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An experimental drug may help curb blood sugar of patients with type2 diabetes without causing it to drop to extremely low levels.

In a new study, a team of researchers has discovered that the compound–dubbed TTP399–improved the blood sugar control of patients, when it was added to metformin, the first-line medication for type 2 diabetes, for 6 months.

Most interestingly, it helped control the blood sugar without causing hypoglycemia in which blood sugar decreases, if severe, can lead to loss of consciousness or convulsions.

Findings of the research are detailed in a paper featured in the journal Science Translational Medicine.

The study extends a previous ‘phase 2’ trial and more research is required before the compound can be added to existing medication of type 2 diabetes, according to senior researcher Carmen Valcarce, chief scientific officer at vTv Therapeutics which is based in North Carolina and develops TTP399.

However, she said that the effects observed so far on patient’s blood sugar control are comparable to or even more improved than the effects of existing medications for the disease.

As reported by American Diabetes Association, type 2 diabetes has affected more than 30 million people in the United States in 2015. It occurs when the body can longer utilize insulin, a hormone responsible for regulating sugar or glucose level in the blood. When the level of blood sugar habitually increases, over time, it can take a toll on the body, causing damage to nerves, blood vessels, heart, eyes, and kidneys.

Although there are various medications for the disease, there is still a need for additional and more effective options, Valcarce said.

TTP399 typically activates an enzyme called glucokinase which acts as a sensor for blood sugar. Other compounds developed to target this enzyme have been stymied by side effects including hypoglycemia and increases in blood fat called triglycerides.

Some of these compounds affected glucokinase in liver as well as pancreas and activation of the enzyme in the pancreas may have caused the blood sugar to drop, Valcarce said. So, TTP399 was designed to prevent such problems.

The researchers tested the compound in 190 study participants who had type 2 diabetes. All were under the medication of metformin; the researchers randomly assigned some patients to add a dose of TTP399 daily, while the rest added either sitagliptin (a diabetes drug) or inactive placebo pills.

After 6 months, patients who added the new compound showed a greater reduction in their A1C level compared to ones who took placebo pills. Researchers found no cases of extreme blood sugar drops or any negative effects on triglycerides.

Longer-term research are still required to determine the effectiveness and safety of the new drug.

A generation of kids will possibly live shorter lives compared to their parents if nothing is done to cope with Wales’ obesity crisis, according to Dr. Frank Atherton, a chief medical officer.

He predicted that obesity will soon takeover smoking as the biggest risk to public health and in 25 years’ time, it can become one of the main causes of cancer in women.

Current Scale of Obesity Problem in Wales

Nearly 60% of population aged 16 and above are either obese or overweight, while 60,000 adults of the same age range are severely obese and are at high risk of health complications.

Over 27% of children aged 4-5 who are starting primary school are obese or overweight and each year, nearly 10,000 more adults are becoming obese.

According to the latest figures, obesity problem in Wales is getting worse than any other regions of the UK which has help responsible for a plethora of various factors such as lower rates of exercise, deprivation, and increasing availability of cheap convenience food.

Some Major Causes of Obesity in Wales

• Around 70% of adults do not consume five essential portions of fruit and vegetables each day.
• On average, both children and adults eat the equivalent 10-12 cubes of sugar a day which is double the recommended amount.
• More than 50% of adults fail to do the essential amount of physical activity each week.
• 20% of boys aged between 11 and 16 does the least recommended level of exercise for 60 minutes each day. It stands at just 1 in 10 for girls the same age.
• Around 50% of primary school children go to school by car.

With rising need to reverse the existing trends, the Welsh government will launch ‘Health Weight: Healthy Wales’, the country’s first-ever obesity strategy, later this year.

The consultation document’s proposals detailed out ‘action points’ where changes are required to be made to facilitate and guide behavioral change among the Welsh public.

Some Important Points in the Consultation Document

1. Creating an improved healthy environment: This aims to allow people to make healthier food choices and be more active each day.
2. Making more healthy settings: This focuses on ensuring that schools, offices and even leisure facilities are contributing to improvement of people’s health and well-being.
3. Motivating people to attain a healthy body weight: This includes influencing people to reach and maintain their body weight in a healthy manner.
4. Enhancing leadership and enabling change: This emphasizes the importance of entire system approach to address obesity.

A recent report, released by Johnson & Johnson’s Janssen Pharmaceutical Companies, uncovers that outdated contracts of mental health commissioning are failing cognitive health services in the UK.

UK mental health services are falling behind its physical health services as the healthcare providers are relying on outdated commissioning process, according to the report. It also revealed the challenges encountered by pressurized mental health units in the UK, with a particular focus on schizophrenia.

Mental health holds for 28 percent the demand on the National Health Service (NHS), but its total CCG budget is only 13 percent. The report has been published to correspond with the Mental Health: Parity of Esteem, an event by IPPR think tank.

Schizophrenia–a mental disorder that affects an individual’s ability to think, feel, and behave clearly–represents the second highest number of total admitted bed days for patient care, in comparison with other health diagnosis including both mental and physical. In 2016-17, the disorder reported 2.5 million bed days approximately.

Schizophrenia is considered among the most complex mental health disorder which is challenging to manage and brings a huge burden to the NHS. In 2012-13, schizophrenia along with psychosis cost the NHS an amount of £2 billion which is expected to increase with growing number of patients. Each year, people with the disorder have an average of 36.4 contacts with healthcare providers.

Analysis in the report indicated that mental health is continuously falling behind physical health, mostly due to how these services are funded and organized. Although new commissioning methods used in physical health have been introduced to enhance innovation and integration of care, findings revealed that most mental healthcare professionals are still relying on outdated commissioning practices.

These practices include block contracts, providing a set payment of service delivery over a time period. Report findings show that use of block contracts could lead to: shortage of beds, ward overcrowding, delayed appointments as well as discharges, lack of personalization and integration of care, and cherry picking patients.

The need to settle these issues has never been given much importance. Compared to 2010, about 1400 more people are accessing mental health services every day. Although UK’s NHS Mental Health Dashboard manages achievement in providing services for mental health, there is no transparency about where the money is spent or whether it is truly leading to better outcomes. Poor accountability suggests that there is less incentive for commissioners to modify the practices.

According to the report, if significant modifications are not brought to improve accountability within the commissioning system, there will be little or no development in efficient services for people suffering from schizophrenia and other mental disorders.

The Lancet, one of the most prestigious medical journals in the world, has released a report which prescribes an ideal and healthy diet. The new dietary plan has taken into consideration all the factors of human body as well as meeting UN Conference on Climate Change goals for reducing carbon emissions.

The report has recommended a reduction in consumption of red meat and sugar by almost 50% along with increasing the intake of nuts, vegetables and fruits. The diet is healthy and environment-friendly causing minimum damage to the planet intended for a worldwide adoption.

The report was submitted by EAT-Lancet Commission, a non-profit and independent organization, which involved 18 co-authors, 19 scientists from 16 countries. The group was tasked with providing global scientific targets for sustainable food production and healthy diet.

The commission proposed recommendations for an average man with the average dietary calorie requirement of 2500 calories. Out of the 2500 calories, 800 calories must come from whole grain i.e. corn, wheat and rice, while 204 calories from vegetables and fruits, and fewer than 30 calories from meat (pork, lamb, beef). Additionally, it suggested an avoidance of added fat and added sugar. The report stated that the proposed diet will abate the approximately 11 million premature deaths per year worldwide as unhealthy diet is one of the leading cause of health issues.

The ideal planetary health diet is aimed at achieving the UNFCCC Paris targets to ensure sustainable food production practices. At the same time, the report has recommended to take cultural sensitivities in consideration. The planet will host 10 billion people by the end of 2050 which will put enormous strain on natural resources by the overgrowth in population. This will inevitably urge us to look for healthy alternatives for unsustainable dietary hobbits.  

One of the members of the commission, a professor at Harvard, Walter Willett said that the diet of people across the globe needs to change. While the environmentally conscious diet allows two fish servings and a beef burger per week it specifies that most of the protein must come from non-meat sources. While one third of each food plate of the diet is sourced from wholegrain more than half of it comes from vegetarian sources.

Marco Springman, a commission member from Oxford University, said that the report is based on sound scientific and epidemiological evidence as researchers studied huge data about dietary needs of cohorts of people. The Lancet is one of the most reputed and prestigious medical journals in the world with an experience which exceeds a century as its first issue was published in the year 1823.  

Eli Lilly, an Indianapolis-based global pharmaceutical company has gained approval for its Verzenio drug used for treating breast cancer patients from UK’s National Institute of Health and Care Excellence (NICE). The approval has set stage for a 3 way competition in the CDK4/6 inhibitor drugs segment. The new drug is another addition to other such drugs including Pfizer’s Ibrance and Novartis’s Kisqali.

NICE has recommended in its draft guidance the use of the drug for treating human epidermal growth factor-2 (HER2) negative, hormone receptor positive and metastatic breast cancer as part of initial hormone therapy. NICE said that the drug is cost-effective compared to other CDK4/6 inhibitor class drugs after Lilly revised its price offering by a revised patient access scheme.

Ibrance was the first drug launched which showed blockbuster performance earning close to $4 billion in 2018 worldwide, Kisqali is far behind with expected sales to reach $1.6 billion in 2022. The Verzenio drugs approval will give competition to the Kisqali for the second position in the market. Although Verzenio is far behind Kisqali and Ibrance as they gained their approval in November 2017, but analysts say that the Verzenio will fare better than others as it requires patient to follow a continuous dosing regimen without going on treatment holidays to avoid toxicity such as neutropenia. The UK listed price of Verzenio is same as its rivals costing around £2,950, but NICE made sure that the company gives discounting offers.

Around 40,000 women across UK are diagnosed with breast cancer every year, while 8000 out of them will be eligible to receive treatment by the Verzenio drug. The drug is being appraised by NICE along with fulvestrant. Delyth Morgan, Breast Cancer Now’s chief executive said that the NICE approval will help in improving choices available to breast cancer diagnosed women, giving them greater control over their life.

Lilly’s drug Abemaciclib (Verzenio), which in 2015 was designated as breakthrough therapy for breast cancer by the USFDA, can be used as a replacement for robociclib and palbociclib. The drug which acts as a CDK4 and CDK6 inhibitor can come with some side effects. It is essential that the patients are informed about the benefits and possible side effects of the therapy they are receiving. She further added that they look forward to the use of the drug as part of National Health Service and giving Verzenio in combination with fulvestrant could significantly improve patient’s response to treatment who have already received hormone therapy.

A new blood test which tracks the level of neurofilament light chain, a protein in the blood may be adopted for the detection of Alzheimer’s and other neurodegenerative diseases a decade before first symptoms occur. The blood test developed as part of research study by collaboration of researchers from German Center for Neurodegenerative Diseases in Germany and Washington University School of Medicine in St. Louis, USA.

When neurons are damaged or dying, a structural protein, neurofilament light chain is leaked into the cerebrospinal fluid which later releases into the blood through the blood brain barrier. Researchers used this protein for developing blood test for early detection of Neurodegenerative disorder.

To detect the damage to the neurons in the brain, rise in the levels of neurofilament light chain protein in the cerebrospinal fluids is checked. Although this is an established procedure, patients are often reluctant to undergo spinal tap which is required to extract the fluid from the CNS.

The researchers wanted to overcome this challenge by investigating the possible link between neurological damage and protein levels in the blood. The study was conducted on 400 participants from Dominantly Inherited Alzheimer’s Network or DIAN. The participants of the study include 247 carrying early-onset genetic variant and 162 with unaffected relatives.

The protein levels were high at baseline and showed a rise over time in people with the faulty genetic variant while in people with healthy gene variant it remained largely same from already lower baseline levels. The researchers said that the significant achievement lies in the fact that the difference in the level of neurofilament light chain protein was detectable by the blood test 16 years before the first symptoms of the disease occurred. The researchers are optimistic about the use of the protein as a primary biomarker for early stage detection of neurodegenerative diseases.

It was observed that patients whose blood tests reported a rise in blood protein levels were most likely to develop symptoms of diminished cognitive abilities and brain atrophy. Additional research still has to be conducted before the adoption of the blood test methodology for clinical scale prediction. But the new test has shown hope for early detection of certain neurodegenerative diseases including multiple sclerosis, Huntington’s disease, Lewy body dementia and Alzheimer’s disease.

The Alzheimer’s Association reports that around 5.7 million people in the US suffer from Alzheimer’s disease and it expects that the figure could rise up to 14 million by 2050. 

An advisory panel working for US Food and Drug Administration split evenly on the decision to whether to approve a first of its kind oral medication for treating Type 1 diabetes. The committee is undecided about the approval with a vote 8-8 and has left the decision to the agency by the end of March 2019.

The drug sotagliflozin made by drug makers Lexicon and Sanofi Pharmaceuticals is planned to be sold under the brand name Zynquista. The medication which is to be taken along with insulin came under increased scrutiny owing to certain severe side effects of the medicine. The drug poses a higher risk to patients in developing diabetic ketoacidosis. Diabetic ketoacidosis (DKA) is a condition where the body doesn’t produce enough insulin leading to high blood sugar and highly acidic substances called ketones. It’s a serious life-threatening complication for Type 1 diabetic patients. The risk of developing DKA has led many reviewers to vote against the drugs release.

In Type 1 diabetes the body doesn’t produce insulin, so people with the condition have to regularly monitor their blood sugar levels from rising beyond a certain limit. Type 1 Diabetes often called juvenile diabetes is usually diagnosed early in childhood. People with the condition are treated with insulin but it often leads to fluctuation in blood sugar levels causing much discomfort. The proposed Zynquista drug is a one-time daily drug which helps manage the patient’s blood sugar level, however it reduces the blood sugar levels by excreting excess sugar into urine.

The drugs approval process was based on three clinical trials which involved around three thousand patients. The results found that there were about 56 cases of patients developing DKA among 1,748 patients, or 3.2 percent while the placebo test showed that 5 patients developed DKA among 1,229 patients or 0.4 percent. The drug trials brought significant benefits to the patient including reduced blood sugar, some weight loss and lowered blood pressure.

The panel members were aware of the risk involved in DKA which has often led to serious hospitalization and death and raised concerns about the higher risk involved in real world adoption of the drugs outside the confines a clinical trial. A panel member who voted against the drug, Dr. Jack Yanovski said that the smaller degree of benefits may not outweigh the increased risk it may pose to the patient. Other panel members disagreed by stating that the patients are in desperate need of the Zenquista drug.

There are about 1.25 million people in USA suffering from Type 1 diabetes and 40,000 are diagnosed every year, according American Diabetes Association. The companies said that they would continue to work towards approval of the drug with USFDA.

A London-based digital health startup Kaia Health has raised $10 million in Series-A round of funding which offers app based training for chronic pain management. The startup founded in 2015 provides ‘mind-body therapy’ to patients suffering from musculoskeletal disorders. The idea is to offer mobile technology based alternative therapy which includes medical education, psychological techniques and guided physical exercises.

The CEO and co-founder of Kaia Health, Konstantin Mehl said that the app is useful for chronic pain patients suffering acute pain for 2-3 days. He said that as the physical therapy for pain management is usually expensive because of physiotherapist fees, only 2% of patients suffering acute pain receive any kind of professional help while the rest 98% extensively rely on pain killers and surgery. The treatment is very ineffective as well as expensive.

Mr. Mehl said that the traditional therapy for chronic pain management includes the patient receiving a one-on-one physiotherapy session for weeks. The patient has to visit the physiotherapist personally and has to pay handsome fees. Instead of this hassle, Kaia Health has developed a personal trainer app which uses computer vision technology to provide guided exercise and pain management techniques by a fully autonomous exercise coach. The app visually monitors the user as they are performing the exercises and gives vocal feedbacks if they are wrongly doing a certain move or exercise.

Kaia’s goal is to reduce the use of pharmaceuticals for pain relief as over-prescription of opioid drugs have escalated into a nationwide epidemic and rise in the number of opioid overdose deaths. The app based approach gives flexibility to users for exercise timings. As many people don’t like to go to physiotherapist every time for an exercise session and also don’t find it comfortable to practice at home without instruction, the app based monitoring helps them get live feedback.

The company released an app called Squat Challenge which taught an exercise called squat, only to see how people use the technology. And then the startup tracked all possible body positions to provide improvising suggestions. It took nearly six months to track all body positions and now Mr. Mehl claims that they have successfully added all the body positions. He added that the app now can correct any exercise and movements on millimeter basis.

Competitors in the app-based pain management field includes another startup Hinge Health. Their approach also involves an app along with wearable sensors to monitor body movements, however quite different from Kaia’s automated sensor free AI approach. Mehl said that they have tried working with wearable sensors but found that users are usually disinclined towards putting sensors on body while doing exercises. As a result they decided against the use of sensors and relied more on Artificial Intelligence based personal training.

The Series-A round of investment was led by Balderton Capital. The new funding will be used to scaling up in the USA with new office in New York.  Kaia is currently used by 250,000 users in Europe and USA.