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    What to Know About CKM, the Link Between Heart Health, Diabetes and Kidney Disease

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    And they’re increasingly common. Here’s what to know about the shared risk factors for these diseases.Heart disease, diabetes and kidney disease are among the most common chronic illnesses in the United States — and they’re all closely connected.Adults with diabetes are twice as likely to have heart disease or a stroke compared with those who don’t have diabetes. People with diabetes — Type 1 and Type 2 — are also at risk of developing kidney disease. And when the kidneys don’t work well, a person’s heart has to work even harder to pump blood to them, which can then lead to heart disease.The three illnesses overlap so much that last year the American Heart Association coined the term cardiovascular-kidney-metabolic syndrome to describe patients who have two or more of these diseases, or are at risk of developing them. A new study suggests that nearly 90 percent of American adults already show some early signs of these connected conditions.While only 15 percent of Americans meet the criteria for advanced stages of C.K.M. syndrome, meaning they have been diagnosed with diabetes, heart disease or kidney disease or are at high risk of developing them, the numbers are still “astronomically higher than expected” said Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Women’s Hospital in Boston and co-author of the study.The research suggests that people should pay attention to shared risk factors for these diseases early on — including excess body fat, uncontrolled blood sugar, high blood pressure and high cholesterol or triglyceride levels.A Dangerous CycleYour kidneys, heart and metabolic system (which helps process the food you eat into energy and maintains your blood sugar levels) work closely together. If something goes awry with one, it can lead to problems with the others.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      How Ozempic Is Changing Diabetes Treatment

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      Millions of patients rely on insulin. But with new drugs, some have been able to lower their doses or stop taking it altogether.For over 20 years, Betsy Chadwell carried her insulin pens everywhere. Day in and day out, she carefully calibrated the doses needed to keep her Type 2 diabetes in check. “Every meal, and every morning and every night — it controls your life,” she said.In late 2021, she started on the diabetes drug Ozempic. Within months, she was able to stop taking the short-acting insulin she typically took before each meal altogether, and she has substantially reduced the dose of long-acting insulin she uses daily. Scaling back on insulin has given her a sense of freedom, she said. She still uses a continuous glucose monitor to track her blood sugar, meticulously watching for slumps and spikes — but even as she took less insulin, she said, Ozempic has helped keep her glucose levels more under control.Millions of Americans rely on some form of insulin, a lifesaving drug that has long been a mainstay of diabetes treatment. But it can also be a burden to patients like Ms. Chadwell, who must juggle different formulations and doses, and often must have insulin on hand at all times. “I really feel for those patients, because you can never stop having it in the back of your mind,” said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity. But in recent years, Ozempic and a similar drug, Mounjaro — both weekly shots that can lower blood sugar, in part by mimicking a hormone that stimulates insulin production — have offered patients an enticing new option to try managing their Type 2 diabetes without relying as heavily on insulin.And drugmakers are examining other ways these drugs might work alongside insulin: Novo Nordisk, the company that makes Ozempic, is studying a new drug called IcoSema, a weekly shot that combines insulin icodec (an ultra long-acting version of insulin) and semaglutide, the compound in Ozempic.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      PCOS Diets Are Unlikely to Ease Symptoms

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      Patients were told for years that cutting calories would ease the symptoms of polycystic ovary syndrome. But research suggests dieting may not help at all.For years, people who had polycystic ovary syndrome and were also overweight were told that their symptoms would improve if they lost weight via a restrictive diet. In 2018, a leading group of PCOS experts recommended that overweight or obese women with the hormonal disorder consider reducing their caloric intake by up to 750 calories a day. That guidance helped to spawn questionable diet programs on social media, and reinforced an impression among people with PCOS that if only they could successfully alter their diets, they would feel better.But the recommendations were not based on robust PCOS studies, and researchers now say that there is no solid evidence to suggest that a restrictive diet in the long-term has any significant impact on PCOS symptoms. Dieting rarely leads to sustained weight loss for anyone, and for people with PCOS, losing weight is particularly difficult. Beyond that, the link between sustained weight loss and improved symptoms is not very clear or well-established, said Julie Duffy Dillon, a registered dietitian specializing in PCOS care.In 2023, the same group, called the International PCOS Network, revised its guidance based on a new analysis of the research and dropped all references to caloric restriction. The group now recommends that people with PCOS maintain an “overall balanced and healthy dietary composition” similar to the Mediterranean diet, which is associated with a reduced risk of the health issues that are linked to the disorder, like cardiovascular disease and diabetes. It’s not known whether eating this way might improve symptoms of PCOS. The changes in the guidelines reflect “the PCOS literature and the lived experience of people with the condition,” said Dr. Helena Teede, an endocrinologist at Monash Health in Australia and lead author of the 2023 guidelines. “It’s no longer about blaming people or stigmatizing them, or suggesting that it’s their personal behavioral failure that they have higher weight.”What is PCOS?PCOS is a hormonal disorder that affects as many as five million women in the United States. It’s characterized by irregular periods, infertility, excessive facial hair growth, acne and scalp hair loss — symptoms that are common with other health conditions, too, making diagnosis tricky. People with PCOS usually ovulate less than once a month and often also have higher levels of androgens (male sex hormones) or multiple underdeveloped follicles on their ovaries (not, as the name suggests, cysts) or both.Typically, when a woman is experiencing symptoms, a doctor will either scan the ovaries to look for those follicles or draw blood to test hormone levels. There is no cure for PCOS; the first line of treatment is often some form of birth control to help regulate the menstrual cycle.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Are You Starting Ozempic or Another GLP-1? We Want to Hear From You.

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      The New York Times is looking to speak with people who are about to start GLP-1 medications such as Ozempic and are open to allowing us to chronicle their experiences.Have you tried numerous avenues to help your chronic illness, obesity or mental health and turned to Ozempic, Wegovy or another GLP-1 drug to address these issues? The New York Times wants to chronicle the journeys of people who are about to start taking one of these medications or who are losing access to them. We’re especially interested in hearing from groups of people, such as friends or families, that are taking these drugs as a group.We will keep all responses confidential and will reach out to respondents whose stories we’d like to learn more about. We will only use your contact information to follow up with you and will not share it outside the Times newsroom. More

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      6 Reasons That It’s Hard to Get Your Wegovy and Other Weight-Loss Prescriptions

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      An array of obstacles make it difficult for patients to obtain Wegovy or Zepbound. Finding Wegovy is “like winning the lottery,” one nurse practitioner said.Talk to people who have tried to get one of the wildly popular weight-loss drugs, like Wegovy, and they’ll probably have a story about the hoops they had to jump through to get their medication — if they could get it at all.Emily Weaver, a nurse practitioner in Cary, N.C., said she told her patients that finding Wegovy was “like winning the lottery.”Here are six reasons why.1. Demand is very high.Fueled in part by TikTok videos and celebrity testimonials, people are increasingly seeking prescriptions for appetite-suppressing medications. The drugs in this class have long been used to treat diabetes but more recently have been recognized for their extraordinary ability to help patients lose weight. The medications are injected weekly and have sticker prices as high as $16,000 a year.About 3.8 million people in the United States — four times the number two years ago — are now taking the most popular weight-loss drugs, according to the IQVIA Institute for Human Data Science, an industry data provider. Some of these prescriptions are for diabetes. The medicines are Novo Nordisk’s Ozempic and Wegovy (the same drug sold under different brand names), and Eli Lilly’s Mounjaro and Zepbound (also the same drug).We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      DeSantis Bows Out, and So Does This Winter Freeze

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      The New York Times Audio app is home to journalism and storytelling, and provides news, depth and serendipity. If you haven’t already, download it here — available to Times news subscribers on iOS — and sign up for our weekly newsletter.The Headlines brings you the biggest stories of the day from the Times journalists who are covering them, all in about five minutes.The Florida governor, who once appeared to be Donald Trump’s most daunting challenger, ran a costly and turbulent campaign that failed to catch on with Republican voters.Nicole Craine for The New York TimesOn Today’s Episode:Ron DeSantis Ends Campaign for President, by Nicholas Nehamas, Maggie Haberman, Jonathan Swan and Shane GoldmacherAs U.S. and Militias Engage, White House Worries About a Tipping Point, by Peter BakerAt Least 72 Deaths in U.S. Are Connected to Severe Winter Weather, by Jacey Fortin and Colbi EdmondsF.A.A. Tells Airlines to Check Panels on a Second Boeing Plane, by Mark WalkerDiabetes Is Fueling an Amputation Crisis for Men in San Antonio, by Edgar SandovalNicholas Nehamas and Jessica Metzger and More

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      An Anti-Obesity Drug and Cultural Stigmas

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      More from our inbox:Seeking More Insight Into Republican VotersScandal at Liberty UniversityFree Analysis? Alice Rosati/Trunk ArchiveTo the Editor:Re “Ozempic Can’t Fix What Our Culture Has Broken,” by Tressie McMillan Cottom (column, Oct. 15):By “broken” in the headline, the column implies that we still perpetuate a cultural bias against obese people.Yes, we do stigmatize fat people. I’m fat. What’s also broken, though, is our habit of blaming society for failing to accept us, and medical institutions for failing to fix us, before we take an honest look at our own choices contributing to becoming unhealthy in the first place.Clearly obesity is an epidemic with complex environmental, economic and genetic factors. But for most, physical activity and healthy eating are still nature’s best prevention and remedy. Unlike Ozempic, they’re not a sexy quick fix. They’re work.Maybe healthy eating and activity are just too simple. But viewing ourselves first as victims of unfair systems is also not the answer.Society will always judge. Institutions will always be profit-driven. Blaming is easy. Honest self-assessment and changing habits are hard.Leslie DunnCarmel, Calif.To the Editor:Tressie McMillan Cottom’s fine column covers almost all the issues that I, as a slightly overweight but not obese woman, have with the new weight-loss drugs.But one issue needs to be addressed: What will we think about and how will we treat people (women) who choose not to take this drug, for whatever reason? Maybe it’s because it’s too expensive; maybe because it’s a commitment to a lifetime of taking the drug; maybe it’s just, amazingly, because they are comfortable in their rounded, plush bodies, and don’t desire to change them. Will they face even more opprobrium for that choice than they already do?I’ve spent the last 66 years (and counting) being told that my body isn’t “right,” by doctors, family and society. I’ve just finally come to terms with the fact that I’m stuck in it, and I’m lucky to be able to wake up every morning and get out of bed. Isn’t that enough?Naomi Weisberg SiegelPittsburghTo the Editor:While I agree with the author on many points, one point she didn’t address effectively is that Ozempic and other weight-loss drugs help cover up a main culprit that is causing our obesity: the U.S. food industry and “ultraprocessed foods.”Up until about the 1980s the U.S. didn’t have such a serious obesity problem. Then sugar began being added to everything, along with other things not found in any garden or kitchen.Dr. McMillan Cottom points out that people can be obese and be healthy, but that is not true of most obese people. Ozempic was created because of rampant diabetes in the U.S., the risk of which is increased by eating ultraprocessed foods.Our food industry is killing us with slow deaths from chronic diseases.Deborah JerardMontpelier, Vt.The writer is a pediatrician.Seeking More Insight Into Republican VotersWhy These 11 Republican Voters Like Trump But Might Bail on HimThe group discusses what it would take for a candidate other than Trump to win their vote.To the Editor:Re “Could These Republican Voters Abandon Trump?” (“America in Focus” series, Opinion, Oct. 22):This piece was disturbing but unenlightening about why voters support Donald Trump.Focus groups are supposed to probe for deeper understanding of participants’ views, yet your moderator accepted answers without delving into how participants reached those views.For example, when Cristian said about Donald Trump that “he does get things done,” the moderator could have asked for specifics. It would have been an interesting answer because Mr. Trump actually got very little done.The most glaring omission was Mr. Trump’s false claims of a stolen 2020 election. Do participants agree with Mr. Trump? Where do they get their news? Does this issue even matter to them?We have known for months that Mr. Trump maintains strong voter support. We might have gotten some insight into why had the moderators asked more clarifying questions.Ann LaubachAustin, TexasTo the Editor:First, I will applaud both Kristen Soltis Anderson for her skilled questions and moderation, as well as Patrick Healy and the Times Opinion team for sticking with your amazing series, most recently “Could These Republican Voters Abandon Trump?” Fascinating stuff.But just like the infamous CNN town hall with Donald Trump, it leaves an urgent set of questions. Mainly these:1. What about the criminal cases against Mr. Trump?2. What about climate change and the green agenda?Without understanding in depth these 11 Republicans on these topics, I just don’t see how I can evaluate. Of course, I recognize that these individuals have most likely completely dismissed these entire areas of thought. Nonetheless, to understand the situation in my country, I need to see what rationales they are using to do that.George OdellNewburyport, Mass.Scandal at Liberty University Julia Rendleman for The New York TimesTo the Editor:Re “The Worst Scandal in American Higher Education,” by David French (column, Oct. 23):Thank you to Mr. French for bringing the truly appalling behavior of Liberty “University” officials to our attention. Yet while he reports that the $37.5 million fine Liberty might face would be “unprecedented,” I can’t help but wonder why the Department of Education wouldn’t strip Liberty of its accreditation altogether, making it ineligible to receive federal money.Such a move is long overdue, and not just because Liberty has lied about campus crime and pressured victims of sexual assault to stay quiet. Liberty, and a host of other Christian institutions, are not colleges in the critical sense. These are places where answers precede questions, where intellectual exploration is hemmed in by theological dogma, and where basic tenets of academic freedom are treated as optional.Why should taxpayers be funding education at such places at all?Steven ConnYellow Springs, OhioThe writer is a professor of history at Miami University.Free Analysis?James AlbonTo the Editor:“How Do You Charge a Friend for a Professional Favor?” (Business, nytimes.com, Oct. 21): Another favor-asking situation that commonly occurs is asking physicians, be they friends or a recent acquaintance at a social event, for free medical opinions or even advice. The many ways of handling those situations would warrant an entire New York Times article.There is another common experience that occurs when one is introduced to someone as a psychiatrist, psychoanalyst or therapist in nonprofessional settings.Such introductions often evoke the question, “Are you analyzing me?” To which I almost always respond, “Not if you’re not paying me.” And we move on.Jack DrescherNew YorkThe writer, a psychiatrist and psychoanalyst, is past president of the Group for Advancement of Psychiatry. More

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      Drugmaker Eli Lilly says it will cut insulin prices by 70%

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      Drugmaker Eli Lilly says it will cut insulin prices by 70%Move comes amid criticism of healthcare companies over rising costs of insulin, as CEO says cuts ‘should be the new standard’Eli Lilly will cut list prices by 70% for its most commonly prescribed forms of insulin, Humalog and Humulin, beginning from the fourth quarter of this year, the drugmaker said on Wednesday.The move comes amid criticism of healthcare companies by US lawmakers over rising costs of insulin, with Joe Biden’s signature Inflation Reduction Act including a $35 cap on insulin for those enrolled in Medicare health insurance plans.More than a million Americans ration insulin due to high costsRead more“While we could wait for Congress to act or the healthcare system in general to apply that standard, we’re just applying it ourselves,” the company’s chief executive, Dave Ricks, told CNN in an interview.The drugmaker will also lower the price of its non-branded insulin injection Lispro to $25 a vial and expand its Insulin Value Program, under which the $35 cap will apply to about 85% of US pharmacies.Rick said patients using other pharmacies that do not participate in the program can get a rebate through the drugmaker’s website.He said the price cuts “should be the new standard in America” and called on other companies and stakeholders “to meet up at this point”.“Insulin has become such a pivotal issue because of affordability,” Rick said.About 8.4 million of the 37 million people in the United States with diabetes use insulin, according to the American Diabetes Association.Eli Lilly, along with Sanofi and Novo Nordisk, makes up 90% of the US market for insulin.Drugmakers had previously priced insulin at more than $275 a vial, representing a 1,200% increase in price over the past 20 years, according to the advocacy group Insulin Initiative.TopicsPharmaceuticals industryDiabetesUS politicsnewsReuse this content More

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      A Resonant Topic in Georgia’s Senate Runoff: Insulin Prices

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      The cost of insulin is nowhere near as contentious as just about everything else raised in the runoff, but in a state with a high diabetes rate, it has proved a powerful issue.MACON, Ga. — The runoff election for Senate in Georgia has not lacked for drama, with a fresh round of attack ads, a fevered get-out-the-vote effort and both sides casting the outcome as pivotal for the nation’s future even though control of the chamber is no longer at stake.But one campaign issue relevant to many voters has little to do with the highly partisan horse race. Rather, it involves one of the most common chronic diseases in America, diabetes, and the soaring cost of the medicine used to treat it, insulin. In both the general and runoff campaigns, Senator Raphael Warnock, the Democratic incumbent, has made much of his efforts in Congress to cap the price of insulin at $35 a month, talking them up in ads, debates and speeches.“It has resonated with just about everyone,” said Dr. Kris Ellis, a physician who also owns the Bearfoot Tavern in Macon, where Mr. Warnock made a recent campaign stop. “If you don’t have diabetes, you know someone with diabetes.”He was describing an unsettling reality in Georgia, as in much of the South, where diabetes rates are staggeringly high and the escalating cost of insulin over the years has led to painful choices and, for some, catastrophic consequences.“I have someone in my family with diabetes who couldn’t afford insulin,” Tony Brown, 57, said on a recent afternoon as he walked into a building in downtown Macon where he works as an engineer. For that reason, he said, he would turn out one more time to vote for Mr. Warnock in Tuesday’s runoff.As campaign issues go, the price of insulin is nowhere near as contentious as just about everything else raised in the four-week runoff between Mr. Warnock and Herschel Walker, the former football star who is his Republican challenger. Even so, interviews with Dr. Ellis and a number of other voters suggested it had broken through the noise of the high-decibel contest, which Georgia requires because neither candidate won a majority of the vote in the general election.“I have someone in my family with diabetes who couldn’t afford insulin,” Mr. Brown said.Nicole Craine for The New York TimesMr. Warnock has focused on lowering insulin prices since arriving in the Senate nearly two years ago, motivated in part by hundreds of letters that have poured into his office, pleading with him to do something. He has also described seeing the ravaging impacts of diabetes, including losing limbs and eyesight, on congregants at Ebenezer Baptist Church in Atlanta, where he is the senior pastor.“This isn’t an ideological matter, it’s a practical one — and it has broad support across the political spectrum,” Mr. Warnock wrote last spring in an opinion essay published in The Atlanta Journal-Constitution.Earlier this year, he introduced legislation that would require both Medicare and private insurers to cap out-of-pocket costs for insulin at $35 a month. The average out-of-pocket cost per prescription reached $54 in 2020, according to an analysis by the Kaiser Family Foundation, which also found that many patients pay significantly more for diabetes care.What to Know About Georgia’s Senate RunoffCard 1 of 6Another runoff in Georgia. More