Diabetes

Losing weight is something nearly every American wants to do but, like a lot of things, it's not always good for your health. Case in point: xylitol, the sugar substitute that's used in a lot of low-calorie foods.

Consumers with diabetes and those trying to lose weight choose artificial sweeteners to safeguard their health. But now, a new study by Cleveland Clinic researchers published in the European Heart Journal finds that xylitol carries an increased risk of heart attack and stroke.  

The study, published this week, examined the effects of xylitol on blood clotting and cardiovascular events. While researchers caution that their findings do not prove cause-and-effect, the results indicate a strong association between xylitol levels and cardiovascular risk.

Xylitol and cardiovascular events

The first part of the study analyzed blood plasma samples from over 3,000 fasting individuals who had participated in an earlier study. These individuals had been followed for three years, and some had experienced major cardiovascular events such as heart attacks or strokes.

When comparing their blood samples, researchers found that those who suffered a cardiovascular event had significantly higher blood levels of xylitol than those who did not.

How Xylitol affects blood clotting

To further explore the potential risks, researchers conducted lab tests on human blood and mice models.

• In human blood samples, they found that xylitol increased platelet activity, causing the blood to clot more easily.
• In mice, they injured the carotid artery and observed an accelerated rate of clot formation in those exposed to xylitol.

Since blood clots can travel to arteries and veins in major organs, they can increase the risk of heart attacks, strokes, and even death.

Testing on volunteers

The researchers also conducted a small human trial to test how quickly xylitol could affect blood clotting. They gave 10 healthy volunteers a drink sweetened with xylitol and measured their blood clotting ability before and 30 minutes after consumption.

• Results showed a rapid increase in clotting ability in those who consumed the xylitol drink.
• In contrast, volunteers who drank glucose or other sugar-sweetened beverages showed no changes in blood clotting.

What it means for consumers

While the findings are concerning, researchers stress that the study does not prove xylitol directly causes heart attacks or strokes.

“We need to determine whether this effect is unique to xylitol or common among all sugar alcohols,” said Dr. Stanley Hazen, a cardiologist and lead researcher of the study.

Until more research is done, experts advise consumers to be mindful of sugar substitutes and their potential health risks.

Novo Nordisk, the maker of Ozempic, reported that compounded versions of semaglutide, the main ingredient in Ozempic and Wegovy, have led to at least 100 hospitalizations and 10 deaths.

CEO Lars Fruergaard Jorgensen expressed concern, stating that only Novo Nordisk makes real semaglutide and does not supply it to others.

“Honestly, I’m quite alarmed by what we see in the US now,” Novo Nordisk President and CEO Lars Fruergaard Jorgensen told CNN. “Patients who believe that they’re getting access to a safe product, and they believe they’re getting semaglutide … I know for a fact that they are not getting semaglutide, because there’s only one semaglutide, and that’s produced by Novo Nordisk, and we don’t sell that to others.”

Compounded drugs, created by other pharmacies when there’s a shortage, are not FDA-approved and may carry risks. The FDA’s database includes reports of adverse effects with compounded semaglutide, including dosing errors and cases involving a salt form of the drug that differs from the approved version.

Semaglutide is still on the FDA’s shortage list, though Novo Nordisk is working to resolve it. The FDA is evaluating supply and demand and monitoring for patient safety.

About semaglutide

Semaglutide is a medication that mimics the glucagon-like peptide-1 (GLP-1) hormone, which plays a crucial role in regulating blood sugar levels and appetite. It is marketed under brand names such as Ozempic, Wegovy, and Rybelsus, each approved for specific uses:

• Ozempic: Approved for managing type 2 diabetes and reducing the risk of major cardiovascular events in adults with type 2 diabetes and known heart disease.

• Wegovy: Approved for chronic weight management in adults with obesity or overweight conditions, in conjunction with a reduced-calorie diet and increased physical activity.

• Rybelsus: An oral form of semaglutide approved for improving blood sugar control in adults with type 2 diabetes.

Reasons for Semaglutide's Popularity:

1. Effective Weight Loss: Clinical trials have demonstrated that semaglutide can lead to significant weight loss, making it a popular choice for individuals seeking to manage obesity.

2. Improved Blood Sugar Control: For patients with type 2 diabetes, semaglutide effectively lowers blood sugar levels, aiding in disease management.

3. Cardiovascular Benefits: Semaglutide has been shown to reduce the risk of major cardiovascular events, such as heart attack and stroke, in individuals with type 2 diabetes and existing heart disease.

4. Convenient Dosing Options: Available in both injectable (once-weekly) and oral (daily) forms, semaglutide offers flexibility to suit patient preferences.

5. Broader Health Benefits: Emerging research suggests potential benefits of semaglutide in reducing risks of conditions like colorectal cancer and kidney disease, further enhancing its appeal.

While semaglutide offers numerous benefits, it's important to be aware of potential side effects, including gastrointestinal issues and, in rare cases, more serious adverse effects. Consulting with a healthcare provider is essential to determine if semaglutide is appropriate for individual health needs.

Millions of people have diabetes and almost all of them first had a condition known as pre-diabetes.

Now, federal medical researchers have discovered a simple tool to alert doctors that a patient is at risk for pre-diabetes and on the path to the full disease.

The tool is simple and costs nothing. A patient is administered an oral glucose tolerance test and the time it takes to reach maximum sugar level is recorded. Those who take longer to reach that maximum threshold are at greater risk of pre-diabetes, the researchers found.

“Our research may help clinicians and public health officials guide patients to better and more cost-effective decisions about risk for pre-diabetes” said Stephanie Chung, M.B.B.S., the study’s first author and an assistant clinical investigator at the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health (NIH).

The implications

The implications are fairly clear. By giving the glucose test and noting the time to reach maximum levels, doctors can get a heads-up that the patient is at risk for developing pre-diabetes, placing them at even greater risk of developing type-2 diabetes.

Simply put, having pre-diabetes means your blood sugar level is higher than normal but not yet high enough to be type-2 diabetes. It's not a given that pre-diabetes turns into full-blown type-2 diabetes, but it happens a lot.

However, with significant lifestyle changes – eating a nutritious diet and getting plenty of exercise – a patient can return his or her blood glucose levels to normal. In fact, there have been cases where people with type-2 diabetes have actually reversed the disease with radical lifestyle changes.

Early damage

However, the Mayo Clinic warns that if you have developed pre-diabetes, you may already be suffering the long-term damage of diabetes.

Unfortunately, pre-diabetes has no obvious symptoms. However, Mayo Clinic doctors say subtle signs include darkening skin in certain parts of the body. You may be at risk for pre-diabetes if you are overweight, eat an unhealthy diet, and get little exercise.

Type-2 diabetes is a serious condition. It's triggered when your body starts having trouble using insulin, which transports glucose into cells. When that happens you are at risk of building up too much glucose in your blood.

There's a lot of talk about the high cost of health care, but do you know which conditions contribute most to health care spending?

If you said diabetes, you're right -- a new study finds diabetes costs $101 billion annually in diagnosis and treatment and is growing 36 times faster than the cost of heart disease, the leading cause of death and the second most-expensive condition. 

"While it is well known that the US spends more than any other nation on health care, very little is known about what diseases drive that spending." said Dr. Joseph Dieleman, lead author of a paper published in JAMA and Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "IHME is trying to fill the information gap so that decision-makers in the public and private sectors can understand the spending landscape, and plan and allocate health resources more effectively."

In fact, the study found that just 20 conditions make up more than half of all spending on health care in the United States.

While diabetes and heart disease primarily affected consumers 65 and over, lower back and neck pain, the third-most-expensive condition, primarily strikes adults of working age.

These three top spending categories, along with hypertension and injuries from falls, comprise 18% of all personal health spending and totaled $437 billion in 2013.

This study distinguishes between spending on public health programs from personal health spending, including both individual out-of-pocket costs and spending by private and government insurance programs. It covers 155 conditions.

$2.4 trillion

In addition to the $2.1 trillion spent on the 155 conditions examined in the study, Dr. Dieleman estimates that approximately $300 billion in costs, such as those of over-the-counter medications and privately funded home health care, remain unaccounted for, indicating total personal health care costs in the US reached $2.4 trillion in 2013.

Other expensive conditions among the top 20 include musculoskeletal disorders, such as tendinitis, carpal tunnel syndrome, and rheumatoid arthritis; well-care associated with dental visits; and pregnancy and postpartum care.

Other key findings include:

• Women ages 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 40% was expended on cardiovascular diseases, Alzheimer's disease, and falls.
• Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a spouse at home to provide care.
• Less than 10% of personal health care spending is on nursing care facilities, and less than 5% of spending is on emergency department care. The conditions leading to the most spending in nursing care facilities are Alzheimer's and stroke, while the condition leading to the most spending in emergency departments is falls.
• Public health education and advocacy initiatives, such as anti-tobacco and cancer awareness campaigns, totaled an estimated $77.9 billion in 2013, less than 3% of total health spending.

Top 10 diseases

The top 10 most costly health expenses in 2013 were:

1. Diabetes - $101.4 billion

2. Ischemic heart disease - $88.1 billion

3. Low back and neck pain - $87.6 billion

4. Hypertension - $83.9 billion

5. Injuries from falls - $76.3 billion

6. Depressive disorders - $71.1 billion

7. Oral-related problems - $66.4 billion

8. Vision and hearing problems - $59 billion

9. Skin-related problems, such as cellulitis and acne - $55.7 billion

10. Pregnancy and postpartum care - $55.6 billion