Medical Bulletin 05/August/ 2025

The second study also conducted by the University of Wisconsin-Madison, analyzed nationwide emergency department data to assess whether those likely using Ozempic had a reduced risk of stroke. The researchers found significant associations between presumed Ozempic use and lower odds of stroke. They emphasized the need for future studies using pharmacy data for more precise analysis.

The third study presented by the University of Texas Medical Branch, focused on hemorrhagic strokes and brain aneurysms. Researchers found GLP-1 inhibitor use was linked to reduced risk of cognitive side effects, seizures, recurrent hemorrhage, and death up to two years’ post-event.

According to Ahmed Elbayomy, MD, a research fellow and data scientist in the Department of Neurological Surgery at the University of Wisconsin-Madison and primary author of two of these studies, these results are very promising. "More research is certainly needed, but seeing the potential protection offered by these medications is a fascinating finding."

Reference: https://snisannualmeeting.org/

Indian Study Shows Type 2 Diabetes Remission May Be Possible without Surgery or Extreme Diets

A new study published in the Indian Journal of Endocrinology and Metabolism is challenging long-held beliefs about type 2 diabetes mellitus (T2DM). The ‘DiaRem-1’ trial, conducted at a single center in India, shows that with a strategic combination of medication and lifestyle modifications, remission of T2DM may be possible.

The trial targeted adults diagnosed with T2DM within the past five years, with an HbA1c level below 8.5%. After an initial three-month period of medication, participants were taken off all antidiabetic drugs for another three months to assess for remission—defined in the study as maintaining an HbA1c level below 6.5% without any diabetes medication.

Participants were divided into two treatment arms. Fourteen patients in the intervention arm received a combination of liraglutide, dapagliflozin, and metformin. The control group of fifteen patients was treated with vildagliptin, glimepiride, and metformin. Both groups also received guidance on maintaining a home-based, healthy diet and daily physical activity, including brisk walking, yoga, or dancing.

At the end of the trial, 9 out of 29 participants (31%) achieved remission—four from the intervention group and five from the control group. "With early, intensive treatment and continued support, many patients may no longer need diabetes medication. That's a powerful message of hope," said Dr Rama Walia, lead investigator of the study, adding: "Physical workout for an hour daily, including brisk walk, yoga or dance, was advised in the trial. Patients were kept on home-based healthy diet."

Significant weight loss was also observed, with the intervention group losing a median of 4.9 kg and the control group losing 3 kg. Both fat mass and body fat percentage decreased in both arms. No baseline characteristics could reliably predict who would go into remission, although shorter diabetes duration and greater weight loss appeared to favor success.

Unlike approaches that require strict diets or expensive surgeries, the DiaRem-1 trial presents a cost-effective, scalable model for outpatient clinics. The PGI team plans further research to determine how long remission lasts and whether longer treatment can improve results.

Reference: Sudhayakumar A, Arjunan D, Bhansali S, Bhujade H, Bhadada SK, Malhotra S, Walia R. Realisation of Remission of Diabetes Using Pharmacotherapy (DiaRem-1). Indian J Endocrinol Metab. 2025 Mar-Apr;29(2):217-223. doi: 10.4103/ijem.ijem_356_24. Epub 2025 Apr 29. PMID: 40416453; PMCID: PMC12101762.

Multiple Sclerosis May Begin 15 Years Earlier with Subtle Symptoms

A new study from the University of British Columbia, published in JAMA Network Open, suggests that early warning signs of multiple sclerosis may emerge more than a decade before the onset of classic neurological symptoms. By analyzing health records of over 12,000 individuals in British Columbia, researchers found that people later diagnosed with MS began engaging with the healthcare system at elevated rates as early as 15 years prior to their diagnosis.

Multiple sclerosis is traditionally diagnosed only after patients present with recognizable neurological symptoms, such as vision problems or limb weakness. However, this study, offers a detailed timeline to date of how patients interact with medical providers in the years leading up to a diagnosis.

The study utilized linked clinical and provincial health administrative data to track physician visits in the 25 years leading up to multiple sclerosis symptom onset. This neurologist-determined timeline is much earlier than previous studies, which typically tracked only five to ten years of data before a first demyelinating event.

Researchers found notable increases in general physician visits 15 years before symptoms, followed by rising mental health consultations 12 years prior, and increases in neurology and ophthalmology visits eight to nine years before symptom onset. Visits to emergency medicine and radiology surged in the final three to five years.

“Multiple sclerosis can be difficult to recognize as many of the earliest signs—like fatigue, headache, pain and mental health concerns—can be quite general and easily mistaken for other conditions,” said Dr. Helen Tremlett, professor of neurology at UBC’s faculty of medicine and investigator at the Djavad Mowafaghian Centre for Brain Health. “Our findings dramatically shift the timeline for when these early warning signs are thought to begin, potentially opening the door to opportunities for earlier detection and intervention.”

“These patterns suggest that multiple sclerosis has a long and complex prodromal phase—where something is happening beneath the surface but hasn’t yet declared itself as multiple sclerosis,” explained Dr. Marta Ruiz-Algueró, first author and postdoctoral fellow at UBC.

While not all individuals with these general symptoms will develop multiple sclerosis, the findings could pave the way for earlier diagnosis, better monitoring, and even preventive strategies.

Reference: Ruiz-Algueró M, Zhu F, Chertcoff A, Zhao Y, Marrie RA, Tremlett H. Health Care Use Before Multiple Sclerosis Symptom Onset. JAMA Netw Open. 2025;8(8):e2524635. doi:10.1001/jamanetworkopen.2025.24635