Sanitation: Glucose sensors are not just for insulin users

Health Rounds

By Nancy Lapid, Health Science Editor

Hello Health Rounds readers! Today we highlight a study that found benefits of wearable glucose monitoring devices for all patients with diabetes, regardless of insulin dependence. We also report on a positive trial of a J&J pill in ulcerative colitis, and a discovery about ovaries after menopause.

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And for those of you interested in canine health: Large dogs age more quickly than small dogs at a molecular level.

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How does the US count measles deaths?

REUTERS/Shannon Stapleton

US Health Secretary Robert F. Kennedy Jr. has changed how the federal government recognizes deaths from measles in the midst of the worst US outbreak of the highly infectious virus in more than three decades. Read more here.

Study Rounds

Continuous glucose monitoring benefits all with diabetes, not just insulin users

The benefits of wearable continuous glucose monitoring devices extend even to patients with diabetes who do not use insulin, a new study found.

Until now, the devices have been recommended only for patients receiving insulin.

In a six-month trial sponsored by device manufacturer Dexcom, 283 adults with type 2 diabetes who were not using insulin received either continuous glucose monitoring with the Dexcom G7 — a coin-size plastic disc worn on the upper arm — or routine care.

The average hemoglobin A1c — a measure of average blood sugar levels over time — fell from 8.8% to 7.2% in the monitoring group and from 8.7% to 8.0% in the routine-care group.

After accounting for individual risk factors, Dexcom G7 users had a nearly 1% greater reduction in HbA1c level compared to patients getting routine care, researchers reported in The New England Journal of Medicine.

Participants using the wearable device also spent approximately five additional hours per day in the glucose target range of 70–180 mg/dL compared with those receiving routine care.

The benefit was seen regardless of age, sex, race and ethnicity, body mass index, income, education, health insurance and use of glucose-lowering medications.

When the study ended, 97% of participants were still using the monitors, most on a daily basis, the researchers noted.

“The consistency of benefit across a broad range of people and treatment regimens supports consideration of the use of a continuous glucose monitor much earlier in type 2 diabetes management before insulin is needed,” study leader Dr. Roy Beck of the Jaeb Center for Health Research in Tampa, Florida, said in a statement.

J&J pill succeeds in ulcerative colitis trial

Johnson & Johnson's new psoriasis pill Icotyde significantly outperformed a placebo as a treatment for ulcerative colitis in a mid-stage trial.

Known chemically as icotrokinra, Icotyde is a first-in-class oral peptide that blocks the interleukin-23 protein on immune cells. Previous IL-23 blockers were given intravenously.

In the 252-patient trial, participants with moderate to severe active ulcerative colitis received either 400 milligrams of icotrokinra, 200 mg, 100 mg or a placebo, daily.

All doses of icotrokinra were superior to placebo for producing a clinical response — a decrease in disease activity and symptoms like rectal bleeding — at week 12, the researchers said. At 400 mg daily, 63% experienced a clinical response. It was 58% in the 200-mg group, 55% in the 100-mg group, and 27% in the placebo group, the researchers reported in The New England Journal of Medicine.

The rate of clinical remission at week 12 was also significantly higher with 400 mg than with placebo at 30% versus 11%, as were the rates of symptomatic remission (46% vs 19%) and endoscopic improvement (37% vs 14%).

Remissions at week 12 were maintained through 28 weeks of treatment, the researchers said.

“Icotrokinra was effective even in hard-to-treat patients who had failed previous drug regimens,” study leader Dr. Maria Abreu of Cedars-Sinai Medical Center in Los Angeles said in a statement. “The fact that the medicine can be taken orally will help us improve the range of options we have for treating patients.”

The researchers said they hope to study the drug in patients with Crohn’s disease as J&J looks to expand approvals for the medication.

Ovaries keep working after menopause

A paradigm-shifting study found human ovaries do not become dormant after menopause, raising questions about whether they play a role in aging and chronic disease.

While their reproductive functions end, ovaries remain biologically active for decades and continue to remodel with age, showing increased inflammation and changes in tissue structure, researchers reported in Aging Cell.

“In the ovary, we reach a point of no return with respect to fertility in which it's no longer producing eggs, and I would venture to say most people assume those ovaries are just sitting there doing nothing, similar to the appendix,” study co-leader Francesca Duncan of Northwestern University Feinberg School of Medicine said in a statement.

Her team's findings challenge that notion.

The researchers studied 28 ovaries obtained from women within 25 years after menopause. Over the decades, some protein levels in the ovaries would go up and some would go down.

For example, ovaries from younger postmenopausal women had more proteins involved in maintaining cells and tissue structure, while older ovaries had more proteins associated with inflammation, immune activity and the ongoing breakdown and rebuilding of the tissue surrounding cells.

The study also found a molecular link between ovarian aging and cancer.

Although all the ovarian tissue in the study appeared normal and cancer-free, some proteins previously associated with ovarian cancer were more abundant in aging ovaries, suggesting that healthy ovarian aging and ovarian cancer share some of the same biological processes.

“It's not that all postmenopausal women get ovarian cancer, but we know that the fibrotic inflammatory environment is certainly an environment that cancer cells prefer to home in on,” Duncan said.

The findings do not mean healthy ovaries should be removed after menopause, the researchers emphasized. But the discovery could spur research into drugs that "target the aging ovary therapeutically to lower the risk of ovarian cancer" or the development of novel biomarkers of ovarian cancer, Duncan said.