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Semaglutide - New Diabetes Medication With Superior Diabetes Control And Weight Loss - Now Approved In Canada

>> Monday, January 15, 2018

In the current era of type 2 diabetes, we are fortunate to have many different medications to choose from to help people control their blood sugars, choosing the medication(s) that fit each individual's unique health situation best.   In the last decade or so, we have developed diabetes medications that can avoid two unwanted side effects of some of the older diabetes medications: weight gain (with some causing weight loss), and low blood sugars.

Health Canada has just approved a new medication, called semaglutide, which is not only superior to any other medication it has been tested against for blood sugar control, but also causes more weight loss than any other medication on the market.

Semaglutide (trade name Ozempic) is a GLP1 receptor agonist, which works by stimulating the pancreas to increase insulin release and suppress the production of a hormone called glucagon, and also acts as an appetite suppressant in the hunger/fullness centre of the brain.  It is a once weekly treatment given by injection under the skin.  It reduces hemoglobin A1C (the diabetes report card) by up to 1.8%, and reduces weight in people with diabetes by up to 6.4 kg (14 lb) in the clinical trials that have been conducted.

In terms of side effects, like other GLP1 receptor agonists that are already available (including liraglutide (Victoza), dulaglutide (Trulicity) and exenatide (Bydureon or Byetta), it temporarily slows down stomach emptying, so can cause nausea, constipation, or diarrhea, which usually goes away after a few weeks, if it occurs.  Also similar to other GLP1s, there is a low risk of pancreatitis.

Unique to semaglutide, there was an increase in diabetic eye complications seen in the largest clinical trial (in which I was an investigator), which is thought to be due to the power of semaglutide to greatly improve diabetes control (we have seen occasional temporary worsening of diabetic eye disease in studies of other medications, including insulin, when there is a big and rapid drop in blood sugars).  This risk is higher in people with existing diabetes eye complications.  However, long term improvement in diabetes control decrease the risk of diabetes eye complications overall.

Semaglutide has also been shown to reduce the risk of cardiovascular events in people with type 2 diabetes and cardiovascular disease - now the fourth diabetes medication available in Canada to show this benefit.  The full product monograph, with a full description of clinical trials and potential side effects, is available here.

Semaglutide is currently being studied as an obesity treatment as well, in people without diabetes, but is not yet approved for this indication.

Disclaimer: I am involved in research trials of semaglutide for type 2 diabetes and obesity.  I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide (Novo Nordisk). 

Follow me on twitter! @drsuepedersen © 2018


Are Less People With Overweight Or Obesity Trying To Lose Weight?

>> Monday, January 8, 2018

As we look forward into a new year, it is also worthwhile to cast a glance backwards in time to understand how perceptions and attitudes towards weight loss may be changing, in the face of a landscape where obesity is on the rise.

One of the most read 2017 studies in the Journal of the American Medical Association used the American National Health And Nutritional Examination Survey (NHANES) data to assess whether there has been any change in the percentage of people with overweight or obesity (defined as BMI of 25 or greater) trying to lose weight during the time frames of 1988-1994, 1999-2004, and 2009-2014.

Upon analysis of the data from 27,350 people aged 20-59, they found that the percentage of people with overweight or obesity increased over time, from 52.7% in 1988-1994, to 65.6% in 2009-2014.

The percentage of people trying to lose weight decreased during the same period, from 55.7% in 1988-1994, to 49.2% in 2009-2014.

So why would the proportion of people trying to lose weight be decreasing, while obesity is actually on the rise? 

Well, we know that there has been a generational shift in perceptions of body weight norms - in other words, people with overweight are less likely to classify themselves as such as they did in years past, because overweight may be perceived more like the 'new normal'.  So if people who carry excess weight perceive themselves to be of a healthy weight, they would be less inclined to try to lose weight.

The authors of this study suggest that the length of time that people struggle with obesity may be a factor - the longer people live with obesity, the more frustrated they may be come with unsuccessful weight loss attempts and thus less likely to try to manage their weight.

I think the issues go even deeper - and likely have much to do with barriers to effective obesity care that we know exist.  The ACTION study in USA highlighted some of these important barriers that needed to be addressed.  Data collection for the ACTION study in Canada (for which I am an author and member of the Steering Committee) is now complete; we are currently working hard to put together and publish our results, to better understand barriers that exist, and how we as a country can overcome these barriers to better help Canadians with weight management.   

Follow me on twitter! @drsuepedersen © 2018


Reflections - Hot Topics 2017

>> Monday, January 1, 2018

Happy New Year!! As we ring in the start of 2018, let's first reflect back on some of the most popular DrSue topics from 2017:

1.  Low Carb Diets: What are they? Do they work?  And what if I have diabetes?

2.  How successful is gastric bypass surgery 12 years later? 

3.  Are the tides turning on artificial sweeteners: could they cause weight gain?

4.  The scoop on intermittent fasting.

5.  Canada's Report Card On Access To Obesity Treatment 

Follow me on twitter! @drsuepedersen © 2018



>> Monday, December 25, 2017

Wishing everyone a fulfilling and joyous holiday season!

Follow me on twitter! @drsuepedersen © 2017


Is My Daughter At Risk Of Getting Her First Period Early?

>> Monday, December 18, 2017

Over the last several decades, we have seen the average age of first period (called menarche) decrease by 1-2 years.  The prevalence of girls in USA having early menarche (before age 11) has also increased from 2.6-4.6% to 6.6-12.2% over the last 60 years.  Understanding why periods are starting earlier is important as it can be distressing for these young girls, and is also associated with a higher long term risk of breast cancer, depression, and metabolic risk factors including type 2 diabetes and obesity.

While some of the trend towards earlier periods over the last several decades is due to better health and living conditions, it is also increasingly recognized that environmental factors including weight gain in pregnancy and energy availability during fetal life and early childhood may play an important role. 

A recent review published in Obesity Reviews summarizes the currently available data on this topic.  While it reveals that the literature on this topic is complex, challenging to interpret, and even contradictory at times, the overarching conclusions were that there may be a higher risk of a girl having an early first period when her birth weight is lower, and with higher body weight and weight gain in in infancy and childhood. 

So why would energy availability/energy stores have an influence on age of first period? Here are some possible links:

1. Leptin, which is a signal of energy availability produced by fat tissue, is elevated in obesity, and also in children with low birth weight experiencing catch up growth. Leptin is thought to be necessary for the onset of puberty, so higher leptin may stimulate earlier puberty.

2. Fat tissue converts testosterone to estrogen (and vice versa). Rapid weight gain and childhood obesity is associated with greater production of testosterone derivatives from the adrenal glands, so there may be more of this testosterone available to convert to estrogen in fat tissue, contributing to an earlier first period.

3. Increased insulin levels (as seen in obesity) may advance sexual maturation; in fact, there is some evidence that metformin, a diabetes medication that lowers insulin resistance, may delay onset of periods in low-birth-weight girls with early onset of puberty.

4. Genes have been discovered to be associated with both obesity and age of first period, suggesting there may be some common genetic threads here too.

Also interesting: 

5. Nutritional factors. Breast feeding, and higher intake of plant proteins and fibre may be protective of excessive weight gain and thus protect against earlier periods.  Formula feeding and high intake of cow’s milk and animal protein is associated with an earlier first period (possibly by stimulation of IGF-1 secretion, thus triggering earlier growth).  Higher sugary beverage consumption is also associated with earlier periods, independent of body mass index (BMI).

6. Chemicals in our environment that mess with our hormone systems (called endocrine disruptors) may modify age of first period directly (by modulating hormone responsiveness, epigenetic effects, or stimulating maturation directly), or indirectly by increasing the risk of childhood obesity.

So, it seems that prenatal life, infancy and childhood may present opportunities to improve overall health, and thereby possibly prevent early onset of menstrual periods.  This includes:

  • Ensuring appropriate nutritional status of mom while pregnant
  • Watching for suboptimal fetal growth (and managing appropriately depending on cause)
  • Watching for, and managing, excessive weight gain in childhood
  • Watching for signs of early pubertal development and intervening where appropriate with lifestyle/weight management strategies.  I would be very curious to hear from my pediatric colleagues whether they are using metformin in this scenario – please contribute your comments at the end of this blog post!

Follow me on twitter! @drsuepedersen © 2017



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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