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Could Your Cholesterol Medication Cause Diabetes?

>> Monday, January 29, 2018

With any medication, there are benefits and risks that need to be considered.  Medications are generally recommended to a patient when the potential benefit of the medication is felt to be greater than the potential risks.

While it is extremely important for both doctors and patients to be well informed of potential side effects of medications, the media unfortunately loves to hype up side effects, often making it seem like the risks of taking a medication must outweigh any potential benefits.

Statins, a group of cholesterol medications, have taken a particular beating in the media over the years.   A colleague of mine approached me not too long ago saying that he was worried about his patients being afraid of taking their statin cholesterol medications because of fear of developing diabetes as a side effect, and asked me if I would publish a post on this topic.

An excellent review was published in The Lancet, which does a great job of addressing the question of benefit vs risk of statin therapy.

If 10,000 people are treated with statin therapy for 5 years: (with the example given of 40mg of atorvastatin (Lipitor) daily)

  • if these 10,000 people had a past history of 'blocked arteries' (occlusive vascular disease) - eg prior heart attack or stroke: 1,000 would be saved from another heart attack or stroke
  • if these 10,000 people had no history of vascular disease: 500 would be saved from a heart attack or stroke

  • 50-100 will develop diabetes because of their statin
  • 5-10 will have a bleeding type (hemorrhagic) stroke
  • 5 will develop serious muscle complications

The risk of developing diabetes due to statin medications is higher with the more powerful statins (atorvastatin (Lipitor) and rosuvastatin (Crestor)), and with higher doses.  However, it is precisely these particular statins at the higher doses that have the biggest benefit to prevent heart attacks and strokes in people who have a past history of vascular disease.

People with risk factors for developing diabetes (eg, prediabetes, obesity) are at higher risk of statins tipping them up into diabetes range blood sugars. However, even if a person develops diabetes due to their statin, the health benefit in preventing heart attacks and strokes is much greater than the adverse effect of diabetes on their health, provided the diabetes is well managed.

For people who already have diabetes, statins also have a powerful benefit in preventing heart attacks and strokes, which is felt to far outweigh any small increase in blood sugars that may occur (and can be managed with adjustment to diabetes medication).

As to how statins increase the risk of developing diabetes, another study in The Lancet suggests that it may be related to the mechanism of statins to inhibit an enzyme called HMG CoA reductase, and may be genetically mediated.

Follow me on twitter! @drsuepedersen © 2018


Is Your Doctor NOT Talking Nutrition?

>> Monday, January 22, 2018

Everyone out there: I would like you to raise your hand if your doctor has NOT recently talked to you about good nutrition.  If you have your hand up, you are not alone - only about 12% of office visits include counselling about diet, despite there almost always being a good reason to talk about nutrition (eg diabetes, obesity, high blood pressure, and so forth).

Doctors out there - do you feel like you don't do a great job in counselling your patients on good nutrition?   If so, you are definitely not alone.

A recent Viewpoint paper published in the Journal of the American Medical Association uncovers some important issues that limit good nutritional counselling in the doctor's office.

Issues cited that limit doctors in providing nutritional counselling:
  • Doctors receive very little nutritional training in medical school. 
  • Limitations of time in an appointment. 
  • Limitations in reimbursement (pay) for doctors to provide nutrition counselling.
  • Frustration in trying to counsel on healthy food choices when our environment is so full of unhealthy choices.
Here are some easy steps that clinicians can take to improve nutritional counselling: 

1. Start the conversation - check out this easy to use tool, which contains eight quick and easy questions you can ask, with suggestions for reasonable changes that you could recommend. 

2.  Use the 5As of Obesity to help start a conversation when you note that your patient carries excess weight. 

3.  Focus on small steps - use the tool for suggestions. 

4.  Don't do it alone (if possible) - nutrition counselling and weight management require multidisciplinary support!  Engage any support you have to help provide your patient the help they need from various avenues: dietitian, nutritionist, psychologist, health/weight management classes - anything you can find to provide your patient with lots of health care provider time to guide them through their journey. 

Follow me on twitter! @drsuepedersen © 2018


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



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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