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Medscape
15 minutes ago
- Medscape
CATALYST: A Novel Approach to Treating Diabetes
This transcript has been edited for clarity. Akshay B. Jain, MD:Welcome, from the ADA 85th Annual Sessions in Chicago. I'm endocrinologist Akshay Jain, from University of British Columbia in Vancouver. With us today is Dr Vivian Fonseca, professor of medicine at Tulane. Welcome, Dr Fonseca. Vivian Fonseca, MD: Hi there. Thank you for asking me to join you. Jain: Dr Fonseca, you're presenting the results of the CATALYST study. Tell us a little bit more about the study. Fonseca: The CATALYST study is a very novel approach to treating diabetes. We took people with uncontrolled diabetes despite taking many medications, including insulin, GLP-1 receptor agonists, dual agonists, SGLT2 inhibitors, and metformin. They also had many medications for hypertension. We asked the question as to whether cortisol was elevated and nonsuppressed in this population. We did a very simple overnight, 1-mg dexamethasone suppression test in a little over 1000 people. We were very surprised to find that 24% of them had a cortisol that did not fully suppress. They met the criteria for hypercortisolism as recommended by the European and the US endocrine societies today, at more than 1.8. Jain: That's a staggering number. Fonseca: That is a staggering number. It was quite a surprise to me and my colleagues. Jain: Once you identify these individuals, what's the next step for them? Fonseca: For the next steps, there is a range of things to do. If you identify hypercortisolism, you want to see whether there's an adrenal tumor or something like that. We did CT scans of the abdomen in that population, and one third of them had some abnormality. Not all of them had a tumor that was surgically resectable. Some had bilateral disease, and some just had thickening, which you would just wait and watch. Here, you have a population with hypercortisolemia at a higher rate than expected, with or without an abnormality on imaging. Some of them were surgically treatable, but for this particular study, we chose to take that group of people and treat them medically. There is a wide variety of medicines available for treating elevated cortisol, which have mainly been tested in Cushing syndrome. Mifepristone is a nonspecific steroid hormone receptor blocker that's known to block cortisol action and is approved for treating hyperglycemia in people with hypercortisolism. It was okay to actually test it in this population, so we did a randomized trial, randomizing those people with hypercortisolemia in a 2:1 ratio to mifepristone or placebo and following them for 24 weeks. Jain: What were the results? Fonseca: Again, another very surprising result. The A1c fell by 1.47%, almost 1.5% from the baseline of 8.5%. That is a very, very robust response. What I like about it is that this is not giving it to everybody with diabetes. You're using what I would call precision medicine. You find an abnormality, you treat that abnormality, and you get a very good result. There were a few other spinoff things. The weight fell significantly. The waist circumference declined significantly. There were also side effects that are consistent with the mifepristone side effect profile. The potassium fell. You get hypokalemia because the cortisol levels don't fall. They rise because you're blocking the receptor and you stimulate the mineralocorticoid receptor. The blood pressure went up a little bit, but it was still mostly at goal in most of the patients. You can treat that hypokalemia, so I won't go into that. We also had what we call glucocorticoid withdrawal syndrome. People on steroids who just stop, when you treat Cushing syndrome, or any of the medications for hypercortisolemia will give you a feeling of withdrawal of the steroid that you're used to. Those are to be expected. The side effect profile shows expected side effects in many people. But still, we can get around it and get a very good result on diabetes treatment. Jain: This is fascinating. We are unmasking hypercortisolemia as an underlying reason for insulin resistance. Fonseca: I wouldn't say unmasking. We are recognizing it in a novel way for the first time, and are able to treat people who we were throwing many drugs at [the problem] — wasting those drugs, if you ask me — when we were not treating the fundamental problem. Jain: When should clinicians think about this as an underlying issue? Fonseca: The way I translate every clinical trial, you do it for what the trial was done for. You have people who are uncontrolled, or you may say difficult to control, uncontrolled or on many medications. Often, you find comorbidities. They have had this problem for a while. Many of them have complications of diabetes, and a significant number had heart disease. You treat them with a very specific treatment, and you get a good result. Now, in some people the treatment may be surgical. You could use this drug or other drugs, and there are some new ones. This has become an important target for therapy, so we will see this approach. That also leaves the question as to [the fact that] there were 24% with this abnormality. What's happening in the other 75%? Maybe there are other abnormalities that we haven't recognized. I think you and I still have a large amount of work to do. Jain: We do indeed. Your target population was individuals with type 2 diabetes. Fonseca: Type 2 diabetes that was not controlled. Jain: Do you think this could be an underlying problem in type 1 diabetes as well? Fonseca: Hypercortisolism can occur in anybody. If you're finding many challenges in type 1 diabetes, you could do it. Obviously, people who are not doing well in their general health without diabetes could have hypercortisolism. This is not what we recognize as the textbook Cushing syndrome. These people did not have those features. The obesity was mild and low central. They had little features, but not the full-blown textbook description, which comes after many years of having very severe hypercortisolism. Jain: For those individuals who, say, are on birth control, would you then recommend doing a urine test? Fonseca: That's a very important question. We excluded those people from the study because you get a false elevation due to raising cortisol-binding globulin with estrogen. We did it in people who had a probability based on some anecdotal things and studies in Europe that were done before, and also excluding people who would have a false positive or a false negative, such as [those with] estrogen use. We don't know how to really identify those people well, without stopping the therapy. Jain: Any final key pearls of wisdom from this trial? Fonseca: I think, like anything that's new, it's exciting. Many of these people were very glad that we found an abnormality. I mean, it sounds bad, but they were blaming themselves, they were being labeled as noncompliant, and they were very frustrated with this. Jain: And the medication burden that they were facing. Fonseca: We actually withdrew a number of medications on several people. Jain: Great. Those are the results of the CATALYST trial. Thank you so much, Dr Fonseca, for joining. Fonseca: Thank you. It's a pleasure to be here.
CNET
15 minutes ago
- CNET
A Ring and a Smart Bed Tracked My Sleep for 30 Nights. Here's What I Learned
Did you know CNET has a dedicated sleep team? Over the years, we've tested around 350 mattresses from dozens of brands. We've tried numerous bedding items, including pillows, sheets, blankets, comforters and more. We've researched and reviewed countless sleep-related products, from white noise machines and sleep masks to supplements and bedtime mocktails. If there's an obscure "sleep hack" trending on social media, you can bet we've given it a shot. CNET's sleep team tests and reviews much more than just mattresses. Cole Kan/CNET We aim to sort through the overwhelming amount of sleep-related information available online to find what works -- and help you avoid the things that don't. Everyone has varying health needs and sleep preferences, so there's no one-size-fits-all approach to enhancing sleep quality. Still, we do our best to back our conclusions with actual sleep data, which is why it's essential for us to use accurate sleep trackers. Our CNET sleep editors have tested various trackers over the years to find those that work best for each of us. Types of sleep trackers The most accurate sleep test is a polysomnography, which is conducted in a lab. It uses sensors to monitor physiological factors such as brain waves, eye movements, heart rate, etc. It's extremely precise -- but it's not practical for everyday use. Most people who receive a polysomnography only do so because they're being tested for a sleep disorder. While not as accurate as PSG and unable to diagnose sleep disorders, many other types of sleep trackers are available for everyday use. They come in all shapes and sizes, from wearable rings and watches to mattress covers or pads. Dr. Carlos Nunez, chief medical officer at Resmed, explains, "Many wearable devices allow you to track your sleep patterns, such as bedtime, wake time, how often you wake up at night and some even track your sleep stages, like REM. Tracking these metrics over time can offer insights into the quality of your sleep health and empower users to make lifestyle changes to improve sleep and overall health." As part of our 30-night mattress testing series, my partner and fellow CNET sleep expert Dillon and I have tested several trackers, including Whoop, Apple Watch, Garmin, Eight Sleep and Oura. We've found wearables generally more accurate than devices you lie on, such as sleep tracking bed frames or mattress covers. Given that information, I have to admit that I was surprised by the results of our experiment testing the Oura Ring against our Sleep Number smart bed. An example of the nightly sleep data provided by my Whoop band. Aly Lopez/CNET Comparing Oura and Sleep Number Dillon and I recently tested the Sleep Number ClimateCool smart bed. This high-tech setup uses integrated sensors and SleepIQ technology to monitor body movements, sleep data and biosignals such as heart rate, breath rate and heart rate variability. Read more: 90-Night Review of the Sleep Number ClimateCool Smart Bed The cover is pulled back to show the tracking sensors running across the top third of the Sleep Number smart bed. Aly Lopez/CNET It tracks sleep metrics such as total time in bed, restful sleep, restlessness, bed exits and the times you fall asleep and wake up. The Sleep Number app collects and displays all this information, providing actionable insights and tips to help you improve your sleep quality. Dillon and I began wearing the Oura Ring 4 while testing our Sleep Number bed. This allowed us to compare and contrast our sleep data and assess the accuracy of both. Oura is widely considered one of the most precise wearables for tracking sleep, thanks to its placement on your finger near the radial artery for heart rate sensing. It tracks more than sleep, monitoring your fitness and activity, menstrual cycle, stress levels and more. For this review, I'll focus on the sleep and biosignals offered by each. Dillon and I have been wearing Oura rings to bed each night to compare our data with Sleep Number. Aly Lopez/CNET Oura offers a bit more detailed sleep data than Sleep Number, including the time spent in light, REM and deep sleep. Knowing when and how much time you spend in each stage provides valuable insights into your overall sleep quality, especially if you struggle with insomnia or other sleep disorders. The symptoms of insufficient REM and deep sleep are similar. Oura's breakdown of these sleep phases can provide more helpful information if you struggle to get quality rest. However, it's important to remember that you shouldn't try to interpret this data on your own. "If you're interested in more advanced data like REM versus deep sleep, sleep apnea detection or unusual breathing patterns, consult your doctor. Sleep trackers are a helpful tool, but not diagnostic devices. Medical guidance is essential for interpreting deeper metrics or addressing potential sleep health concerns," explains Nunez. Sleep trackers compared Sleep Number vs. Oura Ring 4 Metrics Oura Ring Sleep Number Overall sleep score ✓ ✓ Total sleep time ✓ ✓ Time awake ✓ ✓ Time in bed ✓ ✓ Sleep latency ✓ ✓ Heart rate variability ✓ ✓ Heart rate ✓ ✓ Respiratory rate ✓ ✓ Movement ✓ ✓ Helpful insights ✓ ✓ Recovery index ✓ x Light sleep ✓ x REM sleep ✓ x Sleep efficiency ✓ x Body temperature ✓ x Blood oxygen ✓ x Readiness score ✓ x Bed exit x ✓ At the beginning of our test, I didn't have high expectations for Sleep Number's tracking capabilities. However, when comparing the numbers with Oura, the results were surprisingly similar (for the most part). As you can see in the nightly sample below, Oura reported 6 hours and 42 hours of total sleep, while Sleep Number reported 6 hours and 44 minutes. Oura said I spent 44 minutes awake, while Sleep Number reported 38 minutes of restlessness. While it's hard to pinpoint the exact moment on either app, both Sleep Number and Oura reported my sleep and wake times within minutes of each other. Comparison of my sleep data from the Oura Ring (left) and the Sleep Number ClimateCool bed (right). Aly Lopez/CNET/Oura/Sleep Number Oura indicated my total time in bed was 7 hours and 25 minutes, while Sleep Number noted 7 hours and 35 minutes. Sleep Number gave me a SleepIQ score of 80; Oura gave me a 78. As expected, there were nights when the data did not match this well. In those scenarios, Sleep Number almost always displayed the more generous sleep scores and total time slept. Part of this discrepancy is because the Sleep Number smart bed occasionally assumes I've fallen asleep while watching television or reading, while Oura recognizes I have not yet entered dreamland. The bed may sometimes mistake Dillon's body movements or our dog's as mine, whereas our Oura rings don't have that issue. Read more: I Tested Three Sleep Trackers for 30 Days. Here's the One I'd Actually Use Sleep data compared External factors occasionally affected our sleep quality, resulting in data that didn't accurately reflect Oura or Sleep Number's tracking capabilities. An example is when I'd fall asleep on the couch and then move to the bed in the middle of the night. There were a few nights when I put my ring on its charger and forgot to put it back on before falling asleep. Additionally, factors like illness or menstrual cramps sometimes make me uncomfortable enough to sleep somewhere other than our smart bed. I excluded these nights to ensure the accuracy of this comparison. As a result, the sleep data presented here is not perfectly consecutive. Instead, to paint a better picture of how they track, it includes 30 nights of solid sleep on our Sleep Number smart bed while wearing Oura. Using both trackers for 30 nights, Oura reported an average total sleep of 7:35 hours (7.58), and Sleep Number reported 7:36 hours (7.60) -- just one minute difference. Aly Lopez/CNET For 30 nights using both sleep trackers, the average total sleep reported was only one minute apart: 7 hours and 35 minutes according to Oura, and 7 hours and 36 minutes according to Sleep Number. Both reported an average of exactly 1 hour of restlessness or time awake per night. Sleep Number gave me an average sleep score of 86, and Oura gave me 82. The health metrics tracked were also similar: Sleep Number reported my average resting heart rate as 53, and Oura indicated it as 52. Both trackers registered an average breath rate of 17. Oura reported my average heart rate variability to be 64, while Sleep Number reported it as 124. This discrepancy isn't necessarily because one brand is more accurate than the other, but because they calculate HRV differently. Both measure the time intervals between heartbeats throughout the night, but Oura uses a method called Root Mean Square of Successive Differences, while Sleep Number uses Standard Deviation of NN Intervals. Regardless of how it's calculated, higher HRV numbers are considered better, indicating good recovery and physical adaptability. Lower HRV numbers can be indicative of high stress levels, dehydration, alcohol consumption, poor sleep and more. Here's an example of the biosignals reported in Sleep Number's monthly summary. Aly Lopez/CNET/Sleep Number Why does tracking your sleep matter? As Vanessa Hill, PhD, sleep research and specialist, explains, "Tracking your sleep can offer helpful insights into what happens after your head hits the pillow. For many of us, sleep can feel poor quality, maybe because of fragmented sleep or nighttime awakenings. Tracking can show whether you're actually getting the recommended 7 to 9 hours a night." Observing your biosignals over time helps explain how your habits and lifestyle impact your sleep quality and patterns. For instance, my sleep quality on nights after consuming alcohol, not exercising during the day or going to bed later than usual is always worse, and it's reflected in my lower HRV numbers on both trackers. "What's more valuable than a single night's data is looking at sleep trends over time. A month or more of sleep tracking gives a better picture of your overall sleep health," adds Hill. If you're just beginning your sleep tracking journey, making sense of all the numbers can be overwhelming. Nunez recommends starting with the following basics to help you build a consistent sleep routine and improve your sleep health overall: Sleep-wake times: Track what time you go to bed and wake up each day. Research shows that a consistent sleep schedule is key to improved focus, productivity and mood. Track what time you go to bed and wake up each day. Research shows that a consistent sleep schedule is key to improved focus, productivity and mood. Total sleep duration: Aim for the recommended 7-8 hours of sleep each night. Aim for the recommended 7-8 hours of sleep each night. Time awake during the night: Frequent disruptions may signal restlessness or a potential health condition worth exploring with a medical professional. Frequent disruptions may signal restlessness or a potential health condition worth exploring with a medical professional. Sleep interruptions: Noting events like snoring or movement can provide added context to your sleep quality. Noting events like snoring or movement can provide added context to your sleep quality. Trends over time: Focus on patterns, not a single night's data, to make more meaningful lifestyle changes. What sleep tracker should you use? The type of sleep tracker you should use largely depends on your personal preferences and the health information you're looking to uncover. If you're not a fan of wearing a device to bed, such as a wristband or ring, consider a sleep-tracking mattress cover or pad like the Withings Sleep Tracking Mat, which was chosen as the best non-wearable tracker by our CNET sleep editors. There are many types of sleep trackers on the market, as CNET sleep editor Caroline Igo shows here. Caroline Igo/CNET Nunez explains, 'When considering a sleep tracker, it's important to note there is no one-size-fits-all. When choosing one, you can consider: Comfort: You need to be able to easily sleep in it consistently. You need to be able to easily sleep in it consistently. Compatibility: Check that it works well with your smartphone or other devices to access the data without challenges. Check that it works well with your smartphone or other devices to access the data without challenges. Reliability: Some devices have been well-tested and approved by the FDA for sleep monitoring, while others are more general consumer products. Some devices have been well-tested and approved by the FDA for sleep monitoring, while others are more general consumer products. Privacy: Understand how your data is stored and shared. Ultimately, the best tracker is one you'll wear regularly, and that makes accessing and understanding your data simple.' The bottom line If you have a Sleep Number bed and are wondering how accurate the sensors are, I'm pleased to share that they appear pretty dang precise. I had not been expecting the results of this 30-night comparison between the Oura Ring 4 and Sleep Number ClimateCool smart bed to be so similar. Still, there's much more room for error with trackers like smart beds and mattress covers compared to a wearable worn tightly on your body. If you're looking for one of the more accurate sleep trackers, I recommend opting for a wearable like Oura or Whoop -- but as Hill put it, "Choosing a sleep tracker really comes down to comfort and budget. Choose what works best for you, including something you'll actually use."
Fast Company
15 minutes ago
- Fast Company
Pura Scents recalls more than 850,000 diffuser covers over ingestion hazard to children
Pura Scents is recalling more than 850,000 diffuser covers because some magnets may detach and cause a possible ingestion hazard to children. The company is recalling the detachable covers for about 851,400 Pura 4 Smart Home Fragrance Diffusers. It said an additional 1,100 were sold in Canada. Pura Scents said that the magnets on the inside cover of the product can detach, posing an ingestion hazard to children. When high-powered magnets are swallowed, the ingested magnets can attract each other, or other metal objects, and become lodged in the digestive system. This can result in perforations, twisting or blockage of the intestines, infection, blood poisoning and death. The company has received three reports of magnets detaching from the cover. No injuries have been reported. The diffusers were sold at Target, Scheels and other stores nationwide from August 2023 through May 2025 for about $50. They were also sold online through Pura's website, as well as online at Amazon, Target and Scheels. Pura Scents is offering a free replacement cover. Consumers are advised to immediately dispose of the existing detachable cover and to keep the diffusers out of the reach of children and pets. To receive the free replacement cover, individuals may contact Pura Scents at 855-394-5292 from 9 a.m. to 5 p.m. MT Monday through Friday. The company can also be emailed at replacement@ Consumers may also visit the company's website and click on 'Recall' at the bottom of the page for more information.
