Condition State Management: Diabetes

Ketogenic Diet Could Help Manage Advanced Chronic Kidney Disease, Diabetes

The Ketogenic diet— a low carbohydrate diet that aims to induce ketosis (a state during which the body breaks down stored fat instead of glucose for fuel)—could be an effective intervention for patients with diabetes and chronic kidney disease (CKD).¹ Researcher Johannes Kovarik of the Medical University of Vienna, Austria, presented these findings in a session at the American Society of Nephrology Kidney Week 2023 Annual Meeting in Philadelphia, Pennsylvania.²

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The ketogenic diet limits carbohydrate consumption to less than 50 g to 60 g daily while maintaining sufficient protein intake, according to Kovarik. Serum ketone β-hydroxybutyrate should also be greater than 0.5 mms and, in theory, entering ketosis effectively should help patients achieve stable blood insulin and glucose, Kovarik said. Insulin is an important therapeutic target for diabetes and hypertension.

The patients were able to work with psychologists and receive nutritional counseling, so this multidisciplinary approach might be a successful lifestyle intervention, alongside current medications, according to Kovarik. Notably, the diet was effective for glycemic control, and in certain conditions it was found to reverse type 2 diabetes and stabilize or improve glomerular filtration rate, Kovarik said.

Further, the dietary intervention has the potential to reduce morbid obesity (defined as a body mass index of 30 or higher) and it can serve patients with later stage (stage 3 or 4) CKD, along with patients of various economic and racial backgrounds, Kovarik said.—Erin Hunter

FDA Approves Tirzepatide for Chronic Weight Management

The FDA has approved tirzepatide (Zepbound; Eli Lilly) injection for chronic weight management in adults with obesity or overweight with at least 1 weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol. It should be used in combination with a reduced-calorie diet and increased physical activity.

Tirzepatide activates glucagonlike peptide-1 and glucose-dependent insulinotropic polypeptide to reduce appetite and food intake. It is administered by subcutaneous injection once weekly, and the dosage is increased over 4 to 20 weeks to the target dosages of 5 mg, 10 mg, or 15 mg once weekly.

Its efficacy for chronic weight management in combination with a reduced-calorie diet and increased physical activity was established in 2 randomized, double-blind, placebo-controlled trials with adults with obesity or overweight and at least 1 weight-related condition. The studies measured weight reduction after 72 weeks in a total of 2519 patients who received tirzepatide and 958 patients who received placebo.

At the start of the trial in adults with type 2 diabetes, the average body weight was 222 pounds (101 kg) and the average body mass index was 36. Those who received the highest approved dose of tirzepatide lost an average of 12% of their body weight, a statistically significant reduction compared with those who received placebo.—Aislinn Antrim

Metformin Cessation Is Associated With Increased Dementia Risk

Metformin cessation has been associated with an increased dementia incidence in a new study published in JAMA Network Open. Investigators believe that the results are important for the clinical treatment of adults with diabetes.

The study authors reported that a total of 12,220 participants discontinued metformin early and had normal estimated glomerular filtration rate (eGFR). They were compared to metformin users who had either not stopped treatment or had stopped treatment, with or without restarting, after their first abnormal eGFR measurement. Individuals in both groups were matched by age, gender, and duration of diabetes.

Individuals who stopped taking metformin early had a 1.21 times greater hazard of dementia diagnosis compared with those who routinely used metformin. Furthermore, investigators found that there was no association with insulin use at 5 years after stopping metformin and 0.07 years for hemoglobin A1C (HbA1C) level at year 1 after stopping treatment. The study authors concluded that the association of dementia and metformin cessation was independent of changes in HbA1C level and insulin usage.

The study authors said the results of this study could have potential implications for future diabetes treatment, particularly for treatment later in life. Additionally, they said that finding ways to manage or mitigate gastrointestinal adverse effects of metformin might be beneficial for those at high risk of dementia, including those with APoE*ε4 or those who have a history of dementia in their family.—Ashley Gallagher

References

Ketogenic Diet Could Help Manage Advanced Chronic Kidney Disease, Diabetes:

1. McGaugh E, Barthel B. A review of ketogenic diet and lifestyle. Mo Med. 2022;119(1):84-88.
2. Kovarik J. Ketogenic metabolic therapies for CKD. Presented at: American Society of Nephrology Kidney Week 2023 Annual Meeting; November 2-5, 2023; Philadelphia, PA.

FDA Approves Tirzepatide for Chronic Weight Management:

FDA approves new medication for chronic weight management. News release. FDA. November 8, 2023. Accessed November 8, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management

Metformin Cessation Is Associated With Increased Dementia Risk:

Zimmerman SC, Ferguson EL, Choudhary V, et al. Metformin cessation and dementia incidence. JAMA Netw Open. 2023;6(10):e2339723. doi:10.1001/jamanetworkopen.2023.39723