Latest / Morning Medical with Dr. Chow / Tirzepatide vs. Semaglutide, Parkinson's Cognitive Symptoms, and Canadian Dental Care Updates

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Tirzepatide vs. Semaglutide, Parkinson's Cognitive Symptoms, and Canadian Dental Care Updates · Morning Medical with Dr. Chow

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Good morning and welcome to another episode of Morning Medical with Dr.
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Chow.
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I am your host, Dr.
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Chi-Ming Chow, and today we have a fascinating lineup of topics to discuss.
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From groundbreaking studies in weight loss treatments to new insights into cognitive
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symptoms in Parkinson's disease, and even some updates on healthcare policies in Canada.
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So, let us dive right in.
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Our first story today revolves around a recent study comparing two medications, tirzepatide
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and semaglutide, for weight loss in real-world settings.
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The study, published in JAMA Internal Medicine, found that tirzepatide outperformed semaglutide
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in terms of weight loss for individuals with overweight or obesity.
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In the first three months of treatment, patients who were administered tirzepatide
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experienced an average weight loss of 2.5 percent more than those receiving semaglutide.
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This difference continued to be significant at the six-month and twelve-month marks, with
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tirzepatide showing a 4.3 percent and 6.9 percent greater weight loss, respectively,
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compared to semaglutide.
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Dr.
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Nicholas Stucky and his colleagues at the health data collective Truveta in Bellevue,
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Washington, reported these findings.
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According to Dr.
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Stucky, "There has been evidence that these medications are effective for weight loss, but
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it had not been clear just how effective they are, particularly in relation to each other."
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Co-author Tricia Rodriguez added, "While clinical trials do not always generalize to the
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real world, our findings were broadly consistent with placebo-controlled clinical
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trials.
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The majority of patients on both medications experience clinically meaningful weight loss
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within a year on treatment."
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One of the key takeaways from the study is that tirzepatide-treated patients were 76 percent
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more likely to achieve at least a five percent weight loss—the threshold for clinical
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significance—than those on semaglutide.
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Moreover, they were over two-fold and three-fold more likely to achieve at least a
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ten percent and fifteen percent total weight loss, respectively.
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Over the course of a year on treatment, the average body weight loss was as follows: at
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three months, patients on tirzepatide lost 5.9 percent of their body weight compared to 3.6
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percent for those on semaglutide.
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At six months, the figures were 10.1 percent for tirzepatide and 5.8 percent for
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semaglutide.
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Finally, at twelve months, patients on tirzepatide had lost 15.3 percent of their body
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weight compared to 8.3 percent for those on semaglutide.
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Interestingly, the rates of moderate-to-severe gastrointestinal adverse events, which are the
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most commonly reported side effects with GLP-1 receptor agonists, were similar between the two
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medications.
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However, discontinuation rates were high in both groups, with 55.9 percent of patients on
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tirzepatide and 52.5 percent of those on semaglutide discontinuing the medication within
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twelve months.
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The study cohort included 18,386 patients who were matched using propensity scores from a
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subset of Truveta data.
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All patients had either overweight or obesity in the year before their index date and were
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new initiators on tirzepatide or semaglutide labeled for type 2 diabetes from May 1, 2022,
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through September 30, 2023.
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It is worth noting that, at the time of the analysis, tirzepatide had not yet been approved
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for chronic weight management, a designation it received in November 2023.
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On the other hand, a higher dosage of semaglutide approved for weight management
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under the name Wegovy was not included in the analysis.
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Approximately 52 percent of both groups had type 2 diabetes, defined by a diagnosis, a
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prescription for insulin or a DPP-4 inhibitor, or an HbA1c level of 7.5 percent or greater in
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the two years before their index date.
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The average patient age was 52 years, with 70.5 percent being female, 77.1 percent being white,
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and 43.3 percent residing in Texas.
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Among the half of patients who had type 2 diabetes at baseline, they experienced less
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weight loss than those without diabetes.
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This finding was consistent with clinical trials, suggesting that patients with and
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without type 2 diabetes may have different motivations and engage in other weight loss
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activities differently.
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Finally, it is important to mention that the analysis used electronic health record data,
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which means that adverse events might have been underreported.
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Additionally, patients in both groups may have received higher or lower doses than the
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standard type 2 diabetes doses.
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Our next story today delves into the cognitive symptoms associated with Parkinson's disease,
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which often emerge soon after diagnosis.
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A large cross-sectional study has revealed that about a third of people with Parkinson's
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disease report cognitive symptoms early in the disease course.
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The study, which involved over 25,000 participants from the Fox Insight study, found
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that 32 percent of participants who had a Parkinson's diagnosis for a median of three
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years reported at least one cognitive symptom at baseline.
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The most commonly reported cognitive issues were related to memory, language or word
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finding, and concentration or attention.
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Dr.
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Jennifer Purks from the University of Rochester in New York and her colleagues published these
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findings in Neurology Clinical Practice.
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They found that cognitive symptoms were reported by 29 percent of patients in the first
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year after diagnosis, increasing to 32 percent in the next few years, and reaching 35 percent
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within eight to nine years of diagnosis.
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The research team utilized human curation, natural language processing, and machine
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learning to classify the verbatim responses from the Parkinson's patients.
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The study highlighted that subjective cognitive concerns are common in Parkinson's disease and
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do not always align with objective findings.
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However, a recent Fox Insight study suggested that 45 percent of Parkinson's patients with
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self-reported cognitive concerns developed new-onset cognition-related functional
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impairment over three years.
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Co-author Dr.
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Daniel Weintraub from the University of Pennsylvania School of Medicine in Philadelphia
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emphasized that subjective cognitive complaints might be early indicators of future decline in
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cognitive abilities and functional impairment, even when formal cognitive testing shows no
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current evidence of cognitive decline.
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He noted the alignment between self-reported cognitive decline and objective cognitive
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assessments, although some high-functioning patients may notice cognitive changes in
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themselves but still test normally.
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The large sample size of the Fox Insight study, combined with the use of unconstrained free
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text reporting, allowed researchers to identify a broader spectrum of cognitive problems in
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Parkinson's disease than was previously possible.
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The study authors pointed out that cognitive concerns begin early after diagnosis and are
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associated with motor functional impairment and depression.
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According to the study, depression was significantly associated with cognitive
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problems in all domains except visuospatial abilities.
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The odds of experiencing posterior cortical symptoms, which involve visuospatial, memory,
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or language issues, versus frontostriatal symptoms, such as executive abilities,
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concentration, or attention, increased with age and higher scores on the Movement Disorder
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Society Unified Parkinson Disease Rating Scale Part Two, but not with depression.
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The study analyzed data from 25,192 participants in the ongoing Fox Insight study,
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with a median age of 67.
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Every three months, Parkinson's patients responded to the Parkinson Disease Patient
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Report of Problems survey.
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The researchers evaluated age, sex, years since diagnosis, and scores on the Movement Disorder
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Society Unified Parkinson Disease Rating Scale Part Two and the Geriatric Depression Scale-15,
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using data from Fox Insight.
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Among those who reported at least one cognitive symptom, 17 percent experienced posterior
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cortical-related symptoms, 7 percent had frontostriatal-related symptoms, and 14.3
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percent reported both.
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The odds of posterior cortical symptoms versus frontostriatal symptoms increased with age and
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higher scores on the Movement Disorder Society Unified Parkinson Disease Rating Scale Part
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Two, but not with depression.
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The researchers acknowledged several limitations in their study, including the
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potential for ambiguous patient reports and misclassification.
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Additionally, the broad cognitive categories used in the study may have missed more nuanced
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distinctions, such as differences between language comprehension and expression problems.
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The online nature of the study also introduced the possibility of volunteer bias.
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In summary, the findings underscore the importance of early screening for cognitive
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symptoms and depression in Parkinson's disease patients.
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Addressing mood disorders and cognitive concerns early on can significantly impact the
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quality of life and functional abilities of those living with Parkinson's disease.
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Our next story today focuses on a significant update from Ottawa regarding the Canadian
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Dental Care Plan.
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As of today, oral health care providers can treat patients under the Canadian Dental Care
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Plan on a case-by-case basis without officially signing on to the program.
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This is a move by the federal government aimed at encouraging more dentists to participate in
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the new national public insurance plan.
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Health Minister Mark Holland announced the change at a press conference in Dartmouth, Nova
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Scotia.
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He stated, "You can just try it out, submit a claim and see what you think." This new measure
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means that patients who qualify for the Canadian Dental Care Plan may be able to stay
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with their current dental clinic, even if their dentist is not a registered provider.
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However, patients need to check if their dentist is willing to accept them under this
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arrangement.
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Oral health care providers are not required to process claims through the plan since their
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participation is voluntary.
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More than two million people have been approved for coverage so far under the publicly funded
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dental care plan, which aims to eventually cover nine million low and middle-income
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Canadian residents without private coverage.
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To bill on a case-by-case basis, providers must agree to submit claims directly to Sun Life,
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the insurance company contracted by the federal government to run the program.
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Dentists cannot ask their patients to pay the full cost upfront.
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Health Minister Holland emphasized that some patients who are covered cannot afford to pay
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out of pocket.
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Patients who try to submit a claim on their own behalf after treatment will not be reimbursed.
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In most cases, oral health care providers are being paid back within 48 hours.
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Dental professionals must also agree to a claims and processing agreement, which allows
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Ottawa to investigate fraudulent claims.
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This agreement is similar to how private dental plans operate.
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Holland assured, "We have no interest in auditing anybody unless there is evidence of
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malfeasance."
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Despite these changes, the contract has been a major point of contention for dental
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associations.
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Dr.
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Joel Antel, a Winnipeg dentist and head of the Canadian Dental Association, pointed out that
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the new changes do not address all concerns.
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"When you submit the claim, you're accepting the exact same terms, conditions, and
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contracts," he said.
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However, the number of professionals fully registered is growing.
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As of now, 11,800 oral health care providers have signed up, which is slightly less than 40
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percent of all dental professionals in the country.
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This includes dentists, independent hygienists, denturists, and dental specialists.
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Dr.
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Antel mentioned that some dentists are signing up because they fear losing existing patients.
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"Anecdotally, I have heard that the reason [dentists] are signing up is there's a concern
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that their existing patients may change to another office, because they would like the
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government to pay for what they are currently paying for themselves," he explained.
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The Canadian Dental Association has recently launched a campaign called "Know Before You Go"
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to address misconceptions about the federal dental care plan.
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Dr.
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Antel noted, "People are coming in expecting that they walk into a dental office, they get
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whatever they need and it does not cost them anything.
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And we are the ones that have to tell them that that is not the case."
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Health Minister Holland acknowledged that the program is not free.
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Dentists are allowed to charge their patients the difference between what Ottawa pays and
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their own fees.
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Additionally, there is a co-pay, meaning patients with household incomes between seventy
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thousand dollars and ninety thousand dollars are only partially covered by the federal plan.
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Holland advised, "Folks should have a conversation with their provider, and they
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should expect that in many instances there will be some fees."
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The Canadian Dental Care Plan first started covering seniors in May of this year.
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So far, 250,000 seniors have received care under the plan.
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On June twenty-seventh, the program expanded to include children under eighteen years of age
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and adults who receive the disability tax credit.
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Health Canada officials reported nearly ten thousand applications for people with
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disabilities and twenty-five thousand for children since the expansion.
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It can take up to three months to be approved, and applicants will not be covered for dental
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treatment until they have received their insurance information.
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Our final story today addresses the growing concern of social media conflicts during the
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summer months, particularly for children and families.
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As kids are home from school with a more relaxed schedule, they often spend more time on
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devices, which can spark concern from parents.
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WellSpan pediatrician Dr.
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Caroline Hall highlights several inherent dangers of excessive social media use,
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including cyberbullying, interference with sleep, obesity, delays in social skills,
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behavioral problems, and increased depression and anxiety.
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The statistics are alarming.
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A 2019 study by the American Medical Association showed that teens who spend three
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hours a day on social media double their risk of depression.
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However, teens often spend even more time than that—nearly five hours a day, according to a
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Gallup poll.
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Almost half of adolescents say social media makes them feel worse about their bodies,
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according to a survey by the Boston Children’s Digital Wellness Lab.
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Additionally, a Pew Research Center survey found that seventy-four percent of teens feel
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happy, and seventy-two percent feel peaceful, when they do not have their smartphones on
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hand.
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The risks posed to kids' health by social media are so dire that Surgeon General Dr.
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Vivek H.
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Murthy recently asked Congress to place warning labels on social media platforms, similar to
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those found on cigarette packages, cautioning that their use can be harmful to health.
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Whether or not Congress acts on this recommendation, parents have an important role
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to play in helping their children develop a sense of balance and live a full, happy life,
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Dr.
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Hall advises.
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She regularly addresses this topic during her patient visits.
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"Parents often tell me they are concerned that their child spends too much time playing video
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games or on the phone, but they admit that everyday busy life makes it seem impossible to
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restrict digital media use," Dr.
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Hall says.
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"And as a parent of three myself, I can relate to these practical realities!
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It is easier to allow continued usage rather than deal with an upset child.
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And while it is clear that no one plan fits all, I feel it is my job as a pediatrician to
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work together with parents to develop a plan that works for their family."
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Here are some tips from Dr.
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Hall on how to navigate the challenging digital landscape with your children:
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First, start by setting a healthy example.
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Do not be constantly checking or scrolling on your own phone, particularly when you are
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spending time with your children or family.
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Second, talk to other parents of kids who are the same age as yours, particularly if your
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kids are younger and do not yet have cell phones.
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Consider banding together and adopting similar rules on the age a child can get or use a phone
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or, if they already have phones, what restrictions are placed on it, such as hours of
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usage and times of day used, so kids cannot say, "I am the only one who can’t…"
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As a family, collectively put your phones away an hour before bedtime in a central area, like
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the kitchen, to allow yourselves downtime before you go to sleep at night.
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Make certain activities “cell phone free,” such as the dinner table, family gatherings, family
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activities like game night or mini-golf, or sporting or musical events.
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Focus on the time together, not taking selfies or photos of your surroundings.
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If you are going on a vacation, use phones only for practical purposes, such as booking
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activities or getting directions, not as entertainment during downtime.
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Consider sitting down with your kids and drawing up a family media plan that works for
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your family.
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The American Academy of Pediatrics offers a useful tool for this purpose.
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And finally, as a parent, if you are concerned about your child’s behavior, such as withdrawal
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from activities they used to enjoy, please talk to your child’s pediatrician or doctor about
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it.
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We are here to help.
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That is all for today’s episode of Morning Medical with Dr.
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Chow.
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Thank you for joining us.
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Be sure to tune in tomorrow for more updates on the latest medical and health news from around
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the world.
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Stay healthy and have a great day!