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Semaglutide & PAD: 54% Risk Reduction in Diabetics

by DrMichaelLee
written by DrMichaelLee

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Semaglutide (Ozempic) Shows Promise in Improving Walking Distance for Type 2 Diabetes Patients with PAD

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Chicago, IL – New findings from a subanalysis of the STRIDE trial, presented at the American Diabetes Association (ADA) 2025 conference, indicate that semaglutide 1.0 mg (Ozempic) provides significant benefits for individuals with type 2 diabetes and peripheral artery disease (PAD). The research demonstrates significant improvements in walking distance, regardless of HbA1c levels or other diabetes treatments [1].

Semaglutide’s Impact on Peripheral Artery Disease

The STRIDE trial, a double-blind, randomized, placebo-controlled study, investigated the effects of semaglutide on walking distance in patients with type 2 diabetes and PAD. The study, which began in 2020, involved 792 patients across 20 countries who were randomly assigned to receive either semaglutide or a placebo for 52 weeks [2].

Did You Know? Peripheral artery disease affects over 200 million people worldwide, and those with diabetes are at a higher risk.

The primary endpoint of the trial focused on the ratio from baseline in maximum walking distance at 52 weeks. Results showed a significant advantage for semaglutide, with an estimated treatment ratio (ETR) of 1.13 (95% CI, 1.06-1.21; *P* = .0004). Secondary outcomes further supported these findings, including greater betterment in walking distance, significantly higher quality-of-life scores, and improved pain-free walking distance [3].

Key Findings Presented at ADA 2025

professor Subodh Verma, MD, PhD, a cardiovascular surgeon at the University of Toronto and senior author of the STRIDE trial, presented a subanalysis at ADA 2025, highlighting that semaglutide was associated with significantly improved walking outcomes, enhanced quality of life, and a 54% reduction in the risk of disease progression.The median ratio to baseline in maximum walking distance was 1.21 in the semaglutide group compared to 1.08 in the placebo group at week 52 [4].

Pro Tip: Regular monitoring of foot health is crucial for individuals with diabetes and PAD to prevent complications.

Efficacy data indicated that the positive effects of semaglutide were independent of baseline glycemic control, duration of diabetes, or intensity of diabetes treatment.The effects were also consistent across different BMI categories and irrespective of background SGLT2 inhibitor use.

Safety and Tolerability

Additional safety data from the STRIDE trial demonstrated that semaglutide was well-tolerated, with no treatment-related deaths and a safety profile consistent with prior data.This reinforces semaglutide as a safe and effective treatment option for this patient population

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Health

Psoriasis Linked to Increased Metabolic Syndrome Risk, Mediated by Disease Activity

by DrMichaelLee
written by DrMichaelLee

Psoriasis Patients Face Elevated Metabolic Syndrome Risk

Individuals with psoriasis are at a heightened risk of developing metabolic syndrome, according to recent research. This finding underscores the need for vigilant monitoring and proactive health management within this patient population.

Psoriasis as a MetS Risk Factor

A new study reveals that psoriasis significantly increases the likelihood of metabolic syndrome (MetS). The study further suggests that the severity of the psoriasis directly impacts the risk of MetS. The greater the inflammatory burden, the higher the metabolic disorder risk, as noted by the research.

“Early recognition of MetS in psoriasis patients is critical for mitigating long-term health risks and improving clinical outcomes,”

—Xiaoyan Zhang, China-Japan Friendship Hospital

According to the Centers for Disease Control and Prevention, roughly 37% of U.S. adults have metabolic syndrome, highlighting the broad public health relevance of this research (CDC, 2024).

Study Methodology

Researchers conducted a thorough analysis of studies on psoriasis and MetS. The investigation considered articles from databases like CNKI, PubMed, and Web of Science. The search encompassed publications up to February 2025, aiming to find all relevant studies.

The inclusion criteria for the analysis consisted of observational designs, such as cross-sectional and prospective studies. Studies needed to feature a psoriasis case group and a control group. Furthermore, the diagnosis had to be clinically or pathologically confirmed.

Key Findings

The meta-analysis included 14 articles involving 9,641 patients with psoriasis. The collective prevalence of clinically significant metabolic dysregulation among the psoriasis cases reached 26.49%. When compared to control groups, psoriasis patients showed higher odds ratios for MetS.

In patients with severe psoriasis, a higher risk of developing MetS was identified. The study revealed a positive linear trend between PASI scores and MetS incidence. This indicated a link between disease severity and the chances of developing MetS.

Call to Action

The investigators concluded that clinicians should pay closer attention to the metabolic health of psoriasis patients. Regular monitoring, alongside early intervention measures, is vital to prevent the onset of MetS. They emphasized the importance of interdisciplinary collaborations to improve patient care.

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Health

Biologic Decision-Making in Asthma and COPD: Prioritizing Earlier, Precise Intervention

by DrMichaelLee
written by DrMichaelLee

New Respiratory Treatments Reshape Asthma and COPD Care

Advances in respiratory medicine are transforming asthma and chronic obstructive pulmonary disease (COPD) management, moving away from generalized treatments to personalized approaches. These changes are expanding treatment options and redefining long-term disease control for individuals once considered hard to treat.

Biologics Revolutionize Asthma Management

Biologic therapies have been central to this shift in asthma care. New drugs like dupilumab (Dupixent), benralizumab (Fasenra), and tezepelumab (Tezspire) have set new standards for effective intervention. The approval of tezepelumab in 2021, the first biologic for severe asthma not limited by eosinophil count, broadened treatment options. This progress is also strengthening collaboration between allergists and pulmonologists.

Joseph Khaabbaza, MD

COPD management is starting to see similar innovation, with the 2024 FDA approval of dupilumab for eosinophilic COPD marking a significant step. As the lines between asthma and COPD continue to blur, clinicians need to reevaluate traditional treatment pathways.

Expert Insights on Emerging Therapies

A recent clinical forum brought together pulmonologists and allergists to discuss the updates in respiratory care, led by pulmonologist Joseph Khabbaza, MD, of Cleveland Clinic. Panelists discussed the central role of biologics in modern asthma management, particularly for those with type 2 inflammation. The use of biomarkers like eosinophils and FeNO has also grown substantially.

“I’ve been more aggressive with, if my patient needs steroids more than twice in 6 months or so, I’m pulling the trigger faster and faster, even without long-acting muscarinic antagonist (LAMA), just because I first-hand know the major long-term side effects of steroids 10 years, 15 years down the road,”

—Forum Participant

Another shift is that pulmonologists are managing biologics more often, and initiating them earlier to reduce steroid use and prevent long-term problems, despite payer criteria. The global prevalence of COPD is estimated to be around 10% of adults aged 40 years and over, highlighting the scale of the issue (World Health Organization, 2024).

Future Directions in Respiratory Care

COPD management is beginning to adopt similar principles, recognizing that some patients with type 2 inflammation may benefit from biologics. Panelists emphasized the need for longer-acting biologics, better phenotyping, and broader eligibility definitions, especially for COPD patients.

“Asthma and COPD have evolved over the last few years and with a lot of thinking about eosinophils and type 2 inflammation, and we now have more pathways and more treatments than ever before to try to help these patients. And we want to minimize prednisone, and minimize exacerbation. I think those are- If we can do those two things in asthma and COPD patients, that’ll be good for everyone in the system,” Khabbaza concluded.

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Health

Microbiome Testing: Integrating Gut Health into Clinical Practice

by DrMichaelLee
written by DrMichaelLee

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Microbiome‘s Expanding Role in Diagnostics and Therapeutics: A 2025 Update

Table of Contents

The human microbiome, the collection of microorganisms living in and on our bodies, is poised to revolutionize clinical practices within the next decade. Researchers are rapidly uncovering the diagnostic and therapeutic potential of these microbial communities, offering new avenues for disease detection, treatment, and prevention [[1]].

Diagnostic Applications of the microbiome

one of the most promising areas is the use of the microbiome as a biomarker for early disease detection.Specifically, research indicates that analyzing the gut microbiota can aid in early colon cancer screening. According to a 2024 study in the journal *gastroenterology*, specific microbial signatures can identify individuals who woudl benefit most from a colonoscopy, improving early detection rates by up to 15%.

The microbiome also shows promise in predicting a patient’s response to immunotherapy, particularly in oncology. Studies have demonstrated that the composition of the gut microbiota can influence the effectiveness of immunotherapy treatments for lung cancer and melanoma. Patients with a more diverse and balanced gut microbiome tend to respond better to these therapies.

did You Know? The vaginal microbiome, dominated by *Lactobacillus* species, is crucial for women’s health, and imbalances can lead to infections [[3]].

Therapeutic Applications of the Microbiome

On the therapeutic front, fecal microbiota transplantation (FMT) is becoming increasingly refined. FMT involves transferring fecal material from a healthy donor to a recipient to restore a balanced gut microbiome. While already established for treating *Clostridium difficile* infections, researchers are exploring its use in other conditions, such as inflammatory bowel disease and metabolic disorders.

Another exciting area is the use of bacteriophages, viruses that specifically target and destroy pathogenic bacteria. These “lytic” phages offer a targeted approach to eliminating harmful bacteria without disrupting the entire microbial community. Additionally, scientists are engineering probiotics to produce or deliver beneficial compounds directly to the gut, enhancing their therapeutic effects.

Overcoming Challenges in Microbiome Research

Despite the immense potential, several challenges hinder the widespread clinical application of microbiome research. These include:

  • Biological Complexity: Establishing direct causal links between specific microbial compositions and diseases is challenging due to the vast diversity and complexity of the microbiome.
  • Methodological Issues: Clinical studies must account for various factors, such as diet, medications, and environmental influences. Standardized protocols for microbiome analysis are also lacking.
  • Logistical Hurdles: Large-scale, multicenter studies are needed to validate findings, but funding and collaboration remain limited.
  • Cultural Barriers: Many clinicians lack sufficient familiarity with microbiome science, hindering the translation of research into practice.

Pro Tip: Interdisciplinary collaboration between researchers and clinicians is crucial for accelerating the clinical application of microbiome research.

Strategies for Accelerating Clinical Translation

To overcome these challenges, researchers and clinicians are focusing on several key strategies:

  • standardizing research and reporting of microbiota tests across different laboratories.
  • Improving the design of clinical trials to account for confounding factors.
  • Refining the rationale for trials by deepening our understanding of the mechanisms underlying microbiome-disease interactions.
  • Fostering collaboration and interaction between researchers and clinicians.
  • Providing training and education to increase clinicians’ familiarity with microbiome science.

According to Dr. Serena Porcari, a gastroenterologist at the Fondazione Policlinico Gemelli IRCCS, addressing these challenges is crucial for unlocking the full potential of the microbiome in clinical practice.

Application Timeline Potential Impact
colon Cancer Screening Within 5 years Improved early detection and reduced mortality
Immunotherapy Response Prediction Within 5 years Personalized treatment strategies and improved outcomes
Fecal Microbiota Transplantation Ongoing refinement Expanded use for various conditions beyond *C. difficile*
Bacteriophage Therapy 5-10 years Targeted elimination of pathogenic bacteria

the first clinical applications are expected to be colon cancer screening tests that guide colonoscopy recommendations based on a combination of fecal occult blood tests and microbiota analysis. Tests to predict response to immunotherapy in cancer patients,particularly those with lung cancer and melanoma,are also on the horizon.

on the therapeutic side,in addition to FMT for *Clostridium difficile* colitis,future applications include eradicating multi-drug resistant bacteria,such as *Klebsiella*,in intestinal infections and enhancing the effectiveness of immunotherapy in oncology.

What other diseases do you think the microbiome could help treat? How can we encourage more collaboration between researchers and clinicians?

The Microbiome: A Ancient Perspective

The understanding of the microbiome has evolved substantially over the past few decades. Initially, research relied heavily on cultivation techniques, which limited the scope of investigation.However, advances in DNA sequencing technologies have revolutionized the field, allowing scientists to identify and characterize a vast array of microorganisms that were previously undetectable [[2]].

This has led to a paradigm shift in our understanding of human health and disease, recognizing the microbiome as a critical player in various physiological processes, including digestion, immunity, and even mental health.

Frequently Asked Questions About the Microbiome

what is the microbiome?

The microbiome is the collection of all microorganisms, including bacteria, fungi, viruses, and other microbes, that live in and on the human body.

Were is the microbiome located?

The microbiome is found throughout the body, but the gut, skin, and mouth are the most densely populated areas.

Why is the microbiome important?

The microbiome plays a crucial role in various aspects of human health, including digestion, immunity, and mental health.

How can I improve my microbiome?

Diet, lifestyle, and certain medications can influence the composition of the microbiome. Eating a diverse diet rich in fiber, exercising regularly, and avoiding unneeded antibiotics

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Health

Masked Taper & CBT-I: Reducing Reliance on Sleep Meds | Expert Advice

by DrMichaelLee
written by DrMichaelLee

Masked Tapering Boosts Benzodiazepine Discontinuation for Insomnia Patients: SLEEP 2025

SEATTLE, WA – A novel approach to benzodiazepine deprescribing, combining masked tapering with augmented cognitive behavioral therapy for insomnia (CBT-I), shows promising results in helping older adults discontinue long-term use of these medications. The findings, presented at SLEEP 2025, highlight the potential of this method to improve sleep quality and reduce reliance on benzodiazepines (BZRA) among individuals with insomnia.

The Masked Tapering Approach

researchers,led by Dr. Constance Fung from the David Geffen School of Medicine at UCLA,developed a Masked Taper plus cognitive behavioral therapy-augmented program (MTcap) to minimize placebo effects and boost discontinuation. The study involved 188 adults aged 55 and older (average age 69.2 years, 34.6% female) who had been using alprazolam, lorazepam, temazepam, or zolpidem for at least two nights per week for a minimum of three months. Participants used a BZRA an average of 5.9 days a week.

Did You Know? Benzodiazepines are associated with a 36% increased risk of dementia in older adults, according to a 2012 study in JAMA Internal medicine.

Study Results: MTcap vs. Standard Tapering

The multi-site trial compared eight weeks of MTcap with standard, gradual tapering. Six months after treatment, the MTcap group showed a significantly higher BZRA discontinuation rate (73.4%) compared to the standard tapering group (58.6%). Both groups experienced improvements in insomnia severity, as measured by the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index.

Specifically, baseline epworth Sleepiness Scale scores increased from 6.32 and 6.21 at baseline for MTcap and standard taper,respectively,to 3.98 and 3.92 at 1 week and 4.54 and 3.91at 6 months. Pittsburgh Sleep Quality index scores also showed improvements from baseline to week 1 and month 6 in both arms.

Comparison of MTcap and Standard tapering Results
Outcome MTcap Standard Tapering
BZRA discontinuation (6 months) 73.4% 58.6%
Average Age of Participants 69.2 years 69.2 years

Challenging Thoughts About Medication

A key element of the masked tapering program involved a diary where participants recorded their perceived nightly dosage compared to their baseline dose. This approach encouraged patients to question the actual effectiveness of their medication.

Pro Tip: Gradual tapering, combined with behavioral therapies, is recommended by the American Academy of Family Physicians for safe benzodiazepine discontinuation.

Dr. Fung emphasized the importance of patients asking themselves, “Is this pill really doing something for me?” The goal is for patients to recognize that they may not be sleeping well and may not necessarily need a sleeping pill after completing the MTcap program.

Future Research Directions

Further analyses are planned to gain a better understanding of the factors contributing to the sustained discontinuation rates observed in the study. researchers aim to identify the specific mechanisms through which masked tapering and augmented CBT-I promote long-term success.

What strategies have you found most effective in managing insomnia without medication? How can healthcare providers better support patients in safely discontinuing benzodiazepines?

Benzodiazepines and Insomnia: An Evergreen Perspective

Benzodiazepines are a class of psychoactive drugs primarily used to treat anxiety, insomnia, and seizures. While effective for short-term relief, long-term use can lead to dependence, tolerance, and a range of adverse effects, particularly in older adults.Insomnia, characterized by difficulty falling or staying asleep, affects millions worldwide and can significantly impact quality of life. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a non-pharmacological treatment that addresses the underlying causes of insomnia through behavioral and cognitive techniques. Studies have shown that CBT-I is as effective as medication in the short term and more effective in the long term, without the risks associated with drug dependence and side effects. The increasing awareness of the risks associated with long-term benzodiazepine use has led to a growing emphasis on deprescribing strategies and alternative treatments like CBT-I.

Frequently Asked Questions About Benzodiazepine Discontinuation

What are the risks of long-term benzodiazepine use?
Long-term use can lead to dependence, tolerance, cognitive impairment, increased risk of falls, and paradoxical effects like increased anxiety or insomnia.
What is Cognitive Behavioral Therapy for Insomnia (CBT-I)?
CBT-I is a structured program that helps individuals identify and change thoughts and behaviors that contribute to insomnia. it includes techniques like sleep restriction, stimulus control, and relaxation training.
How does masked tapering work?
Masked tapering involves gradually reducing the dosage of a medication without the patient’s knowledge of the specific tapering schedule,minimizing potential placebo effects and psychological dependence.
Is it safe to stop benzodiazepines abruptly?
Abruptly stopping benzodiazepines can lead to withdrawal symptoms, including anxiety, insomnia, seizures, and rebound symptoms. Gradual tapering under medical supervision is recommended.
where can I find more facts about CBT-I?
You can find more information about CBT-I from healthcare providers,sleep specialists,and organizations like the National Sleep Foundation.

Disclaimer: This article provides general information and should not be considered medical advice. Consult with a healthcare professional for personalized guidance on benzodiazepine discontinuation and insomnia treatment.

share this article to spread awareness about safe benzodiazepine deprescribing strategies. What are your thoughts on the masked tapering approach? Leave a comment below!

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Protein Biomarkers May Predict IBD Years Before Diagnosis

by Ethan Caldwell
written by Ethan Caldwell

Protein Signatures Predict crohn’s and Colitis Years Before Diagnosis

Table of Contents



Groundbreaking research has identified specific protein signatures in blood samples that can predict the onset of Crohn’s disease and ulcerative colitis up to several years before clinical diagnosis. The findings, published in Gastroenterology, offer a potential pathway for earlier intervention and improved management of these chronic inflammatory bowel diseases (IBD) affecting millions worldwide.

Inflammatory bowel disease arises from a combination of genetic predispositions and environmental factors that trigger an imbalanced immune response in the gastrointestinal tract. Diagnosis typically involves a combination of blood tests, stool analysis, endoscopic examinations, and imaging studies, according to the Mayo Clinic. However,a period of subclinical inflammation often precedes diagnosis,marked by subtle changes in the body’s immune system.

Did You Know? …

Existing IBD treatments, including 5-aminosalicylic acids, corticosteroids, immunomodulators, antibiotics, and biologics like adalimumab and infliximab, often provide incomplete relief and do not reverse the disease’s progressive nature, according to the Crohn’s & Colitis Foundation. This highlights the urgent need for strategies that can identify and address IBD in its earliest stages.

Predictive Protein Signatures Unveiled

Researchers analyzed preclinical blood samples from large, population-based cohorts to pinpoint protein signatures that could predict the future development of crohn’s disease and ulcerative colitis. The study involved a discovery cohort to identify potential markers and an autonomous cohort to validate their predictive performance.

The median time from blood sampling to IBD diagnosis was 8.7 years for Crohn’s disease and 7.2 years for ulcerative colitis. Analysis of the discovery cohort revealed 34 proteins associated with preclinical Crohn’s disease. A signature of 29 proteins effectively distinguished preclinical Crohn’s cases from controls, achieving an area under the curve (AUC) of 0.85 (95% CI,0.78-0.93).

similarly,the analysis of preclinical ulcerative colitis identified 45 proteins that were differentially regulated in the discovery cohort. This model also demonstrated high predictive capacity (AUC, 0.87; 95% CI, 0.77-0.97) when applied to the preclinical validation cohort.

Model Performance and Stratified Analyses

The predictive accuracy of the logistic regression model improved as the time of diagnosis approached. Notably, when the analysis was restricted to samples collected more than 16 years before diagnosis, the model still exhibited a high predictive capacity (AUC, 0.82). The model for preclinical Crohn’s disease performed better for men (AUC, 0.99; 95% CI, 0.98-1.00) compared to women (AUC, 0.76; 95% CI, 0.57-0.94). No significant differences were observed when analyses were stratified by age at inclusion.

For ulcerative colitis, the logistic regression signature showed a numerically higher capacity within the preclinical discovery cohort (AUC, 0.77; 95% CI,0.71-0.83) compared to the preclinical validation cohort (AUC, 0.67; 95% CI, 0.59-0.76). Stratified analyses indicated that the preclinical ulcerative colitis signature performed better for older (AUC, 0.79; 95% CI, 0.69-0.90) than younger participants (AUC, 0.55; 95% CI,0.42-0.68) in the preclinical validation cohort.

The logistic regression model demonstrated a high discriminatory capacity for newly diagnosed ulcerative colitis cases in the inception cohort (AUC, 0.95; 95% CI, 0.92-0.99). Though, the model had a lower capacity to differentiate between Crohn’s disease and ulcerative colitis in newly diagnosed patients (AUC, 0.67; 95% CI,0.59-0.74).

Genetic and Environmental Influences

Analysis of preclinical Crohn’s disease and external twin controls revealed an AUC of 0.89. However, when accounting for genetic and shared environmental factors, including matching twins with preclinical Crohn’s disease to their healthy twin siblings (P = .04), the predictive ability reduced to an AUC of 0.58. This suggests that genetic and shared environmental factors may have a predominant influence on the predictive protein signature for Crohn’s disease.

In contrast,only a minor difference in predictive performance was observed when contrasting preclinical ulcerative colitis against unrelated twin controls (AUC,0.74) and against their healthy twin siblings (AUC, 0.58). This indicates that genetic and shared environmental factors have a limited impact on the protein signature of ulcerative colitis.

pro Tip: Understanding the influence of genetics and environmental factors can help tailor preventative strategies for individuals at risk of developing IBD.

Study Limitations and Future Directions

Limitations of the study include its reliance on a case-control design, which necessitates consideration of choice study designs. Differences in immune pathway involvement and cellular responses between Crohn’s disease and ulcerative colitis could cause varying expression levels of specific markers.The preselection of proteins could also lead to a more robust signature for Crohn’s disease. The relatively high median age at diagnosis in the preclinical cohorts also limits the study’s applicability to younger populations.

Disease Median Time to Diagnosis AUC (Discovery Cohort) AUC (Validation Cohort)
Crohn’s Disease 8.7 years 0.85 N/A
Ulcerative Colitis 7.2 years 0.87 0.67

Implications for Early Intervention

“Collectively, these findings support the possibility of prognosticating IBD. The long preclinical period in Crohn’s disease endorses the adoption of early preventive strategies (eg, dietary modifications and medication) to potentially attenuate disease progression and improve the natural history of Crohn’s disease,” the study authors concluded.

What are the ethical considerations of predicting diseases like Crohn’s and colitis years in advance? How might this knowledge change patient care and lifestyle choices?

Understanding Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) is a group of inflammatory conditions affecting the colon and small intestine.The two main types of IBD are Crohn’s disease and ulcerative colitis. Crohn’s disease can affect any part of the gastrointestinal tract, while ulcerative colitis is limited to the colon. Symptoms of IBD include abdominal pain, diarrhea, rectal bleeding, weight loss, and fatigue. The exact cause of IBD is unknown, but it is indeed believed to involve a combination of genetic, environmental, and immune factors. IBD is a chronic condition that can significantly impact a person’s quality of life, often requiring long-term medical management and lifestyle adjustments according to the National institute of Diabetes and Digestive and Kidney Diseases.

Frequently Asked questions About IBD Prediction

Can these protein signatures wholly eliminate the need for conventional diagnostic methods?

No, these protein signatures are intended to complement, not replace, traditional diagnostic methods.They can help identify individuals at high risk who may benefit from closer monitoring and earlier intervention.

How soon can these protein signatures be available for clinical use?

Further research and validation are needed before these protein signatures can be widely used in clinical practice. This includes larger-scale studies and the development of standardized testing methods.

Will early prediction of IBD lead to unnecessary anxiety and medical interventions?

It is indeed critically important to carefully consider the psychological impact of early prediction and ensure that individuals receive appropriate counseling and support. Medical interventions should be based on a thorough assessment of risk and potential benefits.

Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It is indeed essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

How could early prediction of Crohn’s and colitis influence public health strategies and research priorities in gastroenterology?

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