FDA Drug Safety Communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain
The U.S. Food and Drug Administration (FDA) is warning that the type 2 diabetes medicines sitagliptin, saxagliptin, linagliptin, and alogliptin may cause joint pain that can be severe and disabling. We have added a new Warning and Precaution about this risk to the labels of all medicines in this drug class, called dipeptidyl peptidase-4 (DPP-4) inhibitors.
Health care professionals should consider DPP-4 inhibitors as a possible cause of severe joint pain and discontinue the drug if appropriate.
In a search of the FDA Adverse Event Reporting System (FAERS) database and the medical literature,1-4 we identified cases of severe joint painassociated with the use of DPP-4 inhibitors. Patients started having symptoms from 1 day to years after they started taking a DPP-4 inhibitor. After the patients discontinued the DPP-4 inhibitor medicine, their symptoms were relieved, usually in less than a month. Some patients
developed severe joint pain again when they started the same medicine or another DPP-4 inhibitor.
In a search of the FDA Adverse Event Reporting System (FAERS) database and the medical literature,1-4 we identified cases of severe joint pain associated with the use of DPP-4 inhibitors. Patients started having symptoms from 1 day to years after they started taking a DPP-4 inhibitor. After the patients discontinued the DPP-4 inhibitor medicine, their symptoms were relieved, usually in less than a month. Some
patients developed severe joint pain again when they restarted the same medicine or another DPP-4 inhibitor. http://www.fda.gov/Drugs/DrugSafety/ucm459579.htm
Using Sugar to Quiet Stress Fuels More Cravings
Studies find sugar limits production of cortisol in the brain, prompting dietary habit...
Sugar overconsumption and chronic stress are growing health concerns because they both may increase the risk for obesity and its related
diseases. Rodent studies suggest that sugar consumption may activate a glucocorticoid-metabolic-brain-negative feedback pathway, which may turn off the stress response and thereby reinforce habitual sugar overconsumption.
Researchers at the University of California, Davis, tested this hypothesized glucocorticoid-metabolic-brain model in women consuming
beverages sweetened with either aspartame of sucrose.
The parallel-arm, double-masked diet intervention study, used data from 19 women (age range 18–40 y) with a body mass index (range 20–34
kg/m2) who were a subgroup from a National Institutes of Health-funded investigation of 188 participants assigned to eight experimental groups.The intervention consisted of sucrose- or aspartame-sweetened beverage consumption three times per day for 2 weeks. Salivary cortisol and regional brain responses to the Montreal Imaging Stress Task were measured.
Compared with aspartame, sucrose consumption was associated with significantly higher activity in the left hippocampus (P = .001). Sucrose,
but not aspartame, consumption associated with reduced (P = .024) stress-induced cortisol. The sucrose group also had a lower reactivity to
naltrexone, significantly (P = .041) lower nausea, and a trend (P = .080) toward lower cortisol.
The researchers concluded that, "These experimental findings support a metabolic-brain-negative feedback pathway that is affected by sugar and may make some people under stress more hooked on sugar and possibly more vulnerable to obesity and its related conditions."
Practice Pearls:
- Sugar may interrupt the normal response to stress in the hippocampus, limiting production of the stress hormone cortisol.
- Cravings peak over 15 to 20 minutes and if delayed and distract yourself for that long the cravings start to come down on their own.
- The study is small and only included women. More research is needed to understand how sugar consumption might impact feelings of stress.
Matthew S. Tryon. Excessive Sugar Consumption May Be a Difficult Habit to Break: A View From the Brain and Body. DOI: http://dx.doi.org/10.1210/jc.2014-4353. J Clin Endocrinol Metab April 2015.
Higher-Dose Liraglutide Creates New Options to Fight Obesity, but Payment Remains a Challenge
Higher dose liraglutide was approved on 12/23/15. Dosing: Obese otherwise healthy - 3mg daily injections (monotherapy only).With diabetes, 1.2
or 1.8 mg daily. http://www.ajmc.com/journals/evidence-based-diabetes-management/2015/april-2015/higher-dose-liraglutide-creates-new-options-to-fight-obesity-but-payment-remains-a-challenge/P-2
A1C levels not statistically related to CV events in diabetes patients
Researchers found a modest, but not statistically significant, correlation between A1C levels and cardiovascular events among type 2 diabetes
patients with or without vascular disease, according to a Dutch study in Diabetes Care. The findings, based on 1,687 adults, also revealed about a 16% increased risk for all-cause mortality with every 1% increase in A1C levels among diabetes patients with and without vascular disease. Healio (free registration)/Endocrine Today
Patients with Hb Wayne may be misdiagnosed with type 2 diabetes
A case report published in Diabetes Care showed that the presence of alpha-globin chain mutant hemoglobin Wayne interferes with A1C measurements and might lead to a misdiagnosis of type 2 diabetes in patients. Canadian researchers investigated the case of a 66-year-old Caucasian female who had persistently high A1C levels and experienced symptoms of episodic hypoglycemia while taking metformin and insulin glargine. PhysiciansBriefing.com/HealthDay News (8/26)
FDA clears continuous glucose monitor from Dexcom
The G5 Mobile CGM system, a continuous glucose monitor with Bluetooth capability from Dexcom, has received 510(k) clearance from the FDA. The monitor can transmit data to up to five individuals on iOS devices. The launch of an Android version of the product's application is planned by the San Diego-based firm in early 2016. MobiHealthNews.com (8/25)