Health Rounds: Death from dementia on the rise among people with type 2 diabetes

By Nancy Lapid

March 10 (Reuters) - Hello Health Rounds readers! Newer diabetes medicines also help a growing number of other health issues, such as heart disease, but dementia is not one of them, according to a study we feature today. We also highlight a study linking low testosterone with prostate cancer progression in patients under surveillance rather than treatment, and a model predicting a massive mental health toll from climate change.

More people with type 2 diabetes are dying of dementia

In people with type 2 diabetes in the world's richest countries, deaths from cardiovascular disease are declining while mortality from dementia is on the rise, a large analysis has found.

Newer diabetes medicines, including GLP-1s such as Eli Lilly's LLY.N Trulicity or Mounjaro, and Novo Nordisk’s NOVOb.CO Victoza or Ozempic, and SGLT-2 inhibitors such as Jardiance from Boehringer Ingelheim and Farxiga ⁠from AstraZeneca AZN.L, provide heart protection along with blood sugar control, the researchers noted in The Lancet Diabetes and Endocrinology.

While the cardiovascular complications of diabetes are increasingly addressed by these drugs and personalized treatment goals, new therapies have not been designed to protect the brain, they said.

Analyzing data from 10 wealthy countries on 2.7 million deaths of patients with type 2 diabetes between 2000 and 2023, the researchers observed overall declines in mortality rates from cardiovascular disease, cancer, and diabetes. They also saw increases in mortality rates and proportions of deaths from dementia and other causes.

“The implication is clear,” according to an editorial published with the study. “If cardiovascular progress defined the last era of diabetes care, the preservation of cognitive health should define the next.”

Low testosterone may require closer prostate cancer surveillance

Patients whose prostate cancer is being regularly monitored rather than actively treated may be at higher risk for progression to a more aggressive malignancy if their testosterone levels are low, according to a new study.

The finding suggests that testosterone may serve as a useful risk marker and help doctors tailor monitoring strategies for patients choosing active surveillance, according to a report of the study published in The Journal of Urology.

“Active surveillance is a safe and effective option for many men with early-stage prostate cancer. However, identifying which patients may be more likely to experience progression remains a key challenge,” study leader Dr. Justin Gregg of The University of Texas MD Anderson Cancer Center said in a statement.

Reviewing medical records from more than 900 men who opted for surveillance, his team found that testosterone levels of 300 nanograms per deciliter or lower at the start were linked with an increase in the likelihood of disease progression to Grade 3, the most aggressive form. This was the case even after accounting for other factors including age, prostate-specific antigen level, body mass index, and tumor density and size.

A low testosterone level was not associated with progression to Grade 2 disease, the researchers also found.

The study does not suggest that low testosterone causes aggressive cancer but rather that the association could help guide monitoring and decision-making, the researchers said.

“Understanding how hormonal factors influence prostate cancer biology may help us refine surveillance strategies,” Gregg said.

Costly toll of climate change on mental health predicted

The mental health toll of climate change could be enormous, leading to hundreds of millions or even billions of additional days of anxiety and depression symptoms in the United States alone, a new study suggests.

The greatest burden of rising temperatures and more severe weather is likely to fall on low-income communities and parts of Appalachia, researchers reported in The Lancet Planetary Health.

Using national mental health survey data and projections from multiple climate models, they estimated that annually, warming in the range of 1 to 6 degrees Celsius could result in up to 1.8 billion additional anxiety symptom-days, up to 1.4 billion additional depression symptom-days, and up to $104 billion in resulting economic damages.

The analysis, funded by the U.S. Environmental Protection Agency, draws on data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and climate projections used in the EPA’s Climate Change Impacts and Risk Analysis framework.

The findings underscore the need for mental health investment, particularly in regions where economic hardship is likely, the researchers concluded.

“Promoting individual and community resilience is crucial,” they said.