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Metformin is a older medication used for type 2 diabetes that’s now being evaluated for improving longevity. Another diabetes medicine called a GLP-1 agonist is being used to treat obesity. Diabetes expert Rita Kalyani at Johns Hopkins says possible expanded uses for these drugs extend to other classes as well.

Kalyani: Older classes of medications though too have indications or benefits outside just diabetes.For instance pioglitazone, which we've had for a long time, we know that there have been studies demonstrating benefit in reducing progression to diabetes, cardiovascular disease also on what we used to call non alcoholic liver disease. So I think it's important to recognize that what we're seeing with the newer classes of agents in terms of pleiotropic potential benefits is not singular to the newer classes of agents. I think it's a win win for all of us.      :32

Kalyani cautions that until the data is in, no one should be taking a diabetes drug for another purpose. At Johns Hopkins, I’m Elizabeth Tracey.

Yet another study has come out recommending the class of medicines called GLP-1 agonists for type 2 diabetes. These medicines are already in the news to treat obesity, both in those with diabetes and those without, and more conditions that might benefit from them are under study. Rita Kalyani, a diabetes expert at Johns Hopkins, says the wealth of indications is striking.

Kalyani: We do know that they have significant effects on weight loss, we've seen that in multiple people with and without diabetes. We are finding that this class of medications may also have significant benefits on those who are at risk for diabetes or other metabolic conditions. We also saw interim results in people with kidney disease and found that there were benefits. That's being studied for liver disease all sorts of currently off label conditions.                       :32

Kalyani says a complete picture of where these medicines might help will require more research. At Johns Hopkins, I’m Elizabeth Tracey.

Diabetes medicine known as GLP-1 agonists and SGLT-2 inhibitors are recommended for people with type 2 diabetes in a recent large study that aggregated data from other studies. Rita Kalyani, a diabetes expert at Johns Hopkins, says while there’s no doubt these medicines are effective, there is a downside.

Kalyani: The challenge becomes that many of these newer medications are also very costly and so they there are significant economic implications for using medications that have high cost in populations that could benefit equally or perhaps if not more from other classes that we currently have available. This meta analysis that we're talking about assumed that everyone was on metformin monotherapy as background which is what we found in the trials, 80 to 90% were on metformin so we're not talking about comparisons to metformin.        :30

Kalyani says it’s important to take into account someone’s entire health picture to choose the diabetes medicines that are best for them. At Johns Hopkins, I’m Elizabeth Tracey.

Let’s say you’ve just been diagnosed with type 2 diabetes, but outside of that condition you have no other health issues. Should you take a newer class of diabetes medicine or will one of the older ones serve you just as well? That’s one issue with a new metanalysis of diabetes medicines, says Johns Hopkins diabetes expert Rita Kalyani.

Kalyani: As someone who has spent a lot of time looking at these trials it is important to recognize that these trials specifically enrolled populations at high risk for cardiovascular disease and whether these findings can be generalized to the general population of people with diabetes we don't have enough evidence to make that statement. And I think because this was meant to look at the outcomes perhaps those nuances of the populations which are important for applicability to real world care may not have been detailed.  :34

Kalyani notes that newer medicine are much more expensive. At Johns Hopkins, I’m Elizabeth Tracey.

If you have type 2 diabetes, what are the best medicines to manage it? A new meta-analysis looks at aggregated data from a number of studies and comes out in favor of the newer classes of drugs. Rita Kalyani, a diabetes expert at Johns Hopkins, describes the results.

Kalyani: They found that as a class SGLT 2 inhibitors and GLP 1 receptor agonists reduced all cause mortality and major adverse cardiovascular events compared to other treatments and when they compared specific combinations such as sulfonylureas and insulin with the newer medications, SGLT 2s and GLP ones for a side effect of interest, severe hypoglycemia, they found that these newer medications also significantly reduced hypoglycemia. Not unexpected.    :32

Kalyani notes that all participants in these studies had risk factors for heart disease, so the results do not apply to everyone with type 2 diabetes. At Johns Hopkins, I’m Elizabeth Tracey.

Cancer of the esophagus can be challenging to treat, and when it’s diagnosed a number of studies are appropriate to fully evaluate the disease. That’s according to Richard Battafarano, director of thoracic surgery at Johns Hopkins.

Battafarano: Undergoing endoscopic ultrasound there's a special probe that can look to see how deep these esophageal cancers travel into the wall of the esophagus. This test is especially important for those patients who felt well and were surprised they had esophageal cancer. All patients will undergo a CT scan of the chest and the abdomen and also a pet CT scan to see if the cancer cells had travelled either to lymph nodes nearby or to places outside of where the esophageal tumor is such as the liver.          :31

Battafarano says these tests help plan surgery as well as determine other modalities that should be employed to treat someone’s esophagus cancer. At Johns Hopkins, I’m Elizabeth Tracey.