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Friday, June 28, 2019

Baking soda affects inflammation and insulin handling in type 2 diabetes

Early research suggests that the common pantry staple baking soda affects inflammation and insulin handling in type 2 diabetes. The findings will be presented today at the American Physiological Society (APS)/American Society of Nephrology (ASN) conference, Control of Renal Function in Health and Disease in Charlottesville, Va.
Obesity-induced inflammation is thought to be a cause of insulin resistance- the inability of the body to respond to insulin properly- which can lead to type 2 diabetes. The immune system- including the spleen, a small organ located behind the stomach- activates to fight chronic inflammation.
Previous research in healthy rats has shown that an oral sodium bicarbonate (baking soda) solution prompts specialized cells that line the digestive tract organs (mesothelial cells) to signal the spleen to produce more anti-inflammatory immune cells. However, “the anti-inflammatory effect of [baking soda] has yet to be explored in a model of chronic systemic inflammation, such as [type 2 diabetes],” the researchers wrote.

In a new study, researchers treated a rat model of type 2 diabetes with baking soda mixed with drinking water. After three weeks, the diabetic animals showed an impaired insulin response, which could indicate a reduced ability of the body to respond to insulin properly, when compared to a control group of healthy rats. Independent from the negative insulin response, the research team also saw positive results. The spleens of the rats treated with baking soda produced more anti-inflammatory cells, thus boosting immunity even when the mesothelial cells were prevented from sending out signals.
These seemingly contrasting results- a worsening of insulin resistance and an increase in immune function suggest that the “effect of sodium bicarbonate on responses to insulin is not mediated by inflammation, but rather could be related to negative effects of the alkali load,” the researchers wrote. Alkali load refers to basic chemical compounds such as baking soda, explained Elinor Mannon, a MD/PhD candidate at the Medical College of Georgia at Augusta University and first author of the study.
Although still in early stages, the finding that the alkalinity of baking soda could have metabolic effects that occur separately from the beneficial immune response could be important in understanding the whole-body effects of sodium bicarbonate therapy”
Elinor Mannon, MD/PhD candidate at the Medical College of Georgia at Augusta University
Elinor Mannon, a MD/PhD candidate at the Medical College of Georgia at Augusta University, presented “Oral NaHCO3 solution impairs response to insulin in type II diabetes in rats” in the session “Renal Consequences of Obesity, Metabolic Syndrome and Diabetes” on Monday, June 24, at the Boar’s Head Resort.
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Livongo Working With Apple Watch and Others to Improve Disease Management

Livongo, a digital health startup that focuses on chronic disease management, recently announced that it will be integrated into wearables like the Apple Watch to provide health reminders to consumers. The company has previously worked to improve the quality of life in employees at Microsoft and Amazon with chronic conditions like diabetes. Moving into the smartwatch industry, Livongo is now aiming to give users personalized “Health Nudges” through notifications that promote health-conscious decisions.
With this system in place, a Livongo user with diabetes may receive alerts reminding them to measure their blood sugar in the morning before breakfast, eat low-starch vegetables before lunch, or to avoid drinking a sugary beverage.
During an interview with CNBC, Livongo’s chief product officer Amar Kendale said that the company’s team has long been studying these alert systems to identify the best way to deliver them. Kendale wants to avoid what is known as “alert fatigue”, a scenario in which these notifications are overloaded and lose meaning. These nudges will also be presented as five-day challenges for the users, a time frame that Kendale claims is optimum for causing changes in behavior.
The updates will not be generic reminders that all users receive but will rather be tailored to each individual user. Livongo hopes to learn about the users’ behavior over time to better identify the behavioral changes that yield the best results.
In addition to the Apple Watch, Livongo will also be connecting with Fitbit devices and Samsung’s Gear smartwatch. Livongo works with roughly 600 employers and health plans, including self-insured employers like Walgreens, Microsoft, and Amazon. These insurers cover the cost of Livongo, allowing employees to utilize the service free of cost.
The company currently has over 164,000 active users and reported $68.4 million in revenue in 2018. Livongo is also one of the first digital health companies to file for an initial public offering, as per headlines that emerged this morning.
Livongo was founded in 2014, initially offering glucose monitors and test strips for diabetic patients. It has since expanded into management of other chronic conditions, including those of behavioral health and obesity.
With 60% of American adults suffering from at least one chronic disease, the incorporation of Livongo software into smartwatches holds great potential in better managing these conditions. Adam Pellegrini, Fitbit’s general manager of health solutions, claimed that the Livongo app improves health outcomes and behavioral changes in smartwatch users.
”(It) underscores the growing role that wearables and Fitbit devices play in the management of chronic conditions,” he stated.
Silicon Valley Business Journal@svbizjournal
Users will get notifications, behavior health “nudges” and other health information straight to their smartwatches as Livongo Health integrates its chronic condition management platform into the massive wearables health market. http://www.bizjournals.com/sanjose/news/2019/06/26/livongo-health-apple-samsung-wearable-expansion.html?ana=TRUEANTHEMTWT_JO&utm_campaign=trueAnthem%3A+Trending+Content&utm_content=5d15a5f3e256f40001189cf5&utm_medium=trueAnthem&utm_source=twitter …
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1:30 AM – Jun 28, 2019

Livongo Health connects to Apple, Samsung in wearable expansion

Users will get notifications, behavior health “nudges” and other health information straight to their smartwatches as Livongo Health integrates its chronic condition management platform into the…
bizjournals.com
https://www.docwirenews.com/docwire-pick/future-of-medicine-picks/livongo-working-with-apple-watch-and-others-to-improve-disease-management/
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Intelligent Testing Can Potentially Defuse the ‘Ticking Time Bomb’ of Liver Disease

Scientists from the University of Dundee and NHS Tayside in the UK have developed an Intelligent Liver Function test (iLFT) that can potentially detect liver disease in its early stages decades before it becomes fatal. The findings of this study were published in the Journal of Hepatology.
Liver disease, which clinicians call a ‘ticking time bomb’ is often asymptomatic and is one of the leading causes of death among people under the age of 65 in the UK. While liver function tests (LFTs) are frequently requested and may indicate the presence of liver disease, the tests often come back as abnormal, which can cause missed opportunities to detect and treat liver disease in its initial stages.
Researchers implemented a stepped-wedged trial design to compare the outcomes of LFT outcomes among General Practices in the UK six months prior and subsequent to the introduction of the iLFT system, which produced a diagnosis and/or management plan based on diagnostic criteria, liver fibrosis estimation, and reflex testing for causes of liver disease. The researcher’s algorithm was integrated into the laboratory management system, and all outcomes were aggregated and analyzed.

System Displays Diagnostic Accuracy

According to the results of the study, the use of iLFT lead to a 43% increase in the diagnosis of liver disease. Moreover, the algorithm exhibited a diagnostic accuracy rate of over 90%. “In looking at a large set of patient data from Tayside we noticed abnormal liver function tests popping up that were not fully investigated,” said Professor John Dillon, Consultant gastroenterologist and hepatologist, in a press release. Dr. Dillon was part of the team who developed the algorithm.
“All too often we were seeing patients dying of liver failure who had abnormal Liver Function Tests recorded years before when something could have been done. This stopped us in our tracks. We asked ourselves if these had been detected earlier, what difference could it have made?”
Professor Dillion added, “We’ve been predicting that a liver failure epidemic has been coming but now we are seeing hard-evidence that it is already here. We hope that, with continued tests, people drinking too much or eating high-fructose sugars can make the lifestyle changes now that will reduce the number of those coming into hospital with fatal liver failure in the years to come.”
Dr Andrew Fraser, Clinical lead for roll out of iLFT from the Scottish Government’s Modernizing Outpatients Directive, concluded by saying that, “For too long have we seen the rise in patients presenting with advanced liver disease which could have been picked up on routine tests at a much earlier stage. The development by the Dundee team will help to identify those at an early stage where directed intervention can prevent progression to end-stage liver disease. This is only available to patients in Tayside at present and we strongly recommend other health boards adopt it as standard practice across Scotland.”
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Bayer finally heading for a Roundup deal? Its new legal team suggests so

Bayer has said it intends to “defend itself vigorously” in thousands of lawsuits that claim its Roundup weedkiller causes cancer. But that harsh tone has softened, increasing the possibility that a settlement could be near.
The German company has hired an independent lawyer to advise its supervisory board on the Roundup litigation and set up a special committee to oversee it.
“The supervisory board recognizes the negative effect the litigation uncertainty has had on the stock price and stakeholder perception and is determined to help the company decisively but prudently advance the matter,” Bayer said in a statement. Besides the ongoing litigation, it also “looks forward to constructively engaging in the mediation process,” the company said.
Investors soon applauded the moves, sending Bayer’s stock in Frankfurt up 8.7% Wednesday, which marked its biggest daily gain in a decade, Reuters reported. The steps are widely interpreted as a sign that a settlement could be on the way.
“Ultimately, we believe today’s announcement makes a settlement more likely,” Bernstein analysts Gunther Zechmann and Wimal Kapadia said in a Thursday note to clients. The analysts just recently called on Bayer management to settle the mounting cases and stop past practices of “campaigning” to defend the chemical.
Billionaire Paul Singer’s Elliott Management, which holds €1.1 billion ($1.25 billion) in Bayer shares, also said the new development could help resolve uncertainty around the litigation and lead to settlements, according to Reuters.

The Bernstein analysts noted that the external lawyer, John Beisner, previously represented Merck & Co. in its Vioxx litigation and negotiated a settlement with plaintiffs claiming the drug caused their heart attacks.
But unlike the Vioxx case, where Merck pulled the drug off the market, the Bernstein team argues Bayer’s goal “should be arriving at a workable solution that continues to enable use.” Marks Manns, a fund manager at Union Investment, one of Bayer’s largest shareholders, also cautioned that he doesn’t want “a settlement at all costs,” as quoted by Reuters.
Unhappy with how management has handled the Roundup mess, investors cast a rare vote of no confidence in Bayer management at its annual general meeting in April.

The situation sure doesn’t look good for Bayer. Aside from the sheer number of suits—13,400 in April, and growing—Bayer lost a California state trial and a federal bellwether trial. Both resulted in multimillion-dollar damage awards to the plaintiffs. Currently, Bayer’s share price reflects a settlement of $33 billion, or $2.3 million per claim, the Bernstein analysts said, adding that “greater disclosure would make investors more comfortable with the ultimate risk faced.”
Roundup is just one headache for Bayer, too. Both Bernstein and Elliott have called for a pharma-crop business split at the German conglomerate, even though the company is already in the process of hiving off its animal health franchise. Zechmann and Kapadia have argued that the conglomerate structure is dragging down Bayer’s stock and a split-up could restore the pharma division to trade at fair multiples.
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FDA OKs Retrophin’s Thiola for cystinuria

The FDA approves Retrophin’s (NASDAQ:RTRX) enteric coated Thiola EC (tiopronin) for the treatment of a rare inherited disorder called cystinuria (high levels of the amino acid cysteine in the urine) that leads to kidney stones.
Commercial launch will commence in July.
Shares are up 3% after hours.
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Pfizer’s sildenafil flunks late-stage study in newborns

A Phase 3 clinical trial evaluating Pfizer’s (NYSE:PFE) intravenous sildenafil (branded as Revatio) added to inhaled nitric oxide (iNO) in newborns with persistent pulmonary hypertension (PPHN) failed to achieve the primary endpoint. Specifically, treatment with IV sildenafil plus iNO did not result in a statistically significant reduction in treatment failure rate or time on iNO compared to iNO alone.
Revatio was first approved in Europe in October 2005 for adults with pulmonary arterial hypertension.
Sildenafil is also the active ingredient in Viagra.
Shares are off a fraction after hours.
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Infections, Especially UTIs, May Be Triggers for Strokes

A urinary tract infection might be more than just a painful nuisance for some, with new research suggesting it could raise the risk of stroke in vulnerable people.
The study of over 190,000 stroke patients found that the risk of suffering a stroke was heightened in the weeks and months following any infection that required a trip to the hospital. But urinary tract infections (UTIs) showed the strongest link.
People were over five times more likely to suffer an ischemic stroke in the week following a UTI, versus the year before the infection, the findings showed.
Ischemic strokes — the most common type of stroke — are caused by a blood clot that diminishes blood flow to the brain.
The researchers said the findings do not implicate milder infections that people manage at home.
“We’re probably capturing more-severe infections with this study,” said senior researcher Dr. Mandip Dhamoon, an associate professor of neurology at Mount Sinai’s Icahn School of Medicine, in New York City.
The study cannot prove that infections actually triggered strokes. But based on past research, Dhamoon said, it is biologically plausible: Infections can increase body-wide inflammation and may contribute to blood clots.
There are a lot of unknowns, though — including whether certain treatments can not only clear a patient’s infection, but also reduce the risk of a subsequent stroke. That’s a question for future studies, Dhamoon said.
For now, people with risk factors for a stroke can focus on things they can control, according to Daniel Lackland, a professor of neurology at the Medical University of South Carolina.
“If you’ve recently been in the hospital for an infection, be even more cognizant of controlling your stroke risk factors, like high blood pressure and diabetes,” said Lackland, who is also a spokesperson for the American Stroke Association.
The findings, published online June 27 in the journal Stroke, are based on more than 190,000 people who were treated for a stroke at New York State hospitals.
Most often, it was an ischemic stroke, but close to 40,000 patients had suffered a hemorrhagic stroke — which occurs when a blood vessel ruptures and bleeds into the brain.
The researchers looked at each patient’s risk of stroke in the week to four months after a hospital visit for an infection, and compared it with the risk in the previous year.
The risk gradually went down, but was still increased by twofold four months out, the investigators found.
At this point, Dhamoon said, it’s not clear why UTIs would show the strongest association with stroke.
Respiratory infections, blood infections and UTIs were also tied to a heightened risk of intracerebral hemorrhage — a type of hemorrhagic stroke. Why might infections contribute to brain bleeding? Effects on blood vessel function could potentially play a role, Dhamoon said. But that can’t be discerned from this study, he added.
Another point: The study looked at people’s stroke risk at a particular time in relation to another time period. So even though the risk was relatively elevated after an infection, that doesn’t mean it was high.
“The absolute risk to any one patient is still probably low,” Dhamoon said.
Past studies, Lackland said, have implicated certain infections as a possible stroke trigger — including herpes zoster, which causes shingles.
“But this study suggests that a range of infections, if severe, are associated with stroke,” Lackland said. That’s important, he added, because it may help researchers figure out the “why.”
More information
The American Stroke Association has advice on lowering stroke risk.
SOURCES: Mandip Dhamoon, M.D., Dr.P.H., associate professor, neurology, Icahn School of Medicine at Mount Sinai, New York City; Daniel Lackland, Dr.P.H., professor, neurology, Medical University of South Carolina, Charleston, and spokesman, American Stroke Association; June 27, 2019, Stroke, online
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