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Type 1 diabetes: Rheumatoid arthritis drug shows promise as treatment

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Researchers are hoping a rheumatoid arthritis drug may someday be prescribed to treat type 1 diabetes. mixetto/Getty Images

Researchers at St Vincent’s Institute of Medical Research in Melbourne, Australia, are reporting that a commonly prescribed rheumatoid arthritis drug can help suppress the progression of type 1 diabetes.

Their findings were revealed in a study published in the New England Journal of Medicine.

The medication, baricitinib (Olumiant), is an immunosuppressant used in the treatment of rheumatoid arthritis.

Baricitinib has also been approved by the Federal Drug Administration (FDA) for use in treating alopecia areata. Additionally, the results of clinical trials of baricitinib in combination with topical corticosteroids for treating atopic dermatitis have also been promising.

Like type 1 diabetes, rheumatoid arthritis, atopic dermatitis, and alopecia areata are autoimmune disorders.

In addition, the FDA granted emergency use authorization in 2020 to baricitinib to treat COVID-19 when combined with remdesivir for people needing a respirator.

In the new clinical trial, researchers said that baricitinib can effectively preserve the body’s insulin production and suppress the progression of type 1 diabetes when treatment begins within 100 days of diagnosis.

“When type 1 diabetes is first diagnosed there is a substantial number of insulin-producing cells still present. We wanted to see whether we could protect the further destruction of these cells by the immune system. We showed that baricitinib is safe and effective at slowing the progression of type 1 diabetes in people who have been recently diagnosed,” said Tom Kay, PhD, a professor at St. Vincent’s Institute and an author of the study, in a press release.

During the study, children and young adults who received a diagnosis of type 1 diagnosis within the previous 100 days received either baricitinib or a placebo for 48 weeks.

The researchers reported that insulin production continued when the participants remained on the medication.

Additional findings for those taking baricitinib included:

  • The variability in glucose level was lower.
  • The percentage of time the glucose level stayed in the target range with higher.
  • There was a decreased need for insulin therapy,.

Three participants did not need insulin therapy by the end of the trial. The remainder did but with lower levels, the researchers said.

 

 

The researchers noted that there was too much irreversible damage by the time of diagnosis to allow for the complete cessation of insulin therapy in participants.

“These are exciting findings since the only medication approved by the FDA to delay the onset of clinical type 1 diabetes is an infusion,” said Dr. Eliud Sifonte, an endocrinologist at NYU Langone Medical Associates — West Palm Beach in Florida who was not involved in the research. “I would like to see further studies showing similar or better efficacy.”

“It remains to be seen whether treating patients earlier in their process may lead to delaying the need for insulin. In this study, we saw decreased dosages, but patients had to continue using insulin nevertheless,” Sifonte told Medical News Today. “The study showed decreased needs for insulin but not resolution or ‘cure’ of diabetes. Patients treated with this agent should continue to monitor their blood glucose as indicated and as required based on their treatment regime.”

Dr. Caroline Messer, an endocrinologist at Northwell Lenox Hill Hospital in New York who also was not involved in the research, agreed.

“The class of JAK inhibitors, in general, shows promise for the preservation of beta cell function (the cells in the pancreas that produce insulin) in patients with type one diabetes,” she told Medical News Today. “There are similarities between this drug and teplizumab (TZIELD), which is already on the market for a similar indication.”

“The study clearly proves that baricitinib can decrease the amount of insulin required by patients with early type one diabetes and decrease the variability of blood sugars,” Messer added. “However, the Hemoglobin A1C (a measure of 3 months of average blood sugars) did not improve. As the authors noted, this trial may have been more successful if baricitinib had been initiated at an earlier stage in the disease process when there was less damage to the beta cells. One of the major advantages to this new medication is that it is administered in pill rather than IV form.”

“There is a higher risk of diabetic ketoacidosis (high acid in the bloodstream seen when insulin levels are low) in patients who are skipping insulin while taking this medication,” Messer noted.

 

The researchers indicate the following limitations:

  • Most of the patients were white, making it difficult to generalize the findings to other races.
  • The sample size was small.
  • The short duration of the trial limited the ability to identify rare adverse events.
  • None of the participants were under 10 years of age.

“The trial was only a phase two trial, which simply looks to see if a medication actually works,” Messer said. “I would need to see a phase three trial, which is a longer trial that compares a medication to the current standard of care. I would also need a larger sample size to make sure that the risks do not outweigh the benefits. Finally, I would want to see how this medication works when administered at an earlier phase of type one diabetes. Also, since the benefits appear to quickly decline once the medication is stopped, I would want to see data on long-term use of this medication.”

 

 

Type 1 diabetes is an autoimmune disorder where the immune system attacks cells in the pancreas that make insulin by the immune system.

According to the Centers for Disease Control and Prevention (CDC), symptoms include:

  • Frequent urination
  • Being very thristy
  • Weight loss without trying
  • Blurry vision
  • Numbness or tingling in hands and feet
  • Dry skin
  • Sores that take a long time to heal
  • More infections than normal

In addition, individuals might experience nausea, vomiting, or stomach pains.

 

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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