August 10, 2022 by John Fernandez
Diabetes Treatment Study With Surprising Weight-Loss Validates Work of Cardiometabolic Clinic at Miami Cardiac & Vascular Institute
The results of a new study on a drug to treat type 2 diabetes have garnered widespread attention because of the surprising outcome. The drug, tirzepatide, was remarkably affective at reducing obesity, with study participants losing as much as 21 percent of their body weight – 50 to 60 pounds in some cases.
The study also validates the work of a burgeoning number of cardiometabolic clinics nationwide, including the one at Miami Cardiac & Vascular Institute, part of Baptist Health, which is overseen by a team led by Adedapo Iluyomade, M.D., preventive cardiologist at the Institute.
The drug used in the study, tirzepatide, has been approved by the U.S. Food and Drug Administration (FDA), but is not widely available yet as it undergoes more testing. The Institute won’t consider its use until future trials determine its overall cardiovascular effect.
Dr. Iluyomade explains that the Institute’s cardiometabolic clinic is already seeing positive results, including weight-loss, in patients taking medication that falls into one of the two primary classes of drugs used in the tirzepatide study. That class — glucagon-like peptide 1 (GLP-1) – is part of therapy already established for the management of type 2 diabetes. GLP-1 therapy its recommended early in the treatment of type 2 diabetes, also resulting in some weight reduction and favorable management of heart disease.
“What we’re able to do is really focus on patients who have diabetes and have heart disease, or who are at high risk for heart disease,” said Dr. Iluyomade. “And we’re able to use this class of medication (GLP-1), as well as other classes of medications, to control their diabetes and reduce their cardiovascular risk. And now you also get that weight loss reduction.”
In the study, another class of medication — glucose-dependent insulinotropic polypeptide (GIP) – was combined with GLP-1 to comprise tirzepatide, said Dr. Iluyomade.
“The way that it works is basically by increasing the secretion of incretin,” he explains. “This is how it enables weight loss by increasing incretin, which is the hormone that tells you to stop eating. So, when you eat a big meal, your stomach stretches. The hormone secretes, and it says, ‘Stop eating. You’re full.’ So, you get full quicker. And your stomach gets full quicker, and you don’t get hungry.”
An estimated 47 million individuals0 in the U.S. are living with cardiometabolic disorders, putting them at an increased risk of developing heart disease or type 2 diabetes. Cardiometabolic disorders represent a range of related risk factors, primarily hypertension, elevated fasting blood sugar, dyslipidemia (unhealthy cholesterol levels), abdominal obesity and elevated triglycerides.
Miami Cardiac & Vascular Institute is one of five founder members of a national Cardiometabolic Center Alliance, where it is participating in creating national standards of care, sharing best practices with other large enters and consolidating data as more is learned about cardiometabolic conditions.
When the complete cardiovascular effect of tirzepatide is known, this drug may be the biggest game changer for cardiometabolic patients. That’s because of its impressive impact on the A1C levels in the study’s participants. The A1C test reflects your average blood glucose (also known as blood sugar) levels over a period of three months. Specifically, the test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar. A higher percentage indicates higher blood glucose levels and a higher risk of diabetes complications.
A normal A1C level is below 5.7 percent. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. An A1C level of 6.5 percent or above on two separate occasions confirms the diagnosis of diabetes.
“Eventually, you’ll see adoption in the cardiovascular world (of tirzepatide) because it seems like if there was ever a one-and-done medication, this one could be it. Its glucose reduction is impressive. The average patient in the trial had hemoglobin A1C of 8.4 percent. And the average reduction was over 2% in hemoglobin A1C. For example, someone who’s at 7.5 percent went down to 5.5 percent. Now they’re back to a normal range. That’s remarkable.”
For now, the cardiometabolic clinic at the Institute is seeing impressive results with its existing range of medications and treatments.
“The referrals to the clinics are picking up,” said Dr. Iluyomade. “But the program is evolving and there’s much more potential for increasing the number of patients we treat. I see many patients in the hospital that would be great candidates for the program. And that’s really motivated us to consider having a preventive-cardiology inpatient service, where our doctors in the hospital can see someone from the cardiometabolic clinic, or our prevention program overall, and get them either started on a medication before they leave or optimize their current medications. And then also plugging them into the program before they head out into the community where we may not see them again.”