Type 3 Diabetes and what does that mean

This is the Truth, Lies and Alzheimer's Show, brought to you by Passionate World Talk Radio and Global Media Network LLC. Passionate World Talk Radio is a wholly owned subsidiary of Global Media Network LLC, and our motto is to educate, enlighten, and entertain. I'm Ken Poglia, and I'm here to introduce Your host, she's an Alzheimer's and dementia expert. She's a best-selling author and world-renowned public speaker. She is Lisa Skinner. We've got a fantastic episode planned for you today. Lisa will be answering for her listeners the question: Why are some researchers and medical professionals calling Alzheimer's disease a type 3 diabetes? I've always wondered that myself. I'm looking forward to hearing Lisa answer the question. And then in today's What's New section, Lisa will be discussing recent FDA approval of a new Alzheimer's treatment called Lecanemab. What does it mean for people with Alzheimer's? Stay tuned to find out. And with that, I'll hand it back over to our host, Lisa Skinner.

Hey, Ken, thanks so much for your always wonderful introduction to our show. Hello to all of you who have tuned in today to once again listen to the newest episode of the Truth, Lies Alzheimer's show. I hope you know me by now, but I am Lisa Skinner, your host, and I'd like to shout out a very warm welcome to all of you who have joined us today, and I can't thank you enough for being here. As I have said in the past, the purpose of this show is to talk about every aspect of Alzheimer's disease and dementia. That's going to include—yes, I've said it before—the good, the bad, and the ugly. My goal is to get to the truth, dispel the lies and myths, and unveil the secret faces of Alzheimer's disease so you will have a better understanding of what it's truly like for people living with this brain disease. My hope is to zoom outside this paradigm of it exclusively being a memory loss condition and to shift people's understanding an understanding of just how dramatically this disease impacts the lives of those who have it, as well as their caregivers and family members. Well, for that matter, anybody who is involved in the life of a person living with dementia. I want people to know how to live their best lives with this heartbreaking disease, including how to manage all of the unexpected surprises that emerge every day. And that way you can spend time focusing on what truly matters, and that's spending quality time with your loved ones. So I'm here now for you to enlighten you on everything you need to know during this Alzheimer's journey. Another thing that I have learned in the last 30 years since I've been doing this professionally is that there are so many aspects of living with dementia that are unexpected and can surface out of nowhere at any time. And this is what I call the hidden or secret faces of Alzheimer's disease. And as many of you already know, they do show up unannounced and are completely unpredictable. And that's why I believe with all my heart that it is so important to be prepared for anything that emerges. Along the way. And knowledge is definitely your power. I'm here to arm you with that knowledge so you too will have the power to negotiate the many challenges you'll face having a loved one or while caring for someone with dementia. You know, living with dementia is unlike anything any of us could ever imagine. Think of it as like falling into a rabbit hole and entering a world unlike anything you've ever known, one that becomes completely unfamiliar. That said, it's equally important to not only understand what will occur on a day-to-day basis, but why these things occur. What is happening to the person's changing brain as they progress through the various stages of Alzheimer's disease? In knowing the answer to these questions, only then will you be prepared for what will challenge you, and that will be the key to being prepared and not being caught off guard. So, as Ken mentioned today, I am going to answer this question. Why is it that some researchers and medical professionals are calling Alzheimer's disease a type 3 diabetes? You've actually heard me refer to Alzheimer's disease as being synonymous with type 3 diabetes in some of my previous episodes, so I thought it would be a great informational segment to answer the question of why is it referred to as a Type 3 diabetes. So insulin resistance, which is the hallmark of Type 2 diabetes, which causes high blood sugar, and it's also linked to Alzheimer's disease, which is a progressive neurodegenerative degenerative disease. Type 1 diabetes is an autoimmune disease in which the body fails to produce insulin, but in Type 2 diabetes, the body still produces insulin, but it does not use it properly, according to the National Institute of Diabetes and Digestive and Kidney Diseases. In recent years, the term Type 3 diabetes has been used in health media and literature to refer to Alzheimer's disease since the neurodegenerative disease is linked to insulin resistance. That which is the hallmark of Type 2 diabetes in the brain. Yet don't expect most doctors to use the term for diagnostic reasons anytime soon. They're not going to refer to it as Type 3 diabetes. So why is it being called this? It's really more of a research term rather than a medical term, says Dr. Bu, who's a PhD and a professor of neuroscience and associate director of the Center for Regenerative Medicine at the Mayo Clinic. Clinic in Jacksonville, Florida. There's a growing body of research indicating the relationship between insulin resistance in the brain and neurodegenerative conditions that can result in cognitive decline vis-à-vis Alzheimer's disease or other types of dementia. In people with Type 2 diabetes, now again, the body does not properly use the insulin. It's a hormone that helps carry the glucose or the blood sugar to your muscles, your fat, and cells for energy. This condition is called insulin resistance when it doesn't work properly. At first, the pancreas tries to compensate by making more insulin, but for many people, this production eventually can't keep up and the amount of glucose in the blood rises to unhealthy levels. Now, Type 2 diabetes typically develops in people over the age of 45 and is brought on by a combination of genetic predisposition positions, the environment, a person's lifestyle, their diet, and other risk factors. However, we have heard all over the news that there is an ongoing or an incurrent epidemic of childhood Type 2 diabetes now. So, my understanding is it probably has to has to do with a lot of these factors, the genetic predispositions, the environment, the lifestyle, the diet. So, it's not limited to people 45 or older. A lot of children and adolescents today have and are developing Type 2 diabetes. Now, as you already know, Alzheimer's disease is a brain disorder Also linked to advancing age, usually affecting people age 65 and older according to the Alzheimer's Association. But again, we are seeing trends of Alzheimer's disease showing up at an earlier age than 65. Now Alzheimer's disease is the most common cause of dementia, but it's not the only one. There actually are over 100 brain diseases that cause dementia. Individuals with the disease experience progressive memory loss, behavioral changes, loss of physical functions, cognitive decline, and this is due to the destruction and death of the brain's nerve cells. Now, Alzheimer's live typically 4 to 8 years after diagnosis, but some people live with it up to 20 years. My grandmother had it for 20 years after we noticed the, the obvious signs and symptoms. Autopsies of people with Alzheimer's disease show a distinctive pattern of deposits of two proteins, The first one is called beta amyloid. This protein fragment builds up in the spaces between nerve cells and forms plaques. The tau proteins, when it builds up within cells in twisted fibers, these are called the tangles. And when this accumulates, it literally suffocates your brain cells. To date, researchers are still trying to figure out exactly what causes Alzheimer's disease, but analysis suggests that the immune system and hormonal pathways may be among some of the factors involved in the development of the condition, says Heather Snyder, PhD. She is the Vice President of Medical and Scientific Operations at the Alzheimer's Association in Durham, North Carolina. And increasingly, researchers are also looking at a connection to diabetes and insulin resistance. Individuals who have diabetes have an increased risk of Alzheimer's disease and related dementias in later life, says Dr. Schneider. The exact mechanisms are not fully understood. However, when we look at the way that our brains are processing energy, it seems that the process changes in people with diabetes. I list diabetes as one of the high-risk factors, which is a manageable risk factor. You can actually negate it from your risk of developing Alzheimer's disease by managing it and treating it, but it is one of the highest risk factors known for the possibility of developing Alzheimer's disease. According to the Mayo Clinic, this may be because of the way type 2 diabetes affects the brain's ability to use the glucose and to respond to insulin. An evolving understanding of how insulin resistance may affect the brain has galvanized this avenue of research. For many years, we thought that the brain was not native insulin-sensitive tissue. However, over the past 15 years, this notion has really changed dramatically, says Dr. Khan, who's the head of integrative physiology and metabolism at the Joslin Diabetes Center at Harvard University in Boston. He goes on to say, we know that insulin does get across the blood-brain barrier in different areas of the brain and also penetrates into the spinal fluid. Which is the fluid that bathes our brain. The brain tissue is exposed to insulin at a somewhat reduced level compared with other tissues in the body, but it's still very much regulated in response to things that cause insulin secretion, like eating a lot of carbohydrates in a meal or a lot of sugar. Okay. We also know that this response in the brain has effects on both the metabolism of the brain cells and the way the brain cells signal the body for different functions. Now, Dr. Kahn participated in a study published in September of 2017 in the publication Neuron that looked at mice with the APOE4 gene that were fed a high-fat diet and developed insulin resistance. If you recall from previous episodes, um, we've talked about the APOE4 gene, and that is the genetic gene that is passed down from parents to children. Doesn't mean that you carry it, There are tests available to determine if you have it. And what this told them was that the older the mice were, the more dramatic the impairment was to the functioning of insulin in the brain. Now, this gene is important because of its link to Alzheimer's disease. They're saying here that 20% of the general human population does carry at least one allele for the APOE4. Dr. Bu points that out. An allele is a variant of a gene. They come in pairs and they're inherited from each parent. Now, somewhere between 50 and 70% of people with Alzheimer's disease do carry at least one copy of this gene. Which makes it a strong risk factor. The genetic testing for the— to determine whether or not you are carrying the APOE4 gene and other variants, you can order the 23andMe kit off of Amazon. There are other services that provide the testing. And it will be able to tell you if you're carrying the gene. But it's worth noting that the gene is only considered a risk factor, and not everyone who has it will develop the disease. Dr. Bu points out that ongoing research is, is exploring potential treatments for preventing Alzheimer's disease in people with insulin resistance. Knowing how a person's genetic profile affects the progression of the disease and could help healthcare providers customize treatments for them in the future. So, both Dr. Boo and Dr. Kahn point to ongoing research led by neuropsychologist Suzanne Kraft into a treatment that administers insulin into the brain through a a special device that targets the olfactory cleft in the nasal cavity. But so far it has not been shown to help. A randomized clinic trial published in June of 2020 in JAMA Neurology involving 289 participants showed that 12 months of the insulin treatment did not have any functional or cognitive benefits. Then, there's research into the use of metformin, which are brand names that include Glucophage and Glumetza, and a lot of people who have type 2 diabetes, that's the go-to prescription that they're given. By their doctors. So probably a lot of people out there who have Type 2 diabetes are currently taking Metformin. It's a commonly prescribed Type 2 diabetes oral drug that helps improve the body's response to insulin and control the amount of glucose that goes into the blood. According to MedlinePlus. To date, the results of metformin's effects on Alzheimer's disease have been mixed. A systematic review and meta-analysis published in 2018 in the Journal of Alzheimer's Disease found that metformin helped protect people with type 2 diabetes against cognitive impairment and dementia. However, a cohort study in Taiwan of 9,000 people that was published in October of 2017 in Progress in Neuropsychopharmacology and Biological Psychiatry found the opposite effect. So the bottom line here is more research is necessary but is underway to investigate metformin's effects on memory and dementia risk. Meanwhile, it's important for people who have type 2 diabetes and prediabetes or a family history of diabetes to understand that they are not automatically destined to develop Alzheimer's disease, nor will consuming sugar in moderation necessarily lead one down that path, assuming that your blood glucose levels are kept under control. Actually, there's plenty of people can do this, that can do— there's plenty of things people can do to decrease their risk. And their advice, and also my advice, whether they have diabetes or not, is that if they want to try to minimize their risk for Alzheimer's disease, then try to do the things that guard against insulin resistance, such as staying lean and maintaining a regular exercise program. That's a quote from Dr. Kahn. But I've done an entire show on the risk factors and how to reduce your risk of developing Alzheimer's disease by managing some of these medical conditions that have shown that they increase a person's risk of developing Alzheimer's disease. And then the lifestyle choices you can make to lower that risk. Diet and Exercise are critical to lowering your risk of developing Alzheimer's disease. So, that said, and these are kind of related, that I'm now going to do my What's News section, and it's very exciting. Exciting news. I wasn't really sure, to be honest with you, how I felt about the announcement recently that the drug Lekanemab has been officially approved by the FDA. It's been given full approval because every article that I have read on this treatment was so vague, and it basically just told us what the pros and cons were. But this article that I have found in Yale Medicine that I'm going to share with you today really breaks it down in a lot more detail, and the understanding of how the disease works is much more clear to me So I want to share this with you so it will be much more clear to you as well. So the Food and Drug Administration has recently granted accelerated approval for the new Alzheimer's treatment called Lecanemab, which has been shown to moderately slow cognitive and functional decline in the early stages of Alzheimer's disease. So what exactly does that mean? Is this a treatment that we want to consider or run the other way from? So again, as we are all aware, Alzheimer's disease is a progressive disorder that damages and destroys nerve cells in the brain. Over time, the disease leads to gradual loss of cognitive functions, including the ability to remember, the ability to reason, to use language properly, to recognize familiar places. It can also cause a range of significant behavioral changes. The FDA's The decision followed results of a Phase 3 clinical trial published in the January 5th issue of the New England Journal of Medicine by Dr. Christopher Van Dyke. He's the director of Yale's Alzheimer's Disease Research Unit and was the lead author of the paper. Dr. Van Dyke is also a paid consultant for the pharmaceutical company Eisai, which funded the trials. They are the manufacturers of the treatment. Sold under the brand name Leqembi, which is made by Eisai in partnership with Biogen Inc., the drug is delivered by an intravenous infusion every 2 weeks. So that's how it's administered. You go to the clinic and it's intravenously infused into your veins. The FDA's Accelerated Pathway allows for earlier approval of drugs that treat serious conditions for which other treatments are not available or may no longer be effective. So, Lekembi works by removing a sticky protein from the brain, the one that, that works with the— causes the plaques and the tangles that is believed to cause Alzheimer's disease to advance. The sticky protein are the ones that form the plaques. It's very exciting because this This is the first treatment in our history that does show an unequivocal slowing of decline in Alzheimer's disease, says Dr. Van Dyke. We talked more with— I'm reading from the article— they talked more with Dr. Van Dyke, who answered 3 questions about the new treatment. And this is probably the most comprehensive information I have been able to find since they approved this new treatment. So, in a trial that involved 1,795 participants, they all had early-stage symptomatic Alzheimer's. Lecanemab, or Lekembi, slowed clinical decline by 27% after 18 months of treatment compared with those who received the placebo. The antibody treatment selectively targets the forms of amyloid protein that are thought to be the most toxic to your brain cells, says Dr. Van Dyke. Now, study participants who received the treatment had a significant reduction in amyloid burning— not burning— an amyloid burden in their imaging tests, usually reaching normal levels by the end of the trial. Participants also showed a 26% slowing of decline in a key secondary measure of cognitive function and a 37% slowing of decline in a measure of daily living, compared to the placebo group. Would he like the numbers to be higher? Of course, he says, but he doesn't think this is a small effect. He believes this is a significant effect. These results could also indicate a starting point for bigger and even more promising effects. The data appear encouraging that the longer the treatment period, the better the effect. But he says we'll need more studies to determine if that will be true. They also beg the question about still earlier intervention, adds Dr. Van Dyke. Lecanemab is already being tested in the global study called AHEAD, A-H-E-A-D, and it's for individuals who are still cognitively normal but at high risk of symptoms due to elevated levels of brain amyloid. Now Yale currently has the largest number of participants in the AHEAD study, which is funded by the National Institutes of Health and ESI, and is enrolling participants as young as 55. So he tells us that we may see a larger benefit if we intervene before significant brain damage has occurred. So here's the $100 million question. Is Lekanemab And this is really what concerned me when I, you know, first started reading about this drug or this treatment, because I read about the side effects and they concerned me. And I'm thinking, okay, is this really worth trying the treatment to see if it's going truly does slow the process of cognitive decline. But after their explanation, I feel more confident about it. So let me share that with you. The most common side effect, and this is 26.25% of the participants versus 7.4% of the participants that ended up with the placebo, of the treatment is an infusion-related reaction, which may include transient symptoms such as flushing, chills, fever, rash, and body aches. The majority, 96%, of these reactions were mild to moderate, and 75% of the reactions happened after the first dose. Dr. Van Dyke says we can medicate those individuals in advance if we find that they do have side effects repeatedly. We can use medications, Benadryl, Tylenol, diphenhydramine, acetaminophen, but this is generally, he says, now this is generally not an issue. So that's a little bit more comforting to me. Another potential side effect associated with Lecanemob was amyloid-related imaging abnormalities with edema, or fluid formation on the brain. Now, this occurred in 12.6% of trial participants compared to 1.7% in the placebo group. The things that I read about it prior to this article basically just said there's been side effects of bleeding of the brain and swelling of the brain, but no other information was given. I'm like, oh my goodness, that does not sound good. But this explanation really filters it down to solid numbers, and the numbers don't really seem to be outrageous. Um, so he says that the Fluid formation on the brain occurred in 12.6% of trial participants compared to only 1.7% in the placebo group. It's usually asymptomatic when it occurs, but we can detect it on MRI scans. We often don't stop dosing if we see it, unless there are symptoms, in which case we would pause the infusion until it's fully resolved, Dr. Van Dyke says. So they are watching it carefully. It's important to note that the studies with Lekanemab show substantially lower rates of this side effect than do published trials of other— similar drugs such as aducanumab. They're at about a third of the rate, explains Dr. Van Dyke. So for drugs in this class, he thinks lecanemab has a very favorable safety profile. Lastly, 17.3% of trial participants experienced amyloid-related imaging abnormalities with brain bleeding compared to 9% in the placebo group. Dr. Van Dyke says most of the time we're really talking about microhemorrhages that are in the order of millimeters, so very, very, very small incidences. People with Alzheimer's disease are more prone to these events. Because of the amyloid deposits in their blood vessels, but a catastrophic bleed is quite rare. The medication's label does include warnings about brain swelling and bleeding and that people with a gene mutation that increases their risk of Alzheimer's disease are at greater risk of brain swelling on the treatment. The label also cautions against taking blood thinners while on this medication. So, while Lekanemab may be offered in doctor's offices soon, this is a little alarming, the price tag, which ESI reportedly has set at $26,500 per year, will make it unaffordable for most people. Excuse me. Access to it will likely depend on whether the drug receives traditional FDA approval and whether Medicare will cover the drug, which is unknown for certain at this point. I have read other articles that claim Medicare will be covering it if doctors, um, agree to provide some information to them about the treatment protocols. But I guess we'll have to wait and see if Medicare ends up covering it. So, that's what I have for y'all tonight or today. And I'm going to turn the mic back over to Ken. He has a couple of announcements for you., and then I'll be talking to you again very shortly.

Again, thank you for listening to the Truth, Lies Alzheimer's show with your host Lisa Skinner. This program can be found on our website at passionateworldtalkradio.com under the shows tab, and you can also search for us on YouTube. You can find Lisa on Facebook by searching for Lisa Skinner Author And if you're interested in Lisa's books or training programs, go to truthliesalzheimers.com. All our books are available on major bookselling platforms, including Amazon and Apple Books, and we highly recommend the audiobook version of her bestselling book, Truth, Lies Alzheimer's: Its Secret Faces. And with that, I'll turn it back over to Lisa Skinner Skinner to take us home.

Okay. Thanks, Ken. And I want to thank all of you again for listening today. Remember, dementia awareness is every day. Kindness is the ability to speak with love, listen with compassion, and act with patience. All very necessary attributes to have in order for any of us to outlast Alzheimer's disease. But before I go, just wanted to mention, if you do have any comments or feedback or ideas for show topics, I would love to hear them. You can send them to me at my email address, which is dementiawhisperer1@gmail.com. Also, if you're listening to this on YouTube or if you got here through our social media page, please leave your comments or questions and I'll do my very best to address them. I will genuinely look forward to receiving your thoughts and ideas. And in the meantime, take care of you. Talk to you all next week. And I hope to hear that you're back listening to us again. Then take care. Bye-bye.