Mounjaro May Aid Weight Loss, Lower Blood Sugar In People With Type 2 Diabetes
As of 2021, an estimated 537 million people globally have diabetes. Of that number, about 96% of them have type 2 diabetes — a type of diabetes where the body no longer uses insulin correctly.
However, many times, people with type 2 diabetes are not aware they have it. Previous research estimates that almost half of all people with diabetes are undiagnosed.
Uncontrolled type 2 diabetes can lead to potentially serious health complications, including heart disease, kidney damage, nerve damage, and vision loss.
Now, researchers from Velocity Clinical Research at Medical City in Dallas, Texas, say adding tirzepatide — marketed under the brand name Mounjaro — to insulin treatments helps lower average blood Sugar levels and provides more weight loss and less hypoglycemia in people with uncontrolled type 2 diabetes.
This study was recently published in the journal JAMA.
In this study, researchers conducted a randomized clinical trial with about 1,400 participants with inadequately controlled type 2 diabetes treated with basal insulin.
Basal insulin is a slow-acting type of insulin that people with diabetes may take between meals to help control their blood sugar levels when not eating.
Study participants were randomly selected to either receive injections of Mounjaro once a week or a prandial — taken during a meal — premix of insulin lispro three times a day.
Upon analysis, scientists discovered study participants who received Mounjaro decreased their hemoglobin A1C (HbA1c) test levels, which measures a person's average blood sugar level over the last three months, compared to those who took the prandial insulin.
Additionally, study participants taking Mounjaro had more weight loss and fewer hypoglycemic events than those given the insulin lispro.
After reviewing this study, Dr. Pouya Shafipour, a board certified family and obesity medicine physician at Providence Saint John's Health Center in Santa Monica, California, told Medical News Today he was not shocked by these findings.
"I've been using Mounjaro since it got approved and I'm not surprised it's very effective in managing diabetes," he continued. "We've been pleasantly surprised with the results."
"It is great news that there is an alternative to insulin to obtain glycemic control especially when it causes weight loss rather than weight gain that occurs with insulin," Dr. Jennifer Cheng, chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center told Medical News Today when asked about her first reaction to this study.
"We have seen this in the clinical environment with significant weight loss for our diabetic patients," she said.
Mounjaro for diabetes
"The GLP-1 class of medications has really transformed the treatment of type 2 diabetes. We have seen significant amounts of weight loss with our diabetic patients. Losing weight and losing insulin resistance will therefore improve sugar control."— Dr. Jennifer Cheng
Mounjaro is the brand name of an injectable medication called tirzepatide, only available by prescription. A person prescribed Mounjaro has to give themselves injections at home.
It was approved by the U.S. Food and Drug Administration (FDA) in May 2022 as a treatment for helping improve blood sugar control in adults with type 2 diabetes.
Mounjaro is currently the only medication that is both a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist.
Similar medications like Ozempic and Wegovy are only GLP-1 receptor agonists.
Both GIP and GLP-1 are primary incretin hormones secreted by the intestine when you eat something containing sugar or any other ingredient that stimulates the secretion of insulin by the pancreas.
Mounjaro mimics these two hormones and signals the pancreas to increase its insulin production and stop the liver from producing more sugar. It also heightens the body's sensitivity to insulin. All of these together help improve the body's blood sugar control.
Additionally, Mounjaro causes you to feel full sooner when eating, as well as staying full for a longer period of time, potentially assisting with weight loss.
A study presented this past October at the European Association for the Study of Diabetes annual meeting reported that Mounjaro was more effective for both weight loss and blood sugar management than Ozempic and Wegovy.
For people with type 2 diabetes who are considering trying a medication like Mounjaro or Ozempic, what do they need to know when making a decision?
First off, Dr. Shafipour said people should understand these are medications that require them to deliver injections to themselves at home, so they must be comfortable with that. And he said when prescribing, doctors need to make sure there are no contraindications.
"The biggest contraindication is if someone is at risk of medullary thyroid cancer based on their family history — it's a pretty rare form of thyroid cancer," he detailed.
Who can't be prescribed Mounjaro
"[If people have] multiple endocrine neoplasia type 2 in their family history, then we can't prescribe [Mounjaro]. Also, if people are at risk of developing pancreatitis or pancreas inflammation, these drugs can cause that."— Dr. Pouya Shafipour
Dr. Cheng said people should know about the potential side effects of these types of medications — including nausea, vomiting, diarrhea, slowing of the gut, and potential for pancreatitis. And people should also factor in the cost of the medications.
"There is a cost consideration for this medication. While there are significant benefits for the medication, there is also a high cost, which is often covered by medical insurance," she continued.
Not yet approved for weight loss
"I would also like patients to know that this medication is not approved for weight loss at this time. Most insurance companies require a diagnosis of type 2 diabetes for coverage. For non-diabetic patients, there is an alternative to [Mounjaro] called Wegovy. Patients will need a weight loss benefit in their insurance to obtain coverage for obesity medication."— Dr. Jennifer Cheng
What's The Relationship Between Hypothyroidism And AFib?
The relationship between Hypothyroidism and atrial fibrillation (AFib) is complex and not fully understood. Some studies suggest an association, while others propose a potential protective effect.
Thyroid hormones can have a significant impact on the function of your heart and vascular system.
Thyroid disease, particularly hyperthyroidism, is a known risk factor for atrial fibrillation (AFib), an irregular and often rapid heart rate that can increase the risk of stroke and heart failure.
However, it's less clear how hypothyroidism — a thyroid condition involving insufficient hormone production — affects AFib.
Although hypothyroidism can trigger other cardiovascular risk factors associated with AFib, a direct connection between hypothyroidism and AFib remains less clear.
AFib can be associated with hypothyroidism and hyperthyroidism, although a relationship with hyperthyroidism is more commonly recognized.
A few studies suggest that hypothyroidism is notably prevalent in AFib, potentially surpassing hyperthyroidism.
For example, in a 2022 study of 2,000 people with AFib, researchers found that 10.5% had thyroid disease. Of those, 90% had hypothyroidism, 6.1% had hyperthyroidism, and 3.3% had typical thyroid function.
However, in the broader context, hypothyroidism is more prevalent than hyperthyroidism. For example, in women, these conditions occur at rates of 5.9% and 2%, respectively.
Thyroid disease is a known risk factor for AFib.
In particular, the link between AFib and hyperthyroidism is well established. This makes sense because hyperthyroidism itself can increase heart rate and cause atypical heart rhythms and palpitations.
However, the association between AFib and hypothyroidism has been less studied, and available research results are mixed. Some studies even suggest that hypothyroidism may have a protective effect against AFib.
For instance, a large registry study published in 2012 from Denmark reported that hypothyroidism was associated with even lower rates of AFib than occurred in people with typical thyroid function.
A 2017 study found no significant association between mild hypothyroidism and AFib risk. However, hyperthyroidism — higher thyroid hormone levels within the typical range — appeared to correlate with an increased AFib risk.
In contrast, a 2013 study in rats concluded that both hypothyroidism and hyperthyroidism increased the rats' vulnerability to AFib. But findings in animal studies don't always translate to humans.
Further research is needed to better clarify this association.
What TSH level can cause AFib?The relationship between thyroid-stimulating hormone (TSH) levels and the risk of AFib is complex. It is not as straightforward as a specific TSH level causing AFib.
In a 2017 study with 30,085 participants, baseline TSH levels did not significantly affect AFib risk in populations with typical thyroid function or subclinical hypothyroidism. Instead, higher free thyroxine levels within the expected thyroid range showed a link to increased AFib risk.
A 2014 study also indicated a trend of lower AFib risk in people with higher TSH levels, which occur in hypothyroidism. But this trend wasn't statistically significant, likely due to the limited number of AFib events in this group.
A 2008 study found that lower TSH levels within the typical range (0.4–4.0 milliunits per liter) and higher levels of free thyroxine in the typical range (0.86–1.94 nanograms per deciliter) were linked to a greater risk of AFib in older adults.
However, this study does not state a specific TSH level that directly causes AFib. It indicates that even levels within the typical range might affect AFib risk.
Hypothyroidism is associated with several cardiovascular risk factors that can indirectly contribute to an increased risk of AFib:
In addition, research suggests that hypothyroidism can influence heart rhythm as well as how the heart pumps and how the blood vessels respond.
These factors may collectively contribute to a potential indirect link between hypothyroidism and AFib.
AFib treatment in people with hypothyroidism typically involves addressing both conditions.
AFib can be managed in two main ways: rate control, which aims to keep the heart rate within a certain range, and rhythm control, which aims to restore and maintain a standard heart rhythm.
The rate- and rhythm-control strategies refer to the types of medications prescribed, with rate-control focusing on managing the pace of the heart and rhythm-control focusing on the consistency of the heartbeat.
It's important to note that levothyroxine, the medication commonly used for hypothyroidism, can occasionally worsen AFib. While levothyroxine effectively corrects thyroid hormone levels in people with hypothyroidism, caution is advised to avoid excessive dosing to prevent AFib from worsening.
For instance, one 2021 study found that higher doses of levothyroxine (above 0.075 milligrams per day) were linked to a greater risk of AFib in older adults with thyroid disease.
Thyroid disease is a known risk factor for AFib, but the direct link between hypothyroidism and AFib is less clear. While hypothyroidism can affect the heart and thus have an indirect effect on AFib, some studies suggest that hypothyroidism might be associated with a lower risk of AFib or even have a protective effect.
Overall, the connection between hypothyroidism and AFib is complex and may be influenced by various factors, including the severity of thyroid dysfunction, your overall health, and other cardiovascular risk factors.
Sweet Poison: How Sugar Impacts Your Body & Mind
Published: October 4, 2023 6:07 PM IST
By Video Desk
Side effects of sugar: It's everywhere, and it tastes great, but did you know it can harm your body, skin, and hair? In this video, we'll break it down in simple terms, with easy-to-understand explanations and practical advice on how bad sugar is for the human body.When you eat a lot of sugar, your blood sugar goes up and down, making your body work extra hard to balance it.Too much sugar can confuse your body's insulin, which can lead to problems like diabetes.While it can make you gain weight, which isn't good for your health.Sugar can make your skin age faster, causing wrinkles and saggy skin.If you're dealing with acne, sugar can make it worse by causing more oil and inflammation on your skin. Sugar consumption may also lead to hyperpigmentation on the skin.Sugar isn't a friend to your hair either,Too much sugar can mess with your hormones and even lead to hair loss. It can weaken your hair, making it more likely to break and look dull. All over sugar intake can make you bald.
