The 2 Minute Medicine Podcast Episode 32

In this episode, we begin by discussing our article of the week which comes from the New England Journal of Medicine and is entitled “Teplizumab and beta-cell function in newly diagnosed type 1 diabetes.” Then we take a closer look at allergies and new treatments on the horizon for food allergies. Next, a discussion about lung cancer, following the recent passing of Andre Braugher. Last but not least, we discuss New Year’s resolutions along with evidence-based ways to make them last and explore the rise in cases of counterfeit Ozempic use, and how this has affected the world.

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Transcript

[Deepti] Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians.

For our full suite of daily medical study summaries and updates written by practicing doctors, please visit our website at 2minutemedicine.com to start reading new daily content right now, for free. On this podcast, twice a month, we cover the latest in health care news and research evidence. We are your hosts Deepti and Andrew. On today’s episode, we’ll start by discussing our two articles of the week. In the second half of the episode, we will look at health issues that have arisen in popular media. 

[Andrew] Our article of the week comes from the New England Journal of Medicine and is entitled “Teplizumab and beta-cell function in newly diagnosed type 1 diabetes.”

Type 1 diabetes is an autoimmune condition characterized by the T-cell-mediated destruction of pancreatic β-cells with a substantial burden of disease management. Glycemic control tends to be particularly difficult in younger patients, rendering rapid disease progression in these populations. Teplizumab, a humanized anti-CD3 monoclonal antibody, was recently approved by the Food and Drug Administration in patients eight years of age or older with preclinical type 1 diabetes to delay the onset of clinical disease. Previous studies have demonstrated that a short course of teplizumab preserves β-cell function without significant long-term safety effects. This phase three, randomized, placebo-controlled trial evaluated the efficacy of teplizumab in the preservation of β-cell function in young patients with newly diagnosed type 1 diabetes. Patients 8 to 17 years of age with stage three disease diagnosed within six weeks were selected. A total of 328 participants were enrolled and randomly assigned to receive teplizumab or placebo in a 2:1 ratio for two 12-day courses, 26 weeks apart. A cumulative dose of 9 mg per square meter was administered to each individual. The primary endpoint was defined as the change from baseline in C-peptide levels at week 78, with levels measured from the area under the concentration-time curve (AUC) during a four-hour mixed-meal tolerance test. Secondary clinical endpoints included mean daily insulin dose, change in glycated hemoglobin, percentage of time in the target glucose range, and clinically relevant hypoglycemic events. Treatment with teplizumab resulted in significantly higher C-peptide AUC levels compared to placebo at week 78 (least-squares mean difference, 0.13 pmol per milliliter; 95% Confidence Interval [CI], 0.09 to 0.17; p<0.001). More specifically, 94.9% of patients treated with teplizumab (95% CI, 89.5 to 97.6) exhibited a clinically meaningful peak C-peptide concentration of 0.2 pmol per millimeter or higher compared to 79.2% of patients receiving placebo (95% CI, 67.7 to 87.4). No significant differences were observed for secondary endpoints, including clinically important hypoglycemic events. In summary, the PROTECT study showed that two short courses of teplizumab were effective in preserving β-cell function but not in improving key clinical outcomes. It demonstrated that teplizumab improved C-peptide levels compared to placebo at week 78, suggesting preservation of β-cell function. Moreover, no significant differences were observed between the teplizumab and placebo groups with respect to secondary clinical outcomes, including mean insulin dose, change in glycated hemoglobin, percentage of time in the target glucose range, and clinically relevant hypoglycemic events. The generalizability of the study results was limited by a lack of racial diversity among its participants.

[Andrew] Now for The Scan.

The Story: Xolair, also known by its generic name omalizumab, is an injectable medication used to treat asthma, hives and other conditions. Recently, Xolair has been explored as a method to treat food allergies, specifically allergies to peanuts, eggs, milk, and other common foods. Briefly, lets take a closer look at allergies.

[Deepti]: Allergies, though often unwelcome and irritating, arise from an ancient system designed to protect us. When the immune system, reacts to foreign substances that do not cause harm in most people, allergies follow. Given the danger posed by many allergies, developing tools to fight them is of utmost importance. Current treatments for food allergies include antihistamines, as well as epinephrine autoinjectors used to deliver a dose of epinephrine in cases of severe allergies. Xolair, if approved, would be the first medication to reduce allergic reactions to multiple foods after unintentional consumption or exposure to these foods.

You may be wondering, how does Xolair fit into all of this? 

Food allergies are particularly dangerous, as they can be life-threatening. As a result, the best treatment is to avoid foods that one is allergic to, though accidental ingestion of allergen-containing foods is always possible. Xolair is an anti-IgEantibody, meaning that it interrupts the action of unnecessary antibodies produced in response to the allergen, thereby reducing the severity of allergy symptoms. In a clinical trial, patients receiving Xolair were able to consume higher doses of allergen-containing foods than patients not receiving Xolair. This news carries hope for families and individuals with food allergies, that a treatment is on the horizon. Next, a closer look at lung cancer.

[Andrew] Andre Braugher, who played the lovable Captain Holt in the TV series Brooklyn Nine-Nine, passed away last month after a battle with lung cancer. Lung cancer is one of the most common forms of cancer in the United States, with over 200,000 new cases in 2023. It is estimated that nearly 2.2 million cases worldwide were diagnosed in 2020. In these cases, the cells of the lung begin to grow abnormally, and can eventually spread to other areas of the body where they do not normally grow, and disrupt the normal functioning of those areas. Lung cancers can be diagnosed through common imaging techniques, and if a cancer is suspected based on imaging, a biopsy may be done to better understand the cancerous cells and develop a treatment plan. Lung cancers are treated using a variety of methods, including surgery, radiation, and chemotherapy. Surgery aims to remove the cancer tissue physically, while radiation therapy uses  high energy beams to kill cancer cells. Chemotherapyuses medications to kill cancer cells and can be used in conjunction with the other treatments. Though commonly thought of as a disease caused by smoking, lung cancer can affect anyone. Kate Micucci, known for her role as Lucy in the TV series The Big Bang Theory, was recently diagnosed with lung cancer despite never smoking. In addition to smoking increasing risk of developing and dying from lung cancer, socioeconomic factors play a role in these risks. Individuals with lower income or in rural areas have an increased risk of developing lung cancer, highlighting the key role that social determinants of health play when facing lung cancer. Next, a conversation about setting new goals in the new year.

[Deepti] As we usher in 2024, many goals and resolutions for the new year have been set, and according to research, these resolutions are notoriously difficult to maintain. One study saw that individuals framing their goals as approaching something had higher rates of success than those framing goals as avoiding something. 

Though change is difficult, it can be modelled in a way known as the transtheoretical model of change.  Of the 5 stages, the precontemplation stage is before an individual identifies that they want to make a change, and comes before the contemplation stage, where the individual realizes that there is a behaviour to change. Next, the preparation stage is where the person recognizes that a change must be made and begins preparing to make such a change, the stage where many new year resolutions come from. Finally it is during the action and maintenance stages where change is made and maintained. Support during these stages is highly valuable for the maintenance of new behaviours, and is part of the recipe for successful goal setting!  It is normal to feel that achieving goals is difficult, and one potential reason is that we simply forget these goals. Getting caught up in everyday life can lead people to forget their goals, and one tool to fix this is known as cognitive offloading. This refers to reducing the amount of mental energy expended in a task, by using physical reminders, such as writing information down or using a calendar for reminders. This practice is associated with enhanced performance in short term memory tasks in laboratory settings, and may be helpful when setting goals as a means to remind a person of those goals. Another difficult aspect relating to achieving goals, is the time it takes! A study from 2009 showed that there is considerable variation in the amount of time it takes an individual to form a habit, ranging from 18 to over 250 days. Knowing this, it may be beneficial to set smaller, micro-goals on the way to the bigger goals. Last but not least, let’s discuss the increasing prevalence of counterfeit ozempic.

[Andrew] As shortages of weight loss wonder drug Ozempic continue, counterfeit production of Ozempic is becoming increasingly prevalent. Ozempic is typically sold as an injectable form of semaglutide, but counterfeit Ozempic injections do not carry the same manufacturing standards and as such, the FDA is warning against the use of counterfeit Ozempic. Though recently touted for its weight loss benefit, Ozempic is traditionally used in patients with diabetes, to reduce their blood sugar. By activating the glucagon-like peptide 1 (GLP-1) receptor, Ozempic is able to help the body’s natural processes to improve blood sugar levels, as well as improve heart health, in patients with diabetes. Ozempic can be used alongside other diabetes medications, such as metformin, to further improve blood sugar control in patients. Due to its potential ability to induce weight loss, the rising popularity of the drug may have contributed to shortages seen around the world. This shortage has led to frustrations from patients and physicians alike, and has opened the door for fake versions to enter the market. In Chicago, one man used what he thought was an Ozempic pen, but was actually a counterfeit pen filled with insulin. This posed a threat to his life, as shortly after he entered a coma due to excessively low blood sugar. Fortunately he received timely care and was able to recover, but this situation highlights some clear dangers. Despite this shortage, turning to alternate forms of Ozempic is not the answer. The highly realistic fake versions of Ozempic have the potential to endanger lives. The quality and safety of ingredients used to manufacture the fake products are not known, and therefore pose risks, including infection risks due to poor sterility, amongst other risks. To help improve this supply shortage, manufacturers Eli Lilly and Novo Nordisk, companies that produce Mounjaro and Ozempic respectively, are spending billions of dollars to match the demand for these critical drugs. Recent results from trials indicate that tirzepatide, the active ingredient in Mounjaro may be effective in weight loss, potentially adding another medication to the weight loss arsenal. Until the availability for these medications is consistent, remaining vigilant and avoiding unlicensed medication is important to ensure safety.

We’d like to acknowledge the following members of our team for their contributions to this week’s episode

• Neerav Mullur
• Junghoon Ko
• Keira Liblik

Thank you for joining us today for this episode of the 2 Minute Medicine Podcast. New episodes come out every other week and all of our content has been curated and written by practicing physicians.

Please head to our website at 2minutemedicine.com to learn more and to access all of our content including medical study summaries, visual abstracts, excerpts from our Classics book series which is available on Amazon, and The Scan, which is our medical newsletter.

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©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Thank you for joining us today for this episode of the 2 Minute Medicine Podcast. New episodes come out every other week and all of our content has been curated and written by practicing physicians.