Medical Bulletin 11/ July/ 2024

Here are the top medical news for the day:

Semaglutide and Very-Low-Calorie Diet Combo Shows Superior Results in Diabetes Control: Study

Scientists at the University of Nottingham, UK, have conducted a short-term intervention study to explore the effectiveness of a very low-calorie diet and Semaglutide, individually and in combination, in reducing body weight and controlling blood glucose in patients with type 2 diabetes.

The findings of this study have been published in the journal Clinical Nutrition.

Type 2 diabetes is a complex disease marked by high blood glucose levels and insulin resistance, primarily caused by impaired insulin secretion from pancreatic beta-cells. Overweight and obesity are significant risk factors, affecting 90% of individuals with type 2 diabetes.

Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), is an antidiabetic medication known for its effectiveness in reducing body weight. Additionally, a very low-calorie diet (VLCD) is a powerful weight loss strategy that shows promise in restoring beta-cell function and enhancing glycemic control in patients with type 2 diabetes. Combining semaglutide with a very low-calorie diet offers a potent approach to managing this multifaceted disease.

In the study, 30 adults with type 2 diabetes and a body mass index (BMI) of 27 – 50 kg/m² were randomly divided into three groups: the VLCD group, the Semaglutide group, and the VLCD-Semaglutide combined group.

Participants in the VLCD group followed a diet restricted to 800 kilocalories per day. Those in the Semaglutide group received subcutaneous Semaglutide once weekly, starting at 0.25 milligrams and increasing every two weeks to 1 milligram. The combined group received both interventions simultaneously. All treatments were administered for a duration of 12 weeks.

The researchers observed significant weight reduction in all intervention groups, with the VLCD and combined groups seeing a 5.4% and 7% higher weight loss than the Semaglutide group. Fat mass reduction was over twice as high in the VLCD and combined groups. Glycemic control improved across all groups, with the highest reduction in the combined group. Insulin sensitivity significantly improved in the VLCD and combined groups, but not in the Semaglutide group.

Mild nausea was common in the Semaglutide group, while constipation was prevalent in the VLCD and combined groups. Combining Semaglutide with VLCD proved more effective in reducing insulin resistance and improving beta-cell function.

Reference: Oluwaseun A. 2024. Metabolic effects of very-low calorie diet, Semaglutide or combination of the two, in individuals with type 2 diabetes mellitus. Clinical Nutrition, DOI: 10.1016/j.clnu.2024.06.034, https://www.sciencedirect.com/science/article/pii/S0261561424002267

Study Finds Ketogenic Diet and Exercise as Effective Primary Treatments for Narcolepsy

A ketogenic diet and regular physical exercise appear to be effective first-line treatments for narcolepsy, new research suggested.

Results of a randomized, controlled trial on the impact of physical exercise and a ketogenic diet on narcolepsy showed both exercise and the diet improved excessive daytime sleepiness (EDS) in narcolepsy type 1.

The results were presented at the Congress of the European Academy of Neurology (EAN) 2024.

Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness and sudden, uncontrollable episodes of falling asleep during the day. It often includes symptoms like cataplexy (sudden loss of muscle tone), sleep paralysis, and hallucinations. The condition results from the brain's inability to regulate sleep-wake cycles properly.

In the study involving 60 adult patients with type 1 narcolepsy (NT1), participants were divided into three groups: regular physical activity, a ketogenic diet, and a control group for 10 weeks. Participants had a BMI > 20 and did not have severe cardiovascular disease or be on certain medications.

The primary outcome measured was excessive daytime sleepiness (EDS) using the Epworth Sleepiness Scale (ESS), with secondary outcomes including sleep quality, quality of life, well-being, cataplexy frequency, and fatigue.

The exercise group performed power walking and logged daily steps and training minutes. The ketogenic diet group received nutritional counselling and monitored ketone levels, weight, and waist circumference.

Results showed significant improvements in excessive daytime sleepiness and sleep quality in the exercise group. The ketogenic group also saw improvements in sleep quality, though not significantly, while the control group showed no changes. There were no adverse effects from the interventions.

“European guidelines on narcolepsy, particularly from patient feedback, emphasize the need for non-pharmacological treatments. However, specific recommendations on physical activity or nutrition are lacking. In the study, both physical activity and a ketogenic diet significantly improved excessive daytime sleepiness (EDS) to levels comparable with drug treatments. These interventions also reduced fatigue and enhanced both physical and mental quality of life. The ketogenic diet additionally resulted in significant weight loss. Both interventions are widely accessible, cost-effective, and showed no adverse effects,” said study investigator Frederike Tepel.

Reference: Frederike Tepel, Centre for Narcolepsy and Hypersomnia, Witten/Herdecke University, Witten, Germany; Ketogenic Diet, Exercise Effective First-line Treatments for Narcolepsy; Congress of the European Academy of Neurology (EAN) 2024

Study Finds Unique Gut Flora in Children with Autism

The traditional process for diagnosing autism heavily relies on a parent’s description of their child’s behavior and a professional’s observations. This subjective approach leaves plenty of room for human error. Parents' concerns may skew their responses on questionnaires, providers may hold biases that lead to underdiagnosis in certain groups, and children may show widely varying symptoms depending on various factors.

Now, in a study published in Nature Microbiology, researchers have added strong evidence to the idea that the gut microbiome could help create more accurate autism diagnosis.

For decades, researchers have studied the human genome, medical histories, and brain scans for a reliable indicator of autism spectrum disorder, with limited success. Although the Food and Drug Administration has approved two diagnostic tests based on eye-tracking software, these require significant involvement from a psychiatrist.

The new study analyzed more than 1,600 stool samples from children aged 1 to 13 and discovered several distinct biological markers in the samples of autistic children. These unique traces of gut bacteria, fungi, viruses, and other microorganisms could serve as the basis of a diagnostic tool. Such a tool based on biomarkers could help professionals diagnose autism sooner, allowing children to access more effective treatments at a younger age.

In the past 15 years, some researchers have begun investigating whether stool samples, which provide a window into the trillions of fungi, bacteria, and viruses living in the intestines, might offer clearer diagnostic answers. Until now, most of those studies relied on small groups and often produced mixed results.

The idea that the gut microbiome might play a role in the development of autism remains controversial among researchers. However, the new study used machine learning to identify significant biological differences between the stool samples of autistic children and others.

Unlike past studies that focused mainly on intestinal bacteria, this research included other microorganisms in the gut, such as fungi, archaea, and viruses, as well as related metabolic processes. The scientists identified 31 biological signatures distinguishing the groups. They then tested these markers on an entirely new group of samples, successfully identifying which stool samples belonged to children with autism almost all the time.

While more research is needed to confirm that these biomarkers are valid indicators of autism, this study marks a significant step forward. If confirmed, these findings could revolutionize the way autism is diagnosed, leading to earlier and more accurate diagnoses and, ultimately, better outcomes for children with the disorder.

Reference: Su, Q., Wong, O.W.H., Lu, W. et al. Multikingdom and functional gut microbiota markers for autism spectrum disorder. Nat Microbiol (2024). https://doi.org/10.1038/s41564-024-01739-1