Pharmacy and Health Blog from myGenericPharmacy.com

Invokana is a brand-name prescription drug. It’s FDA-approved for use in adults with type 2 diabetes to:

Improve blood sugar levels. For this use, Invokana is prescribed in addition to diet and exercise to lower blood sugar levels. Reduce the risk of certain cardiovascular problems. For this use, Invokana is given to adults with known cardiovascular disease. It’s used to lower the risk of heart attack and stroke that don’t lead to death. The drug is used to reduce the risk of death from a heart or blood vessel problem.
Reduce the risk of certain complications in people who have diabetic nephropathy with albuminuria. For this use, Invokana is given to certain adults who have diabetic nephropathy (kidney damage that’s caused by diabetes) with albuminuria* of greater than 300 milligrams per day. It’s used to lower the risk of:
End-stage kidney disease
death caused by a heart or blood vessel problem
doubled blood level of creatinine
the need to be hospitalized for heart failure
For more information about these uses of Invokana and certain limitations of its use, see the “Invokana uses” section below.

• With albuminuria, you have high levels of a protein called albumin in your urine.

Drug details
Invokana contains the drug canagliflozin. It belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT-2) inhibitors. (A drug class describes a group of medications that work similarly.)

Invokana comes as a tablet that’s taken by mouth. It’s available in two strengths: 100 mg and 300 mg.

Effectiveness
For information on Invokana’s effectiveness for its approved uses, see the “Invokana uses” section below.

Invokana generic
Invokana contains one active drug ingredient: canagliflozin. It’s available only as a brand-name medication. It’s not currently available in generic form. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Invokana side effects
Invokana can cause mild or serious side effects. The following list contains some key side effects that may occur while taking Invokana. This list doesn’t include all possible side effects.

To learn more about possible side effects of Invokana or how to manage them, talk with your doctor or pharmacist.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Invokana, you can do so through MedWatch.

More common side effects
The more common side effects of Invokana can include*:

urinary tract infections / urinating more often than normal / thirstiness / constipation / nausea / yeast infections† in men and women / vaginal itching.

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist. You should also call your doctor if you think you have a urinary tract infection or yeast infection.

• This is a partial list of more common side effects from Invokana. To learn about other mild side effects, talk with your doctor or pharmacist or visit Invokana’s medication guide.
  † For more information about this side effect, see the “Side effect details” section just below.

Serious side effects
Serious side effects from Invokana aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

Dehydration (low fluid level), which can cause low blood pressure. Symptoms can include:
dizziness/feeling faint/lightheadedness/weakness, especially when you stand up
Hypoglycemia (low blood sugar level). Symptoms can include:
drowsiness/headache/confusion/weakness/hunger/irritability/sweating/feeling jittery/fast heartbeat
Severe allergic reaction.*
Amputation of lower limbs.*
Diabetic ketoacidosis (increased levels of ketones in your blood or urine).*
Fournier’s gangrene (severe infection near the genitals).*
Kidney damage.* Bone fractures.*

Side effect details
You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction
As with most drugs, some people can have an allergic reaction after taking Invokana. In clinical studies, up to 4.2% of people taking Invokana reported having mild allergic reactions.

Symptoms of a mild allergic reaction can include:

skin rash/itchiness/flushing (warmth, swelling, or redness in your skin)
A more severe allergic reaction is rare but possible. Only a few people in clinical studies reported severe allergic reactions while taking Invokana.

Symptoms of a severe allergic reaction can include:

swelling under your skin, typically in your eyelids, lips, hands, or feet
swelling of your tongue, mouth, or throat/trouble breathing
Call your doctor right away if you have a severe allergic reaction to Invokana. But call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Amputation
Invokana may increase your risk of amputation of lower limbs. (With amputation, one of your limbs is removed.)

Two studies found an increased risk for lower limb amputation in people who took Invokana and had:

type 2 diabetes and heart disease, or
type 2 diabetes and were at risk for heart disease
In the studies, up to 3.5% of the people who took Invokana had an amputation. Compared with people who didn’t take the drug, Invokana doubled the risk of amputation. The toe and the midfoot (arch area) were the most common areas of amputation. Some leg amputations were also reported.

Before you start taking Invokana, talk with your doctor about your risk of amputation. This is especially important if you’ve had an amputation in the past. It’s also important if you have a blood circulation or nerve disorder, or diabetic foot ulcers.

Call your doctor right away and stop taking Invokana if you:

feel new foot pain or tenderness
have foot sores or ulcers
get a foot infection
Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. If you develop symptoms or conditions that increase your risk for lower limb amputation, your doctor may have you stop taking Invokana.

Yeast infection
Taking Invokana increases your risk of a yeast infection. This is true for both men and women, according to data from clinical trials. In the trials, up to 11.6% of the women and 4.2% of the men had a yeast infection.

You’re more likely to develop a yeast infection if you’ve had one in the past or if you’re an uncircumcised male.

If you get a yeast infection while taking Invokana, talk with your doctor. They can suggest ways to treat it.

Diabetic ketoacidosis
Although it’s rare, some people who take Invokana can develop a serious condition called diabetic ketoacidosis. This condition occurs when cells in your body don’t get the glucose (sugar) they need for energy. Without this sugar, your body uses fat for energy. And this can lead to high levels of acidic chemicals called ketones in your blood.

Symptoms of diabetic ketoacidosis can include:

excessive thirst/urinating more often than normal/nausea/vomiting/stomach pain/tiredness/weakness/shortness of breath/breath that smells fruity/confusion
In severe cases, diabetic ketoacidosis can cause coma or death. If you think you may have diabetic ketoacidosis, call your doctor right away. But if your symptoms are severe, call 911 or go to the nearest emergency room.

Before you start taking Invokana, your doctor will assess your risk for developing diabetic ketoacidosis. If you have an increased risk of this condition, your doctor may monitor you closely during treatment. And in some cases, such as if you’re having surgery, they may have you temporarily stop taking Invokana.

Fournier’s gangrene
Fournier’s gangrene is a rare infection in the area between your genitals and rectum. Symptoms can include:

pain, tenderness, swelling, or reddening in your genital or rectal area
fever malaise (overall feeling of discomfort)
People in clinical trials of Invokana didn’t get Fournier’s gangrene. However after the drug was approved for use, some people reported having Fournier’s gangrene while taking Invokana or other drugs in the same drug class. (A class of drugs describes a group of medications that work in the same way.)

More serious cases of Fournier’s gangrene have led to hospitalization, multiple surgeries, or even death.

If you think you may have developed Fournier’s gangrene, call your doctor right away. They may want you to stop taking Invokana. They will also recommend treatment for the infection.

Kidney damage
Taking Invokana can increase your risk of kidney damage. Symptoms of kidney damage can include:

urinating less often than normal
swelling in your legs, ankles, or feet
confusion
fatigue (lack of energy)
nausea
chest pain or pressure
irregular heartbeat
seizures
After the drug was approved for use, some people taking Invokana reported that their kidneys worked poorly. When these people stopped taking Invokana, their kidneys began to work normally again.

You’re more likely to have kidney problems if you:

are dehydrated (have a low fluid level)
have kidney or heart problems
take other medications that affect your kidneys
are older than age 65
Before you start taking Invokana, your doctor will test how well your kidneys are working. If you have kidney problems, you may not be able to take Invokana.

Your doctor may also test how your kidneys are working during your treatment with Invokana. If they detect any kidney problems, they may change your dose or stop your treatment with the drug.

Bone fractures
In a clinical study, some people who took Invokana experienced bone fractures (broken bones). The fractures weren’t usually severe.

Symptoms of bone fracture can include:

pain/swelling/tenderness/bruising/deformity
If you’re at high risk for a fracture or if you’re concerned about breaking a bone, talk with your doctor. They can suggest ways to help prevent this side effect.

Falls: In nine clinical trials, up to 2.1% of people who took Invokana had a fall. There was a higher risk of falls in the first few weeks of treatment.

If you have a fall while taking Invokana or if you’re concerned about falling, talk with your doctor. They can suggest ways to help prevent this side effect.

Pancreatitis (not a side effect)

Pancreatitis (inflammation in your pancreas) was extremely rare in clinical trials. Rates of pancreatitis were similar between people who took Invokana and those who took a placebo (treatment without active drug). Because of these similar results, it’s not likely that Invokana caused the pancreatitis.

If you have concerns about developing pancreatitis with Invokana, talk with your doctor.

Joint pain (not a side effect): Joint pain wasn’t a side effect of Invokana in any clinical trials.

However, some other diabetes drugs may cause joint pain. In fact, the Food and Drug Administration (FDA) released a safety announcementTrusted Source for a class of diabetes drug called dipeptidyl peptidase-4 (DPP-4) inhibitors. (A drug class describes a group of medications that work in the same way.) The announcement said that DPP-4 inhibitors may cause severe joint pain.

But Invokana doesn’t belong to that drug class. Instead, it belongs to a class of drugs called sodium-glucose co-transporter-2 (SGLT2) inhibitors.

If you have concerns about joint pain with Invokana use, talk with your doctor.

Hair loss (not a side effect)/Hair loss wasn’t a side effect of Invokana in any clinical trials.

If you’re concerned about hair loss, talk with your doctor. They can help you determine what’s causing it and ways to treat it.

Invokana dosage
The Invokana dosage your doctor prescribes will depend on several factors. These include:

the type and severity of the condition you’re using Invokana to treat
your age
other medical conditions you may have
how well your kidneys are working
certain other medications you may be taking with Invokana
Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths
Invokana comes as a tablet. It’s available in two strengths:

100 milligrams (mg), which comes as a yellow tablet
300 mg, which comes as a white tablet
Dosage for lowering blood sugar levels
Recommended dosages of Invokana to lower blood sugar levels are based on a measurement called estimated glomerular filtration rate (eGFR). This measurement is done using a blood test. And it shows how well your kidneys are working.

In people with an:

eGFR of at least 60, they have no loss of kidney function to mild loss of kidney function. Their recommended dosage of Invokana is 100 mg once daily. Their doctor may increase their dosage to 300 mg once daily if needed to help manage their blood sugar level.
eGFR of 30 to less than 60, they have mild-to-moderate loss of kidney function. Their recommended dosage of Invokana is 100 mg once daily.
eGFR of less than 30, they have severe loss of kidney function. It’s not recommended that they begin using Invokana. But if they’ve already been using the drug and are passing a certain level of albumin (a protein) in their urine, they may be able to continue taking Invokana.*
Note: Invokana shouldn’t be used by people who are using dialysis therapy. (Dialysis is a procedure that’s used to clear waste products from your blood when your kidneys aren’t healthy enough to do so.)

• For this use, people would be taking Invokana at a dosage of 100 mg to lower the risk of certain complications of diabetic nephropathy. See the “Invokana uses” section for more information.

Dosage for reducing cardiovascular risks
Recommended dosages of Invokana to reduce cardiovascular risks are the same as they are to lower blood sugar levels. See the section above for details.

Dosage for reducing the risk of complications from diabetic nephropathy
Recommended dosages of Invokana to lower the risks of complications from diabetic nephropathy are the same as they are to lower blood sugar levels. See the section above for details.

What if I miss a dose?
If you miss a dose of Invokana, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take the next dose at the normal time. Don’t try to catch up by taking two doses at once. This can cause dangerous side effects.

Using a reminder tool can help you remember to take Invokana every day.

Be sure to take Invokana only as your doctor prescribes.

Will I need to use this drug long-term?
If you and your doctor agree that Invokana is working well for you, you’ll likely use it long-term.

SAN DIEGO The significant kidney and cardiovascular benefits of people with chronic kidney disease (CKD) show over 2 years of treatment with empagliflozin begin to subside within about a year after treatment discontinuation, suggesting the need for ongoing treatment.

We know that empagliflozin is safe we know it works and now we know we need to keep people on the treatment to maximize the benefits, said first author William G. Herrington, MD, of the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK, at a press briefing at the American Society of Nephrology (ASN) Kidney Week 2024.

The New England Journal of Medicine published the study at the same time. Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that was discontinued early in the EMPA-KIDNEY trial because of its effectiveness in lowering the risk of kidney disease or its progression in patients with a variety of kidney disease causes and kidney function levels. The study demonstrated that empagliflozin decreased the primary outcome of kidney disease progression or cardiovascular death by 28% compared to a placebo, with no significant safety concerns, over a median follow-up of two years.

Herrington and colleagues examined data on 4891 (74 percent) of the 6609 CKD patients who participated in an extra 2-year post-trial observational period to better examine the changing effects of the medication following discontinuation. Adult patients with CKD-EPI estimated glomerular filtration rate (eGFR) of 20 to 45 mL/min/1.73 m2 or 45 to 90 mL/min/1.73 m2 plus urine albumin-to-creatinine of ≥ 200 mg/g were specifically included in the study. In the post-trial randomization, the average age was 63 years, 34% of the participants were female, and roughly 57% of both groups had never had diabetes before. About 35% of each group had a mean eGFR of less than 30 mL/min/1.73 m2, while the mean eGFR was 37 mL/min/1.73 m2.

Patients were randomized to receive a matching placebo or 10 mg of empagliflozin once daily. During the post-trial phase, neither placebo nor trial-related empagliflozin was given. However, open-label SGLT2 inhibitors, such as empagliflozin, were administered to patients as directed by their physicians. Similarly, during the post-trial phase, open-label SGLT2 inhibitors were utilized by 40% of the placebo group and 43% of the empagliflozin group.

Herrington stated that an evaluation for any carry-over effects is made possible by the absence of a between-group difference in SGLT2 inhibitor use after the trial. The primary outcome, a composite of kidney disease progression or cardiovascular death, was observed in 865 out of 3304 patients (26.2 percent) in the empagliflozin group compared to 1001 out of 3305 patients (30.3 percent) in the placebo group when the effects from the active and post-trial periods were combined (hazard ratio [HR], 0.79; P < .0001).

The hazard ratio for the primary outcome was still significant during the post-trial period. Still, it was less so at 0.87 (P = .04). Regarding other specific outcomes, the risk of kidney disease progression during the combined periods was 23 percent for the empagliflozin group and 27 percent for the placebo group; the risk of cardiovascular death was 3 point 8 percent and 4 point 9 percent, respectively; and the risk for the composite of death or end-stage kidney disease was 16 point 9 percent with empagliflozin and 19 point 6 percent with placebo. The percentage of deaths from noncardiovascular causes (5.3% in both groups) did not differ between the groups.

According to Herrington, the carry-over effect was only about a year long and reduced the risk for the primary outcome by 13 percent overall, which was less than the 28 percent reduction that occurred while taking empagliflozin during the active trial. According to the authors, the effects of empagliflozin were seen after the follow-up regardless of the degree of albuminuria, diabetes status, kidney function level, and primary kidney diagnosis. According to the study, analyses of the long-term eGFR slope from the active-trial period also revealed that empagliflozin slowed the progression of all albuminuria subgroups.

Finally, they conclude that the results show that the benefit after the trial was less than the benefit during the study treatment and seemed to be transient. Therefore, long-term CKD treatment is necessary to optimize the cardiorenal clinical benefits of SGLT2 inhibitors. Emily Chang, MD, an associate professor of medicine at the University of North Carolina, Chapel Hill’s Division of Nephrology and Hypertension, commented on the study and agreed that the results offer valuable information about the possible consequences for patients, irrespective of their disease stage, who stop taking empagliflozin.

Chang told Medscape Medical News, “I think it is important to know that these are probably lifelong drugs, although I have already been operating under that premise in my practice at least.”. However, knowing that this is probably the best course of action is comforting. Regarding comparable effects with other SGLT2 inhibitors, Chang speculated that this effect would hold true for all SGLT2 inhibitor classes, though we can’t be certain until more research is conducted. A patient’s ability to take the medication will be limited if they are unable to tolerate it, she continued. Otherwise, I intend to keep these patients taking this medication for the rest of their lives if it is tolerated.

Pietro Canetta, MD, an associate professor of medicine in the Division of Nephrology at Columbia University Irving Medical Center in New York, added that while there is a wealth of information about the advantages of SGLT2 inhibitors during treatment, this study was noteworthy for demonstrating that a significant portion of the benefits appeared to last for at least a year after the study populations stopped taking the prescribed medication.

Although we cannot definitively determine the mechanism from this trial, the strong effect that persisted even after stopping the drug highlights that there appear to be advantages beyond its immediate effects. For instance, he said, they might be promoting better vascular health or beneficial remodeling.

Important disclaimers were mentioned by Canetta, who told Medscape Medical News that patients with a history of ketoacidosis or recent immunosuppression were not included and that patients had to be taking an adequate dosage of an RAS [renin-angiotensin system] inhibitor. Furthermore, he added, it’s critical to remember that the advantages were different when taken off a drug than when taken on one. Although the group that initially received empagliflozin outperformed the group that initially received a placebo, the difference was more noticeable while both groups were taking the study medication.

This is significant because, according to Canetta, the trial’s message shouldn’t be taken to imply that you can quit after a year and still anticipate the same advantages indefinitely. The main takeaway from this is that there is more proof that these medications are a great addition to our toolbox for slowing the progression of kidney disease and cardiovascular consequences.

References:
https://www.medscape.com/viewarticle/empagliflozin-effects-subside-discontinuation-2024a1000jm9

Globally, diabetes is becoming increasingly prevalent, as are the myths and misconceptions that surround it. Here, we discuss 11 of these repeated untruths.

Approximately 10% of Americans currently suffer from diabetes. Over 422 million people worldwide are afflicted by the illness. Diabetes is a common term, but the biological mechanisms underlying it are complicated, and symptoms can vary. Half-truths abound because it’s both common and complex. Regrettably, a few of the misconceptions debunked in this piece contribute to the stigma surrounding diabetes. It is crucial to refute these lies just for that reason. First, we will define diabetes in brief and discuss the distinctions between type 1, type 2, and gestational diabetes, the three most prevalent types of the disease.

The autoimmune condition known as type 1 diabetes is characterized by an attack on the insulin-producing pancreatic cells by the immune system. Compared to type 2 diabetes, it usually manifests earlier in life. Type 2 diabetes is characterized by insufficient insulin production, impaired insulin sensitivity, or both. At least 90 percent of people with diabetes in the U. S. possess type 2. As the name implies, gestational diabetes happens during pregnancy. Pregnancy increases the body’s need for insulin. When the body is unable to meet these new requirements, gestational diabetes develops. Even though gestational diabetes typically disappears after delivery, there is a chance that it will recur in subsequent pregnancies and that type 2 diabetes will manifest later in life.

Eating sugar causes diabetes
Diabetes is not directly brought on by sugar consumption. However eating a diet high in sugar can result in obesity and overweight, which are risk factors for type 2 diabetes. This is a widespread misconception, which makes sense given that blood sugar levels are crucial in the development of diabetes. However, sugar by itself is not a causative agent. As usual, the story is complicated, but it seems that regular soda consumption is associated with a higher risk of type 2 diabetes. Drinking soda has been associated with a higher risk of developing the disease, even after adjusting for energy intake and body mass index (BMI), according to a large 2013 study. Regarding other beverages, like fruit juices and artificially sweetened beverages, the study did not discover this correlation. Why some people develop type 1 diabetes and others do not is still a mystery to scientists. Nutrition is not a risk factor, though.

Diabetes is not serious
Maybe because diabetes is so prevalent, some people don’t think it’s a serious illness. This is untrue. Diabetes has no known treatment, and improper diabetes management can lead to some negative outcomes. Heart disease, nerve damage, kidney damage, blindness, skin disorders, and hearing loss are among the complications. In the United States in 2018, diabetes was the primary cause of 84,946 deaths. S. According to estimates from the World Health Organization, 11.6 million deaths worldwide in 2016 were attributed to diabetes.

Diabetes only affects people with obesity
Type 2 diabetes and gestational diabetes can affect individuals of any weight, but being overweight or obese increases the risk of developing the disease. According to information from the 2020 National Diabetes Statistic Report published by the Centers for Disease Control and Prevention (CDC), 11% of persons in the U.S. are not obese or overweight.
Type 1 diabetes has no association with body weight.

Obesity always leads to diabetes
Obesity raises the risk of diabetes, but the condition is not always caused by obesity. The CDC reports that approximately 39.8% of adults U.S. are obese, whereas 13% have diabetes.

People with diabetes cannot eat sugar
People with diabetes indeed need to closely monitor their carbohydrate intake and manage their diets. They may still include treats, though. According to the American Diabetes Association, the key to enjoying sweets is to limit your intake to special occasions and concentrate your meals on healthier options. To maintain stable blood sugar levels, people with diabetes must carefully schedule their meals and snacks. Another misconception is that individuals with diabetes must consume particular diabetes-friendly foods. These goods can still elevate blood sugar levels, and they are frequently more costly.

Diabetes always leads to blindness and amputation
Fortunately, this is untrue. Diabetes does not always result in blindness or amputations, even though it can in certain situations. Furthermore, these results are uncommon in people who take good care of their condition. According to the CDC, 11.7 percent of adult diabetics have some degree of visual impairment. About 0.56% of diabetics in the United States have lower-extremity amputations. S. Some risk factors that raise the possibility of developing complications related to diabetes have been identified by experts. These include smoking, being overweight or obese, not exercising, having high blood pressure, and having high cholesterol.

People with diabetes should not drive
A diabetes diagnosis does not always imply that a person should give up driving. The American Diabetes Association explains in a position statement on driving and diabetes: Most people with diabetes operate motor vehicles safely without creating any meaningful risk of injury to themselves or others. But they also clarify that individuals should be assessed individually if there are any concerns. As stated by the U.S. Department of Transportation: Diabetics can drive unless their condition prevents them from doing so. These include vision issues or dangerously low blood glucose levels. You should collaborate closely with your diabetes healthcare team to determine whether diabetes impairs your driving ability if you are dealing with complications related to your diabetes.

Prediabetes always leads to diabetes
Within the U.S. 88 million adults, or one in three, are thought to have prediabetes. Blood sugar levels that are higher than average but not quite high enough to be considered diabetes is known as prediabetes. Type 2 diabetes can develop from prediabetes if it is not treated. It is not a given, though. A shift in lifestyle can reverse the trend. Diabetes can be stopped in its tracks with a more nutritious diet and regular physical activity.

People with diabetes cannot be active
Again, this is not accurate. As a matter of fact, exercise plays a big part in managing diabetes. Exercise lowers blood pressure and promotes weight loss, which lowers the risk of complications. It may also improve how well the body uses insulin. However, exercise has various effects on blood sugar levels; sometimes it rises and sometimes it lowers. As stated by Diabetes UK Even though you consume the same foods and engage in the same activities on certain days, your blood sugar levels might behave differently than you would anticipate. Additionally, they provide advice on controlling blood sugar levels while exercising, including taking notes on how your blood sugar behaves and showing them to your doctor. This can direct any necessary adjustments to insulin. Those who are susceptible to hypoglycemia should always have fast-acting carbohydrates on hand. Put on a diabetes identification so that others can assist you if necessary.

You can ‘catch’ diabetes
This is a myth. Pathogens do not cause diabetes, so someone cannot pass it to someone else. Doctors classify it as a noncommunicable disease.

Some natural products cure diabetes
Diabetes currently has no known treatment. It is untrue to say that a product can treat diabetes. Many herbal or natural products are ineffective or even harmful; diabetes co . uk explains: It is often argued that using natural therapies could reduce blood sugars to dangerously low levels and raise the risk of other diabetes complications because certain herbs, vitamins, and supplements may interact with diabetes medications (including insulin) and increase their hypoglycemic effects. Diabetes is a complicated yet widespread illness. Dispelling myths as we come across them is crucial as their ubiquity rises.

A person with prediabetes has a higher chance of developing type 2 diabetes as a warning sign. Prediabetes can cause long-term harm, including to the heart and blood vessels if left untreated. But can it be reversed? Can diet and exercise modifications help achieve this? Type 2 diabetes, in particular, is fast emerging as one of the most difficult health issues of the twenty-first century. It is also anticipated that 380 million people globally will receive a diabetes diagnosis by 2025. Diabetes management and treatment are increasingly important because it is a risk factor for many other diseases and chronic health conditions, including stroke, kidney disease, cardiovascular disease, and blindness, to name a few.

However, many people are thought to be in a precursor stage known as prediabetes before they go on to develop type 2 diabetes. This medical condition is characterized by blood sugar levels that are higher than normal but not high enough to be classified as type 2 diabetes. However, a significant risk factor for type 2 diabetes is prediabetes. The numbers of individuals with prediabetes provide a clear picture when it comes to scaling this issue: more than one in three individuals in the U.S. S. along with the U.K. have been identified as prediabetic. Therefore, if prediabetes is considered an early warning sign of type 2 diabetes, what steps can people take to reverse the course of this condition? Is it not possible to reverse this condition with significant lifestyle changes?

On our May podcast, “In Conversation: Can diet and exercise help reverse prediabetes?” Dr. Thomas Barber, an associate clinical professor at Warwick Medical School and consultant endocrinologist at University Hospitals Coventry and Warwickshire, joined Dr. Hilary Guite and me. Additionally, Healthline Media and Medical News Today Managing Editor Angela Chao shared her personal story of reversing her diagnosis of prediabetes and the lifestyle changes she made to maintain it. An unusual case: In Angela’s instance, few medical professionals would have thought that her blood sugar levels were cause for concern. She is not thin, youthful, and energetic like most people with prediabetes or those at risk of getting diabetes. She did, however, admit that at the time she led a fairly sedentary lifestyle.

She said that because my readings were so low on the spectrum, I don’t even think my primary care physician at the time talked to me about it beyond providing the range and the diagnosis. She did, however, add that some doctors and her medical friends seemed concerned about the changes to the cutoff point for readings that qualified as prediabetes. Being diagnosed with prediabetes: In my opinion, receiving the diagnosis was a bit of a wake-up call. Whether or not the threshold has changed, “You need to increase your exercise level; you need to make some changes to your lifestyle to get back to a healthy range.

How to measure prediabetes
According to Dr. Barber, the diagnosis of diabetes and prediabetes was previously made using fasting glucose readings or a conventional glucose tolerance test. In this test, participants were given 75 grams of a sugar-filled beverage, and their blood sugar levels were monitored for the following two hours. Additionally, the definition of prediabetes is constantly changing and may vary from nation to nation. Definitions vary amongst societies and prestigious organizations. And the most important thing to remember, in my opinion, is that there is a continuum when it comes to diabetes and prediabetes, Dr. Barber stated. Should we choose the U. S. along with the U. K. For instance, there are variations in the thresholds and units of measurement applied when diagnosing prediabetes.

As you point out, there are various units, which makes it a little confusing. However, in essence, in the U. K. for glucose, we use millimoles per liter, and in the U.S. S. milligrams per deciliter, to be exact. We typically use millimoles per mole in clinical settings these days, and we have for a while, according to Dr. Barber. He went on, “I think that further complicating matters is the hemoglobin A1C, which has two different percentage units—one that we have historically used and the other that is now replaced by millimoles per mole. Dr. According to Barber, glucose is a continuous variable rather than a discrete measure. He clarified that while everyone can agree on what is elevated and what is normal, there are kind of disagreements about everything in between. The World Health Organization approved hemoglobin A1C as a test for diabetes a few years ago. While additional glucose readings can be useful, Dr. Barber stated that medical professionals primarily rely on A1C in current clinical practice. About prediabetes in the U.S. K, he said, this is based on an A1C range of 39 to 47 mmol per mol, with 39 corresponding to an A1C of 5 points 7 percent.

Anything that raises the hemoglobin A1C level above 48 millimoles per mole, or 60.5 percent, is statistically defined as diabetes. He stated that to diagnose type 2 diabetes, we should ideally have at least two of those readings that are elevated. When Angela was diagnosed, her A1C was 5 points8 percent, and anything above 5 points7 was considered prediabetes. Dr. Barber reminded us that, in the United States, Angela’s readings would not have been regarded as prediabetes and that, in recent years, the diagnostic criteria for diabetes have gradually decreased. K. at the time, since the values were extremely near to normal and not quite below the cut-off. Usually, prediabetes shows no symptoms at all. But occasionally, people might get frequent thirst, wake up in the middle of the night to urinate, experience blood sugar spikes, or have energy slumps.

Prediabetes is frequently asymptomatic, so many people who are diagnosed with it may have had it for months or even years. Furthermore, it can easily go unreported unless people are tested for it, according to Dr. Barber.

Angela recounted her own experience:
I most definitely didn’t experience a variety of symptoms. But drinking water was something I was definitely already doing quite a bit of the time. I therefore found it difficult to determine whether anything was changing. Low blood sugar, particularly if she went for prolonged periods without eating, was something she did notice before the diagnosis. Over the years, she said, there has been a consistent pattern of significant fluctuations in her blood sugar levels, which she could feel physically. She can, however, fast trouble-free for more than 16 hours now because of certain lifestyle adjustments. Sugar surges and falls may be considered preemptive indicators of diabetes. According to Dr. Dot Barber, prediabetes is a general term that can refer to either elevated fasting glucose or elevated postprandial glucose. Dr. Dot Barber stated that fluctuations in blood sugar levels, or glycemia, were often observed in the context of insulin resistance. Glucose levels tend to rise a little higher than they should, he explained, because the beta cells can’t produce enough insulin, for example, or the insulin isn’t as effective after a meal.

The main difference, I suppose, is that most of the time we are unaware of this when it comes to prediabetes because the majority of patients actually do not. monitor their blood glucose, he said, noting that people might not notice these changes physically if blood sugar levels are not closely monitored throughout the day. It makes perfect sense that as you lead a healthier lifestyle, lose weight, and reverse prediabetes, your blood sugar levels will stabilize. He mentioned Angela’s description of the changes she saw and said that the insulin becomes more effective and can handle the fluctuations in glycemia better.

Who is most at risk of developing prediabetes?
Obesity, having a high body mass index, and being overweight are some of the most well-known risk factors for type 2 diabetes. Additionally, as we age, our vulnerability increases. And the reason for that is that as we age, the beta cells and insulin receptors can no longer function as well, and insulin itself becomes slightly less effective. Accordingly, as we age, our chance of having prediabetes and diabetes rises, according to Dr. Barber. Dr. Barber added that eating a diet heavy in high-glycemic foods and sugary drinks, as well as stress, can all raise risk. Conversely, he asserted that a diet low in simple carbohydrates and high in fiber can delay the onset of dysglycemia. Being sedentary means spending most of the day sitting or lying down, especially when it comes to watching TV, which is, in my opinion, the least sedentary activity that can increase risk. Sedentary behavior raises the risk of insulin resistance, a condition that increases the likelihood of prediabetes and type 2 diabetes. Genetics and ethnic origin are other factors to consider.

Dr. Barber presented the results of a recent investigation they carried out in the U.S. K. which revealed that, at a BMI of 23.9%, individuals of South Asian ethnicity had the same risk of developing diabetes as did white people at 30. In contrast, Angela’s risk was increased by her family history. My mother, a retired medical doctor, had warned me since I was a teenager about the slight family history of type 2 diabetes on my father’s side. She also mentioned that everyone on that side of the family was thin and had no weight problems. Dr. According to Barber, diabetes is frequently attributed to lifestyle decisions, but many people are unaware that it is a hereditary disorder. According to him, patients with a strong family history may not always exhibit the characteristics of type 2 diabetes, such as obesity, middle age, male gender, and large abdomen. That’s the idea that most people with type 2 diabetes have of the typical person. He added that, as you point out, Angela defies all of those stereotypes about what that entails. Dr. Barber also emphasized that having a genetic predisposition to diabetes at birth can result in dysglycemia even in the absence of those other factors. More than 40 genes and gene mutations have been found to increase your risk of developing type 2 diabetes. Additionally, he added, that even though each effect alone is rather weak, adding them all together can have a cumulative effect.

Lifestyle changes to reverse prediabetes
Through a combination of intermittent fasting, a balanced diet with an increased amount of lower-glycemic index foods and complex carbohydrates, and significantly increased physical activity, Angela was able to reverse her diabetes. She added that she did not make any significant dietary changes and that she also worked with a personal trainer on weight and resistance training. She advised against strict dieting, keto, and quick, drastic changes that aren’t long-term. Dr. Barber conceded that while this approach obviously worked for Angela, it might not be feasible for many others to make such drastic life changes and that doing so can be challenging. We are aware that rigorous lifestyle interventions that emphasize food, exercise, weight loss, and other factors can significantly aid in preventing type 2 diabetes, or at least postponing its onset, according to Dr. Barber. In my opinion, it serves as a kind of early warning system that indicates when a person needs to make a lifestyle change. And it has to be beneficial if it inspires or motivates people to alter [their] way of life, he added.

Why building muscle is important
Angela’s BMI was already low, so losing weight would not have been a wise course of action. I was diagnosed with a sedentary lifestyle behavior [issue] because I could not afford to lose weight. Without a doubt, I wasn’t working out frequently. She recalled, “I was working [in] very high-stress, high-demanding journalism jobs, covering disasters, traveling, breaking news, you name it.”. Strength training is a useful tool for improving insulin sensitivity and reducing insulin resistance. Dr. According to Barber, the benefits of cardiometabolism may be mediated by the act of exercising and the release of myokines from muscles. In fact, having more muscle mass can increase your metabolic rate overall, which will help you maintain your current weight. He went on to say that burning fat and oxidizing it through exercise also helps because your muscles use this energy source.

Moving throughout the day
Regular exercise, not just intense exercise, has been demonstrated in studies to help stabilize blood sugar and enhance blood sugar management. Although working up a sweat on a treadmill or running a 5k is certainly a form of exercise, Dr. Barber stated that the real message when it comes to fitness should be avoiding inactivity. We are aware that standing up increases caloric expenditure and is therefore beneficial to health. It’s even better if you’re moving around, he said. Additionally, some intriguing studies have examined ways to modify sedentary behavior, such as getting up every hour or every 30 minutes, taking short walks, and performing squats in a room corner. He went on to say that they demonstrated how just that amount of activity throughout the day can have transformative effects on glucose levels.

What it actually means to be active: You don’t have to run on a treadmill or scale Mount Everest. All you have to do is get up occasionally and move around. And that will now significantly improve your metabolic health on its own.

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530 million adults worldwide are estimated to have diabetes. Individuals diagnosed with diabetes mellitus are more susceptible to various health complications. Multiple long-term conditions (MLTCs) are health complications related to diabetes that affect more than one person. Imperial College London researchers have discovered that diabetes not only causes MLTCs to occur 15–20 years earlier, but it also drastically shortens the life expectancy of those who have the disease. Approximately 529 million individuals worldwide are estimated by researchers to have diabetes, with 90–95 percent of those cases being type 2 diabetes.

Serious complications such as heart disease, nerve damage, kidney disease, gum disease, dementia, mood disorders, and eye issues are more common in people with diabetes. Multiple long-term conditions (MLTCs) are the terms used to describe the presence of multiple complications in a person with diabetes. According to recent research from Imperial College London in the United Kingdom, diabetes not only causes MLTCs to occur 15–20 years earlier, but it also drastically shortens the life expectancy of those who have the disease. The study was just released in the Nature Medicine journal.

Diabetes patients with several chronic conditions by the age of 50 Researchers examined medical records from more than 46 million U.S. K. utilizing the National Bridges to Health Segmentation Dataset, adults aged 20 and above. Over 3 million individuals in the research had diabetes mellitus, whether it be type 1 or type 2, or another type. After analysis, researchers discovered that roughly one-third of study participants with diabetes had at least three MLTCs by the time they were 50 years old. On the other hand, people without diabetes did not develop three MLTCs until they were 65 to 70 years old.

Researchers also discovered that individuals with diabetes had an average onset age of 66–67 years for at least two MLTCs. Furthermore, a person’s levels of MLTCs would be more severe as they age if they were diagnosed with diabetes at a younger age. One of the most difficult global population health risks has emerged to be multiple long-term conditions, Edward W. Gregg, PhD, as well as the School of Population Health at RCSI University of Medicine and Health Science in Ireland.

Age has been the main cause, and while longer lifespans do play a role, it is not the whole story. We’ve confirmed that this is a serious problem that still shows up in early and middle adulthood,” he said. When Gregg and his team examined specific MLTCs, the most prevalent conditions they observed were depression, asthma, osteoarthritis, and hypertension. People of all ages and genders were observed to have these conditions. Although the link between diabetes and MLTCs was expected, we were surprised by the breadth and depth of the findings, i.e. e. the prevalence of having 3, 4, or 5+ conditions and their comparatively early age of onset, according to Gregg. Hypertension and coronary heart disease were expected. On the other hand, there were no associations with asthma or osteoarthritis. It was surprising that a significant proportion of young adults would also have diabetes, even though the link to depression was expected.

4 years of life lost for each co-occurring condition
The number of years that diabetes patients lost as a result of MLTCs was another area of study for the researchers. Researchers discovered that individuals with more MLTCs lived with them for fewer years and passed away sooner than those without MLTCs. Researchers discovered, for instance, that individuals with diabetes who had three MLTCs lived roughly ten years with them and five years less than the overall population, whereas individuals with diabetes who had at least five MLTCs lived five years with them and passed away six years sooner than those without MLTCs. Gregg and his colleagues also discovered a higher number of life years spent and lost in young adults with diabetes who suffer from MLTCs. For instance, compared to people without MLTCs, a person with diabetes and MLTCs lost roughly 4 years of life by the time they were 40. According to Gregg, “It might be a sign that these conditions are more severe when they arise in young adulthood. However, chronic illnesses typically worsen disability and shorten life expectancy over time, so we must find strategies to prevent people from developing these conditions at an early age. Diabetes can be prevented in many ways, and delaying its onset can help prevent the development of other conditions.

Furthermore, the researcher noted that diabetes is also highly manageable and can reduce the development of MLTCs with good control. The next stages involve determining, creating, and evaluating the effectiveness of interventions that can stop MLTCs from developing or getting worse. Pouya Shafipour, MD, a board-certified family and obesity medicine physician at Providence Saint John’s Health Center in Santa Monica, California, told MNT he was not surprised by the study’s findings and asked why so many conditions co-occur with diabetes. Shafipour clarified, “This is something we expected because the state of insulin resistance in the body starts way before someone is diagnosed with diabetes. They frequently have fatty livers and insulin resistance, and that’s when the body’s damage to all of the organs really begins. Diabetes increases the risk of several conditions, including atherosclerotic heart disease, cerebrovascular disease (CVD), stroke, retinopathy, neuropathy, and kidney disease,” he continued. As a result, it was not at all surprising because the ailment actually affects the entire body.

In addition, Yu-Ming Ni, MD, a board-certified cardiologist and lipidologist at Fountain Valley, California’s MemorialCare Heart and Vascular Institute at Orange Coast Medical Center, concurred with MNT’s assessment. Diabetes affects a wide range of conditions, according to Ni. We are discussing an issue with the body’s metabolism of sugar. It has an impact on more than just blood sugar levels. It has an all-encompassing effect on how your body functions physically and how well your organs function. From a cardiac perspective, we frequently consider heart disease to include conditions like high blood pressure, coronary artery disease, and the risk of heart attack and stroke,” he said. All of this is related to diabetes; it is not only a direct result of diabetes’s impact on organ and blood vessel function, but it also occurs in tandem with diabetes as a result of underlying metabolic issues, particularly obesity. Therefore, I do not find the study’s conclusions surprising. It merely emphasizes how seriously long-term diabetes exposure can impact your health in a variety of ways.

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The body produces more of an appetite-suppressive molecule when taking the diabetes drug metformin, according to research from Stanford University in California that was just published in Nature Metabolism. Researchers at Stanford University and Baylor University in Texas found two years ago that the same molecule is also produced during and after intense exercise. Called the anti-hunger molecule, scientists think the lac-phe molecule accounts for the modest effects of metformin, the world’s most prescribed diabetes drug, on weight loss. It was unclear up until now how the blood sugar-controlling medication metformin also caused weight loss, but it turns out that it works by decreasing hunger in the same way as intense exercise. Knowing how these pathways are regulated may help develop practical methods to reduce body mass and enhance millions of people’s health.

Researchers examined blood plasma samples from patients with type 2 diabetes both before and after they took metformin for 12 weeks, following trials conducted on obese mice. The starting dose for each participant was 500 mg, which was progressively increased to 2,000 mg. According to research, the participants’ lac-phe levels considerably rose during this time. Additionally, in a larger study involving 79 individuals with diabetes and heart disease, the researchers examined blood samples. The participants who were taking metformin exhibited significantly higher levels of lac-phe in comparison to the non-medication group.

Conversely, Long and colleagues discovered that inhibiting mice’s production of lac-phe reversed appetite suppression and led to weight gain. It’s strange and intriguing that metformin and sprint training have the same effect on body weight through the same pathway. He went on to say that these discoveries might inspire the creation of novel drugs for weight loss. Within the first few months of starting the medication, there has been evidence of a slight reduction in body weight for those who take metformin, also known by the brand names Fortamet and Glumetza. The Food and Drug Administration has not yet granted metformin approval for use in managing weight loss.

The advantages of metformin for weight loss and overall health go beyond the lac-phe molecule, according to experts in the care of diabetic patients. According to the Diabetes Care Nurse, a virtual diabetes educator who was not involved in the new study, metformin is an incredible medication. Jose has lived with type 1 diabetes for 42 years and has supported others with type 1 and type 2 diabetes for more than 15 years. Jose claimed that during her career, she has worked with thousands of individuals who have type 2 diabetes and has personally witnessed the effects of metformin. It’s among the most economical, safest, and efficient diabetes treatments available. For those with type 2 diabetes who receive a new diagnosis, it remains the standard of care. That will always remain the same.

Although metformin isn’t a medication for weight loss, all providers are aware that it will cause some weight loss. Jose continued, It’s just a positive side effect. Nevertheless, it is generally advised that people with diabetes or obesity lose 7 to 10 percent of their body weight. If metformin is used in conjunction with healthy lifestyle choices, this can definitely be accomplished. Jose emphasized that you have to make a commitment to making significant changes in your daily diet and exercise routine, just like Ozempic and other GLP-1 medications are making headlines. If you stop taking these medications, your weight will return to its initial level if you don’t make those adjustments.

The importance of physical activity is further highlighted by the fact that this medication increases the production of the same molecule that suppresses your appetite after exercise. Exercise enhances every bodily function, not just the burning of calories. It is so important and so underappreciated. Every aspect of your health is impacted by daily exercise, including your mental and physical well-being, your heart and lungs, your metabolism, your energy, and the quality of your sleep. Diabetes management and weight loss necessitate a multifaceted strategy that takes into account all factors. Medication is but one component. You also need to make use of realistic, sustainable eating practices and physical activity.

Since metformin doesn’t garner as much media attention as Ozempic, many people are hesitant to even begin using it. Alternatively, they are adamant about controlling their type 2 diabetes naturally due to the social stigma associated with taking medicine, which implies that you have failed on your own. Metformin, however, improves your body’s performance if your entire metabolic system is lacking. Jose asked people to recognize the advantages of GLP-1 drugs, although their effects are more pronounced and almost instantaneous than those of metformin. Most people with type 2 diabetes who receive a new diagnosis don’t routinely check their blood glucose levels. You will not experience the gradual effects of metformin if those numbers are not visible to you.

REFERENCES:

https://www.medicalnewstoday.com/articles/how-diabetes-drug-metformin-can-suppress-hunger-and-help-with-weight-loss
https://pubmed.ncbi.nlm.nih.gov/9526970/
https://www.healthline.com/health/diabetes/metformin-weight-loss
https://www.webmd.com/diabetes/metformin-cause-weight-loss

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About 537 million adults worldwide live with diabetes, and 90-95% of these cases are type 2 diabetes. People with diabetes are at increased risk of many health problems, including eye problems. These include diabetic retinopathy trusted source, diabetic macular edema, glaucoma, cataract trusted source, chronic dry eye, and retinal detachment. There is currently no cure for diabetic retinopathy or diabetic macular edema. Current treatment options for both conditions include drugs injected directly into the eye, laser treatment, and eye surgery. Soon, less invasive treatment for diabetic retinopathy and diabetic macular edema may be available in the form of eye drops.

Recently released data from a phase 1b/2a trial of the new treatment showed it to be safe and tolerable, with 100% of participants completing the study. Additionally, the researchers reported a significant reduction in central macular thickness and prevention of further increases in vascular leakage after 85 days of use.

The current standard of care for diabetic macular edema involves anti-VEGF agents in the eye, so new approaches to treating diabetic retinopathy and diabetic macular edema are required, according to the study’s presenting author and manufacturer of new eye drops. entails several injections, which are painful and need clinical time to complete even though they are effective.
A non-invasive approach is required to enhance these patients’ quality of life by promoting comfort and lowering pain levels through self-management. According to Dr. Lhuillier, patients with non-proliferative diabetic retinopathy in the early stages of the condition are not given a treatment option other than to wait for their symptoms to get better. It’s possible that the condition won’t worsen due to proliferative diabetic retinopathy. When the patient’s condition reaches an advanced stage or they develop diabetic macular edema, anti-VEGF injections are recommended. He said that treating diabetic retinopathy patients with non-invasive, safe, and effective therapies early on will help stop the condition from getting worse. About 7 and a half million Americans are thought to have non-proliferative diabetic retinopathy, and another 1 and a half million have advanced the disease to more severe forms, which hasten its progression and deteriorates vision. There is a strong motivation to cut back. Dangerous complications.

According to reports, the novel eye drop, known as EXN407, is the first topical treatment for retinal vascular conditions like diabetic macular edema and diabetic retinopathy. The eye drop is a small molecule treatment that employs an inhibitor of serine-arginine protein kinase 1 (SRPK1). Numerous factors contribute to the development of diabetic eye disease, but the primary cause is the overgrowth of blood vessels in the retina. These blood vessels eventually leak, causing subretinal edema to appear and blindness to result. VEGFTrusted Source is a growth factor that causes this phenomenon. According to him, EXN407 is a molecule that only inhibits the members of the family that cause disease, leaving the non-disease-causing members intact, allowing the VEGF to be balanced again. In addition to being more convenient as an eyedrop formulation as opposed to an injection, it provides a more nuanced approach than anti-VEGF agents.

REFERENCES:

https://www.sciencedirect.com/science/article/pii/S0753332218346705
https://www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy
https://my.clevelandclinic.org/health/diseases/8591-diabetic-retinopathy
https://www.medicalnewstoday.com/articles/could-an-intervention-as-simple-as-eye-drops-treat-eye-damage-in-diabetes#Improvements-in-macular-thickness,-vascular-leakage

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