Once-weekly GLP-1R agonists:Moving the goal posts

Glucagon like peptide-1 receptor (GLP-1R) agonists for the treatment of type 2 diabetes were first introduced to Europe and the USA in 2005.1 Since then, these compounds have become well-established treatment options in the management of type 2 diabetes.2 GLP-1 R agonists have several attractive features including potent and sustained glucose lowering, low risk of hypoglycaemia because of their glucose-dependent effects on insulin and glucagon secretion, sustained weight loss, and a favourable effect on cardiovascular risk factors together with reduction in cardiovascular event rates (liraglutide and semaglutide)

Cardiopulmonary outcomes in people with impaired lung function: the role of metabolic syndrome

Impaired lung function, either with airflow limitation or with preserved ratio impaired spirometry (PRISm), is common globally and associated with increased cardiorespiratory morbidity, cause-specific mortality and overall mortality.1,2 In this context, understanding the impact of metabolic syndrome on cardiopulmonary outcomes is clinically important, given the growing global prevalence of metabolic syndrome, driven in part by the increasing obesity rates, and its associations with major adverse cardiovascular events and all-cause mortality

Exenatide once weekly: clinical outcomes and patient satisfaction

Exenatide once-weekly is effective, well tolerated in patients with T2DM and should be a useful addition to the available range of anti-diabetes treatments

Exploring the experiences of people with obesity and post-bariatric surgery patients after three months using the mindful eating reflective practice:An interpretative phenomenological analysis

Background: Experiential dimensions of Mindful Eating Practices are scarce in the literature.Aim: The study focuses on thirteen individuals with clinical obesity and nine post-bariatric surgery patients who engaged in MERP over three months. Methods: The present research utilized Interpretative Phenomenological Analysis (IPA) as the analytical framework of interviews.Results: Four overarching themes emerged from the analysis: 1. “Enhanced Awareness of Eating": This theme underscores MERP's central emphasis on cultivating heightened mindfulness during food consumption, highlighting the importance of being present at the moment while eating; 2. “Facilitating the Transition to Healthier Eating Habits": This theme explores how MERP influences participants’ dietary choices, eating pace, portion control, and overall enjoyment of meals. It reveals that MERP encourages individuals to reflect on their eating habits and transition towards healthier choices; 3. “Diverse Perspectives on Satisfaction with MERP": Within the context of MERP, participants held varied interpretations of satisfaction. Some encountered practical limitations or engaged in reflective self-examination, while others found sensory satisfaction, enhancing their overall eating experiences; and 4. “Utilization and Development of MERP": This theme delves into participants’ patterns of using MERP. It reveals a tendency to avoid MERP in the morning, a gradual decline in its usage over time, and a preference for an electronic version of the practice.Conclusion: The MERP shows promise in improving overall eating habits by enhancing enjoyment of food, increasing awareness of body cues, promoting healthier choices, and encouraging mindful eating practices. These findings provide valuable insights for future research and the refinement of clinical tools aimed at effective weight management and the promotion of sustainable healthy eating practices by effectively addressing a significant gap in our understanding of the experiential facets of eating practices.</p

Managing idiopathic intracranial hypertension in pregnancy: practical advice

Idiopathic intracranial hypertension (IIH) is more common in women of reproductive age who have obesity, yet there is little information on its management specifically in pregnancy. Women with IIH should plan their pregnancy including discussing contraception before pregnancy, recognising that hormonal contraceptives are not contraindicated. Potentially teratogenic medications including acetazolamide and topiramate are not recommended during pregnancy or in those with immediate plans to conceive; prescribing acetazolamide in pregnancy must only follow discussion with the patient and their obstetrician. Ideally, patients should aim to achieve disease remission or control before pregnancy, through optimising their weight. Although weight gain is expected in pregnancy, excessive weight gain may exacerbate IIH and increase maternal and fetal complications; evidence-based recommendations for non-IIH pregnancies may help in guiding optimal gestational weight gain. The vast majority of women with IIH can have a normal vaginal delivery, with spinal or epidural anaesthesia if needed, provided the papilloedema is stable or the IIH is in remission

Socio-demographic predictors of uptake of a virtual group weight management program during the COVID-19 pandemic

Background: The COVID-19 pandemic has had a significant adverse impact on the delivery of weight management programmes (WMPs), in order to ensure the safety of patients and healthcare professionals. Videoconferencing could provide safe remote access to group WMPs during the COVID-19 pandemic. The objectives of this study were to determine the uptake of a virtual group WMP and its predictors. Methods: All patients enrolled on a face-to-face group WMP, which constitutes part of a Tier 3 WMP delivered by the NHS, at the time of the COVID-19 pandemic lockdown were invited to transfer to a virtual format of the group WMP. Baseline data included weight, BMI, age, gender, ethnicity and Index of Multiple Deprivation (IMD) quintile score. The outcomes were accept/decline transfer to the virtual group WMP. Logistic regression was performed to assess for predictors of uptake. Results: The 315 participants were included, of which 72.1% (n = 227) accepted. After adjusting for gender, deprivation and BMI; older patients (OR 0.966, [95% CI 0.944, 0.989]; p = 0.003) and Black, Asian and Minority Ethnicity (BAME) patients (OR 0.460 [95% 0.248, 0.851]; p = 0.023) were less likely to accept the virtual group WMP. Conclusion: Strategies aimed at improving uptake of group WMP among BAME and older adult groups are needed, particularly considering the increased risk of severe COVID-19 in these two groups, and the links between obesity and poor COVID-19 outcomes

Clinical and Cost Implications of Insulin Degludec in Patients with Type 1 Diabetes and Problematic Hypoglycemia::A Quality Improvement Project

INTRODUCTION: To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal-bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness.METHODS: Patients with T1D who were aged ≥ 18 years, were on a basal-bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness.RESULTS: Six months of follow-up data were available for 42 patients. At 6 months, there was a significant reduction in median (interquartile range) HbA1c, from 8.6 (8.0-9.3)% [70 (64-78) mmol/mol] to 8.4 (7.9-8.9)% [68 (63-74) mmol/mol]; p &lt; 0.05. Median daily basal insulin dose reduced significantly from 30.0 (14.7-45.0) to 25.5 (14.0-30.2) units; p &lt; 0.0001. Data from hospital records showed reductions in the frequency of episodes of severe hypoglycemia from eight in the 6 months preceding degludec initiation to two in the 6 months following initiation. In the same period, diabetic ketoacidosis (DKA) episodes reduced from two before degludec initiation to no episodes after initiation. No patients reported worsening treatment satisfaction after switching to degludec. Considering the reductions in the basal dose required and the frequency of hypoglycemia episodes, we estimate that switching such patients to degludec from other basal insulins could provide significant savings in direct healthcare costs.CONCLUSION: In patients with T1D, switching to degludec was associated with an improvement in HbA1c and reductions in basal insulin dose, severe hypoglycemia, and DKA. When used in appropriate patients, degludec could lead to significant cost savings.FUNDING: Novo Nordisk.</p