patients (33 to 48 percent) reached the American Diabetics Association target of HbA1c less than 7 percent within 12 weeks, compared with placebo (19 percent) and was similar to glimepiride (40 percent).

Ref : http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61879-5/fulltext

UMass Amherst Researchers Test a Drug-Exercise Program Designed to Prevent Type 2 Diabetes

In continuation of my update on Metformin...

Kinesiology researcher Barry Braun of the University of Massachusetts Amherst and colleagues recently reported unexpected results of a study suggesting that exercise and one of the most commonly prescribed drugs for diabetes, metformin, each improves insulin resistance when used alone, but when used together, metformin blunted the full effect of a 12-week exercise program in pre-diabetic men and women.

Ref : http://www.umass.edu/newsoffice/newsreleases/articles/142505.php