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Dr David Johnson highlights new preoperative recommendations to protect against consequences of some diabetes and weight loss drugs that delay gastric emptying.
https://www.medscape.com/viewarticle/994762?src=soc_yt
-- TRANSCRIPT ---
Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology in Eastern Virginia Medical School in Norfolk, Virginia.
Recent national media attention has focused on the gastrointestinal (GI) side effects of glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs are used to treat type 2 diabetes and weight loss. The GI side effects include nausea, vomiting, and gastroparesis-like symptoms.
I wanted to emphasize two key points especially important to clinicians providing this class of therapy.
One: Clinicians need to be increasingly aware of the potential GI side effects and inform their patients when they start to prescribe these medications.
And two: The American Society of Anesthesiologists (ASA) has recently released consensus-based recommendations for preoperative assessment and management of adults and children undergoing surgery who are taking these medications. The recommendations also apply to endoscopic procedures whereby anesthesia will be delivered.
Gastric Impact of GLP-1 Agonists
What are these GLP-1 agonists? The drugs for weight loss include liraglutide (Saxenda and Victoza) and semaglutide (Ozempic, Wegovy, Rybelsus, among others). The type 2 diabetes medications include semaglutide, dulaglutide (Trulicity), and exenatide (Byetta, Bydureon BCise), among others. They can be taken daily or by injection once a week.
The GLP-1 agonist drug class works at the GI level to increase insulin secretion and decrease glucagon release, both of which mediate glycemic control, particularly postprandially. The drugs slow the gastric motility through decreased peristalsis and increased tonic contractility of the pylorus, essentially causing a delay in gastric emptying.
Dr Michael Camilleri and his colleagues at the Mayo Clinic, in Rochester, Minnesota, conducted a small randomized, placebo-controlled double-blind study of the GLP-1 agonist liraglutide to investigate the mechanism of weight loss in patients who were overweight. They showed that there was a diminution in gastric emptying over 16 weeks in patients taking liraglutide. They found evidence of tachyphylaxis, but the rate of gastric emptying of solids remained slow compared with placebo, even at 16 weeks.
Despite the observed waning of the gastric impact, we just don't know how long significant side effects persist when patients stop the drug for good. There are some reports of patients with protracted symptoms a year or more after they've stopped their GLP-1 agonist medications.
Guidance for Preoperative Management
These drugs would commonly be reviewed before patients go through procedures, and we need to be better aware as we start to see these patients for endoscopy.
The ASA recommendations address the potential consequences of delayed gastric emptying and provide guidance for preoperative management of these drugs to prevent regurgitation and pulmonary aspiration of gastric contents.
In patients on daily dosing, the ASA recommends holding these agents the day prior to the procedure.
For patients on weekly dosing, the recommendations suggest withholding the dose a week before the procedure. Importantly, this should be in consultation with their diabetologist, just to assess any need for a bridging therapy to avoid hypoglycemia.
On the day of the procedure, if GI symptoms, such as severe nausea, vomiting, retching, abdominal pain, and bloating, are present, clinicians should consider delaying the elective procedure and discuss the risks of the potential risks for aspiration.
If the patient has no symptoms and the GLP-1 agonist has been withheld as advised, then you should proceed as usual.
But if the patient has no symptoms and has not held their GLP-1 agonist, you should proceed with what the anesthesiologists call the "full stomach" precaution, which considers patients at potentially high risk for aspiration. There's a way of checking for that. Some centers can do a quick ultrasound on the stomach and see if there's food, debris, or liquid, and if that is not the case, they could proceed with no delay. But if there is no way to check gastric contents, then you should manage accordingly, which may require intubation or postponing an elective procedure for another day.
These are new and changing issues. In our world as gastroenterologists, we should be considering — very strongly — mitigating strategies to protect the patients on this wonderful class of therapy. Sometimes these drugs can have significant side effects that we need to at least be aware of. Nothing is perfect, but let us be better informed.
https://www.medscape.com/viewarticle/994762?src=soc_yt
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Semaglutide, a medication originally developed to treat type 2 diabetes, has recently gained attention for its potential to aid in weight loss. As more research is conducted on the effects of semaglutide on weight management, healthcare providers are beginning to implement specific protocols and guidelines for its use in weight loss programs.
The Science Behind Semaglutide and Weight Loss
Semaglutide is a glucagon-like peptide-1 (GLP-1) analogue that works by mimicking the effects of GLP-1 in the body. GLP-1 is a hormone that is released in response to food intake and helps regulate blood sugar levels by stimulating insulin release and reducing appetite. By mimicking the effects of GLP-1, semaglutide can help reduce appetite, increase feelings of fullness, and ultimately lead to weight loss.
In clinical trials, semaglutide has been shown to be more effective in promoting weight loss compared to other weight loss medications currently available on the market. Participants in these studies experienced significant reductions in body weight, body mass index (BMI), and waist circumference when taking semaglutide as part of a weight loss program.
Furthermore, semaglutide has been found to have additional health benefits beyond weight loss. It can help improve glycemic control, reduce the risk of cardiovascular events, and lower blood pressure levels. These added benefits make semaglutide an attractive option for individuals who are looking to not only lose weight but also improve their overall health.
Implementing a Semaglutide Protocol for Weight Loss
When implementing a semaglutide protocol for weight loss, healthcare providers must consider a number of factors to ensure its effectiveness and safety. It is important to screen patients carefully to determine if they are suitable candidates for semaglutide treatment, taking into account their medical history, current medications, and weight loss goals.
Patients prescribed semaglutide should be educated on how to properly administer the medication and understand its potential side effects. Regular follow-up appointments should be scheduled to monitor progress, adjust dosages if necessary, and provide ongoing support and guidance throughout the weight loss journey.
In addition to semaglutide treatment, a comprehensive weight loss program should incorporate dietary changes, physical activity, and behavioral modifications to help patients achieve long-term success. Healthcare providers should work closely with patients to develop personalized plans that address their unique needs and challenges.
Potential Challenges and Considerations
Despite its efficacy in promoting weight loss, semaglutide is not without limitations and potential challenges. Some patients may experience gastrointestinal side effects such as nausea, vomiting, diarrhea, and constipation when taking semaglutide. These side effects can be managed through dose adjustments, dietary modifications, and other supportive measures.
Cost may also be a barrier for some individuals, as semaglutide can be expensive and may not be covered by insurance. Healthcare providers should work with patients to explore alternative options and resources to help make semaglutide treatment more accessible and affordable.
Furthermore, long-term safety and efficacy data on semaglutide for weight loss are still limited, and more research is needed to fully understand its potential risks and benefits. Healthcare providers should stay informed about the latest evidence and guidelines surrounding semaglutide use in weight management.
Conclusion
Semaglutide shows promising results as a potential treatment for weight loss in individuals struggling with obesity. By understanding the science behind semaglutide, implementing appropriate protocols, and addressing potential challenges, healthcare providers can help their patients achieve significant weight loss and improve their overall health.
It is important for healthcare providers and patients alike to stay informed about the latest research and guidelines on semaglutide for weight loss to make informed decisions about treatment options. With the right support and guidance, semaglutide can be a valuable tool in the fight against obesity and its associated health risks.
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I found a dinner that is delicious, chewy, filling, high in both fiber and protein- and comes in at about 400 calories. And perhaps even better- no cooking (just microwaving). This video is actually the following week- I ran out of time and willpower to do the whole series in one week. But I tried not to stray too far from my set meals and I managed to lose about a pound over the intervening week.
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Semaglutide is a medication that has been in the spotlight recently for its potential to aid in weight loss. Originally used for managing type 2 diabetes, semaglutide has shown promising results in clinical trials for promoting significant weight loss in individuals who are overweight or obese. As obesity rates continue to rise globally, the search for effective weight loss solutions has become increasingly important. In this article, we will explore the pros and cons of using semaglutide for weight loss, providing you with all the information you need to make an informed decision about this medication.
Pros of Using Semaglutide for Weight Loss
One of the major benefits of using semaglutide for weight loss is its ability to significantly reduce body weight. Clinical trials have shown that individuals who took semaglutide experienced greater weight loss compared to those who took a placebo. This can be especially beneficial for individuals who have struggled to lose weight through diet and exercise alone.
Furthermore, semaglutide has been shown to improve other markers of health, such as reducing blood pressure and cholesterol levels. This can help lower the risk of developing serious health conditions like heart disease and stroke, making semaglutide a valuable tool for improving overall health in addition to aiding in weight loss.
In addition to its weight loss benefits, semaglutide may also help individuals better manage their appetite and food cravings. By working on the brain’s appetite control centers, semaglutide can help individuals feel more satisfied with smaller portions of food, making it easier to stick to a healthy eating plan and maintain weight loss over time.
Cons of Using Semaglutide for Weight Loss
While semaglutide has many potential benefits for weight loss, there are also some drawbacks to consider. One of the main concerns with using semaglutide is the potential for side effects. Common side effects of semaglutide include nausea, diarrhea, and constipation, which can be bothersome for some individuals and may impact their quality of life.
Another consideration is the cost of semaglutide treatment. As a newer medication, semaglutide can be expensive, and insurance coverage may vary. For individuals who are on a tight budget or do not have insurance coverage, the cost of semaglutide may be prohibitive and limit access to this weight loss treatment.
It is also important to note that semaglutide is not a magic solution for weight loss. While it can help individuals lose weight, it is not a replacement for healthy lifestyle habits like regular exercise and a balanced diet. In order to see long-term success with weight loss, individuals using semaglutide must also make sustainable lifestyle changes.
Real-World Experiences with Semaglutide
For many individuals, using semaglutide for weight loss has been a game-changer. Real-world experiences show that semaglutide can help individuals achieve significant weight loss when combined with healthy lifestyle habits. Many people have reported feeling more in control of their eating habits and experiencing improved health outcomes as a result of using semaglutide.
However, it is important to remember that individual results may vary, and not everyone will have the same experience with semaglutide. It is always recommended to consult with a healthcare provider before starting any new medication, including semaglutide, to ensure that it is safe and appropriate for your specific health needs.
Conclusion
In conclusion, semaglutide shows promise as a weight loss treatment for individuals who are overweight or obese. With its ability to promote significant weight loss, improve health markers, and aid in appetite control, semaglutide has the potential to be a valuable tool in the fight against obesity. However, it is essential to weigh the pros and cons of using semaglutide, including potential side effects, cost, and the need for sustainable lifestyle changes, before deciding if it is the right choice for you.
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