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It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Gillaspy and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Dr Becky Fitness LLC and Dr. Rebecca Gillaspy, D.C. are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this video or site.Intermittent Fasting Diet Plan Secret Of Bharti Singh Weight Loss Journey Eat More Lose MoreIn today’s video, I take a trip down memory lane and react to MORE of my old fat acceptance content. 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CardioNerds Dr. Ty Sweeney (CardioNerds Academy Faculty Member and incoming Cardiology Fellow at Boston Medical Center), Dr. Rick Ferraro (CardioNerds Academy House Faculty and Cardiology Fellow at Johns Hopkins Hospital), and special guest Dr. Franck Azobou (Cardiology Fellow at UT Southwestern) sat down with Dr. Darren McGuire (Cardiologist at UT Southwestern and Senior Editor of Diabetes and Vascular Disease Research) to discuss important trial data on GLP-1 RAs in patients with heart disease, as well as recent professional society guidelines on their use. Show notes were drafted by Dr. Ty Sweeney. Audio editing was performed by CardioNerds Intern student Dr. Diane Masket. If you haven’t already, be sure to check out CardioNerds episode #350 where we discuss the basics and mechanism of action of GLP-1 RAs with Dr. Dennis Bruemmer. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit. Claim CME for this episode HERE. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - GLP-1 Agonists: Diving into the Data Patients with diabetes and clinical atherosclerotic cardiovascular disease (ASCVD) or who are at high risk of ASCVD benefit from treatment with a GLP-1 RA. For persons with sufficient ASCVD risk and type 2 diabetes, GLP-1 RAs and SGLT2 inhibitors can, and often should, be used in combination. "Just like we don’t consider ‘and/or’ for the four pillars of guideline-directed medical therapy for heart failure with reduced ejection fraction, we shouldn’t parcel out these two therapeutic options...it should be both.” Setting expectations with your patients regarding injection practices, side effects, and expected benefits can go a long way toward improving the patient experience with GLP-1 RAs. Utilize a multidisciplinary approach when caring for patients on GLP-1 RAs. Build a team with your patient’s primary care provider, endocrinologist, clinical pharmacist, and nurse. “This is really a cardiologist issue. These are no longer endocrinology or primary care drugs. We need to be prescribing them ourselves just like we did back in the nineties when we took over the statin prescriptions from the endocrinology domain...we need to lead the way.” Show notes - GLP-1 Agonists: Diving into the Data For which patients are GLP-1 RAs recommended to reduce the risk of major cardiac events? For patients with type 2 diabetes and ASCVD, starting a GLP-1 RA carries a Class 1, Level of Evidence A recommendation in the most recent ESC and ACC guidelines. For patients without diabetes or clinical ASCVD with an estimated 10-year risk of CVD exceeding 10%, consideration of starting a GLP-1 RA carries a Class 2b, Level of Evidence C recommendation to reduce CV risk. The STEP-HFpEF trial showed that among patients with obesity and HFpEF, once-weekly semaglutide may be beneficial in terms of weight loss and quality of life. The results of the FIGHT and LIVE trials question the utility and safety of liraglutide in treating patients with advanced HFrEF. Of the over 17,000 patients enrolled in the SELECT trial, about 25% had heart failure, of which about one-third had HFrEF. Stay tuned for sub-analyses from that trial for more info! 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By activating the GLP-1 receptors, semaglutide helps to increase insulin production, decrease glucagon secretion, and slow down gastric emptying, leading to improved glycemic control and reduced appetite. Initially, semaglutide was only available as a once-weekly injection for the treatment of type 2 diabetes. However, in 2021, the US Food and Drug Administration (FDA) approved an oral formulation of semaglutide for the same indication. This oral version provides a more convenient option for patients who may have reservations about self-injecting the medication. Studies have shown that oral semaglutide is not only effective in lowering blood sugar levels in individuals with type 2 diabetes but also in promoting weight loss. This dual benefit makes it an attractive option for individuals struggling with both conditions, as obesity is a common comorbidity of diabetes. The weight loss effects of oral semaglutide are believed to be a result of decreased appetite and increased feelings of fullness, which lead to reduced caloric intake. Mechanism of Action The mechanism of action of oral semaglutide involves its interaction with the GLP-1 receptors located in various tissues throughout the body. When semaglutide binds to these receptors, it triggers a series of events that help regulate blood sugar levels and body weight. One of the key effects of GLP-1 receptor activation is the stimulation of insulin secretion from pancreatic beta cells, leading to better glucose uptake by cells and lower blood sugar levels. In addition to its effects on insulin production, oral semaglutide also inhibits the release of glucagon, a hormone that raises blood sugar levels by promoting the breakdown of glycogen in the liver. By decreasing glucagon secretion, semaglutide helps prevent excessive glucose production in the body, further contributing to improved glycemic control. This dual action on both insulin and glucagon makes oral semaglutide a potent tool in the management of type 2 diabetes. Furthermore, oral semaglutide has been shown to slow down gastric emptying, which delays the absorption of nutrients from the gut into the bloodstream. This delayed nutrient absorption results in prolonged feelings of fullness and satiety, reducing the overall caloric intake of individuals taking the medication. By promoting a lower calorie intake, oral semaglutide aids in weight loss and can help individuals achieve a healthier body weight. Side Effects and Safety Concerns Like any medication, oral semaglutide is associated with a number of potential side effects that individuals should be aware of before starting treatment. Common side effects of semaglutide include gastrointestinal symptoms such as nausea, vomiting, diarrhea, and constipation. These side effects usually subside over time as the body adjusts to the medication but can be bothersome for some patients. In rare cases, oral semaglutide may also increase the risk of pancreatitis, a serious inflammation of the pancreas that can lead to severe abdominal pain, nausea, and vomiting. Individuals with a history of pancreatitis or pancreatic cancer should not take semaglutide due to this increased risk. Additionally, semaglutide has been associated with thyroid tumors in animal studies, although the relevance of this finding to humans is not yet clear. Prior to starting treatment with oral semaglutide, individuals should discuss their medical history and any existing health conditions with their healthcare provider to determine if the medication is appropriate for them. It is important to weigh the potential benefits of oral semaglutide in terms of improved glycemic control and weight loss against the potential risks and side effects associated with the medication. Conclusion In conclusion, oral semaglutide has shown promising results as a treatment option for weight loss in individuals with obesity. The medication works by activating GLP-1 receptors in the body, leading to improved glycemic control, decreased appetite, and increased feelings of fullness. These effects contribute to a reduction in caloric intake, resulting in weight loss over time. While oral semaglutide is generally well-tolerated, it is important for individuals to be aware of potential side effects and safety concerns associated with the medication. Close monitoring by a healthcare provider is essential to ensure the safe and effective use of oral semaglutide in the management of type 2 diabetes and obesity. 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