Samantha LaLiberte, a social worker in Nashville, thought she had made a full recovery from Covid-19. But in mid-November, about seven months after she’d been sick, a takeout order smelled so foul that she threw it away. When she stopped by the house of a friend who was cooking, she ran outside and vomited on the front lawn.“I stopped going places, even to my mom’s house or to dinner with friends, because anything from food to candles smelled so terrible,” Ms. LaLiberte, 35, said. “My relationships are strained.”She is dealing with parosmia, a distortion of smell such that previously enjoyable aromas — like that of fresh coffee or a romantic partner — may become unpleasant and even intolerable. Along with anosmia, or diminished sense of smell, it is a symptom that has lingered with some people who have recovered from Covid-19.The exact number of people experiencing parosmia is unknown. One recent review found that 47 percent of people with Covid-19 had smell and taste changes; of those, about half reported developing parosmia.“That means that a rose might smell like feces,” said Dr. Richard Doty, director of the Smell and Taste Center at the University of Pennsylvania. He noted that people typically recover their smell within months.Right now, Ms. LaLiberte can’t stand the scent of her own body. Showering is no help; the smell of her body wash, conditioner and shampoo made her sick.What’s more, she detected the same odor on her husband of eight years. “There is not a whole lot of intimacy right now,” she said. “And it’s not because we don’t want to.”“It’s a much bigger issue than people give it credit for,” said Dr. Duika Burges Watson, who leads the Altered Eating Research Network at Newcastle University in England and submitted a journal research paper on the topic. “It is something affecting your relationship with yourself, with others, your social life, your intimate relationships.”“That means that a rose might smell like feces.”Caroline Tompkins for The New York TimesR.I.P. Dinner Dates and ‘Spontaneous Kissing’Many sufferers of parosmia lament the loss of social customs, like going out to dinner or being physically close with loved ones, especially after an already-isolating year.“For me it’s a freaking battle,” said Kaylee Rose, 25, a singer in Nashville. She’s been playing live music in bars and restaurants across the country, and walking into those spaces has become unpleasant. “I was in Arizona for a show, and we went into a restaurant and I almost threw up,” she said. But having to deal with people’s reactions to her condition is almost worse.“My friends keep trying to get me to try their food because they think I am exaggerating.” Now she skips most social gatherings, or goes and doesn’t eat.Jessica Emmett, 36, who works for an insurance company in Spokane, Wash., got Covid twice, once in early July and once in October. Parosmia has been a lingering symptom. “I feel like my breath is rancid all the time,” she said.Before she touches her husband, she uses mouthwash and toothpaste. Even then, she can’t shake the feeling that she stinks. And it’s not just her breath. “My sweat, I can smell it, and it’s altered a bit,” she said.The result: a lot less intimacy. “There is no really passionate, spontaneous kissing,” she said.Her only consolation is that she’s been with her husband for more than 20 years. “How would you explain this to someone you are trying to date?” she said.Dr. Burges Watson said she has come across young people with parosmia who are nervous to make new connections. “They can be repulsed by their own body odors,” she said. “They find it very difficult to think about what other people might think of them.”When Ms. Rose first started experiencing parosmia, her boyfriend didn’t understand it was a real condition. And though more sensitive to her needs now, it still can feel lonely. “I wish for one meal he could be in my shoes,” she said.She has also had family members who think she is overreacting. She remembers one day close to Thanksgiving, when her mother ordered her a special meal with a smell she could tolerate, and her sister accidentally ate it. A fight ensued. “My sister thought I was being overly sensitive,” she said. “That was really frustrating.”Many people with parosmia feel isolated because people around them don’t get what they are going through, Dr. Doty said. “They hope people can relate to their problems, but often they can’t.”Ms. LaLiberte said she can finally sit next to her husband on the couch. “I am still self-conscious about myself though,” she added. “Mine hasn’t improved yet.”Finding a CommunitySome parosmia sufferers have turned to Facebook groups to share tips and vent to people who can relate to their symptoms. “I went to the doctor, and the doctor legitimately looked at me like I was a crazy person,” said Jenny Banchero, 36, an artist in St. Petersburg, Fla., who has had parosmia since early September. “It wasn’t until I joined a Facebook Group that I learned people take this seriously.”Sarah Govier, a health care worker in England who experienced parosmia after getting Covid-19, created Covid Anosmia/Parosmia Support Group over the summer. “The day I opened it in August, five or six people joined,” she said. “By January we hit 10,000 people.” Now it has nearly 16,000 members.Another Facebook group, AbScent, which was started before the pandemic and is associated with a charity organization, has seen increased interest. “People are coming from all over, from South America, Central Asia, Far East Russia, the Philippines, Australia, New Zealand, South Africa, India and Canada,” said Chrissi Kelly, the founder of AbScent.In March, Siobhan Dempsey, 33, a graphic designer and photographer in Northampton, England, posted to the Covid Anosmia/Parosmia Facebook group: “I’m happy to say that I have now got 90 percent of my taste and smell back after almost a year of catching Covid.” She was flooded with congratulatory remarks.It had been a long journey for her. For months, everything had a burning, chemical odor. Vegetables, which made up most of her diet since she is a vegetarian, were intolerable. “Anything sweet was terrible,” she said. “Dr. Pepper, Fanta, it was disgusting.”In the past few weeks, however, she’s noticed a shift. “It sounds cliché, but this past weekend in the U.K. was Mother’s Day, and my partner and 3-year-old boy bought me flowers,” she said. “I was like, ‘These smell really nice.’”

Serious illness and suffering. Fear and fresh awareness of death. The uncertainty they all bring and what, for each, would constitute humane and effective medical treatment. Those physical and emotional concerns, central to palliative care, have forced their way into so many of our lives during the pandemic, even as we edge toward some skewed version of normalcy. They’re also the concerns that Dr. Diane E. Meier has been working on and thinking deeply about for decades. Meier, 68, is the longtime director of the Center to Advance Palliative Care, which is part of New York City’s Mount Sinai Hospital, and a 2008 recipient of a MacArthur Foundation “genius” fellowship. She has been a uniquely qualified observer of the Covid-induced cataclysms — often existential — experienced by patients and physicians. “If ever we needed to be reminded of how important human connection and support is for people with serious illness,” Meier says, “this pandemic has made the point very, very clearly.”

In September, you were quoted in The Washington Post saying that during the pandemic, other physicians have been looking to palliative-care doctors “to be the human side of medicine.” What does that imply about the medical system’s deficiencies? That the public’s experience with the medical profession has been subsumed by the marketplace, where there is enormous pressure on everyone working in the system to see multiple patients in a very short period of time and ensure that the services we offer are well reimbursed. Which is why the pandemic was such a blow to the economy of many health care systems: The major sources of income, which had to do with elective surgical and other procedures, were shut down because of the need to repurpose health systems for masses of people with Covid. The pandemic is the exemplar of why that is such a fragile foundation for a major first-world country’s health care system. The drivers are about doing what is necessary to get paid as opposed to what we thought our profession was all about, which was serving human beings who are suffering. It’s not that my colleagues are uncaring or don’t realize that their relationship with patients is a powerful instrument of healing; my point is not that my colleagues don’t want to be bothered. They can’t bother. So they’re relieved to have palliative-care colleagues who will take the time that they know their patients and patients’ families need. That enables our colleagues to overcome the moral distress and ethical inner conflict that the business side of medicine creates.

Do patients feel differently about palliative care when the need for it is caused by something unfamiliar like Covid-19 as opposed to, say, a cancer diagnosis? The fear and anxiety is completely different. It’s not that getting a diagnosis of dementia or cancer or kidney failure is not frightening. It is, but it’s somewhat normalized. You know people it’s happened to. Whereas the Covid pandemic — there was so much interesting coverage marking the 500,000th death about how invisible all the grieving is and how the whole country is in a state of numbness and denial because it is all too much to take in. It is too much to process. Let’s say that’s been your mind-set: It’s not going to happen to me. Then it does. All that denial falls apart. All that numbness won’t protect you. It is frightening, and compounded by the fact that family members can’t be with patients. One of the largest sources of suffering is the isolation of the patient and that the people who love them best can’t be with them. I will tell you, iPads and iPhones do not substitute.

Dr. Diane E. Meier in her office at Mount Sinai in 1997.
Linda Rosier

Has the pandemic affected our collective attitude toward grief? There are many shadow pandemics. One is the trauma to the entire health profession during this last year. The other trauma is the roughly 10 people for every person who has died from Covid who are grieving. That’s over five million people. That is a shadow pandemic that will be with us long after we get the virus under control. Our current president has worked hard to begin to address that through the ritual ceremonies to remember the dead and honor them, and he has talked a lot about his own losses, to normalize talking about losses and how they’re with you every day. That’s important. We need other people to do it too.

This is a bit of a sidetrack: In December, you published a piece in JAMA Internal Medicine about the “slippery slope” of increased access to physician-assisted death. But I’m still not quite clear why there would be a major concern about people unduly requesting medical assistance with ending their life when, by and large, people don’t want to die. Countries that have enabled euthanasia or assisted suicide have claimed that it has to be totally voluntary, cannot be due to financial or family pressures, cannot be due to untreated or unrecognized depression and cannot be due to untreated, poorly managed pain. They state that, and yet there is no evidence that those are not the major factors driving this. What it takes to adhere to those guidelines is incredibly expensive and time-consuming and doesn’t happen. That’s the situation in the Netherlands and Belgium and Canada: All the heartfelt adherence to restrictions that are announced when you first get the public to vote in favor of this go up in smoke once the practice is validated. And it’s always with the talking points that it’s about relief of suffering, that the person, even though he cannot say this, would agree that he would be better off dead. Ethically, do I think people should have the right to control the timing of their death? I do. I think it’s dangerous public policy. It’s a dangerous path to go down with the claim that it is all about respect for autonomy, when the real drivers are getting rid of a painful and expensive burden on society.

But couldn’t we always say that if people had access to better care then they wouldn’t consider this other option? What if the reality is that access to better care isn’t there? Are we saying to suffering people, “There are ways to still find meaning in life; we just can’t necessarily guarantee you’ll be able to take advantage of them”? There is a real tension there. Our system is so broken. But do we solve that problem by offering them physician-assisted death? I wouldn’t want to be part of that society. There was a recent case in Canada: a guy with neurodegenerative disorder who was cognitively intact. In order to go home from the hospital, he needed 24-hour care, and the government would not pay for 24-hour care. He recorded hospital staff offering him medical aid in dying as an alternative. You think that doesn’t create pressure on people who already feel like burdens? They need to be met with a resounding commitment to continued relationship. Not: “You’re right. I agree you’d be better off dead. Here’s a prescription.” That pushes someone who is struggling right over the cliff.

Might there be a lack of understanding on the part of some advocates of physician-assisted death that while palliative care maybe can’t relieve the entirety of one’s pain, it can still help patients find quality of life? It’s important to disabuse you of the notion that pain is the reason people request medical aid in dying. Pain is not the reason. It is existential and spiritual. The only treatment for that is relationship, attention, sitting with. Not trying to fix. That willingness to be with and engage the person in giving voice to that suffering is such a powerful intervention. It requires training. It’s a procedure. It isn’t about, “We can fix everything.” But we can enable giving voice to profound suffering, and that makes a huge difference.

Meier and a Mount Sinai colleague, Dr. R. Sean Morrison (right), discussing palliative care with Senator Sheldon Whitehouse of Rhode Island in Washington in 2011.
Kevin Wolf/Associated Press, for Center to Advance Palliative Care

Should we think of suffering as inevitable? That’s a great question, and the answer to any great question is “It depends.” It depends on the type of suffering. Dame Cicely Saunders used to talk about “total pain.” It was not just pain or constipation or fatigue or depression or difficulty sleeping. It was issues of purpose, meaning, identity, relationships. So while the practice of medicine is pretty good at the mechanics of treating things that cause tremendous suffering, the existential, spiritual and relationship fundamentals are addressed very often in the purview of palliative care teams. We see that as part of our job. In the rest of medicine, clinicians don’t, and people are left to find their way. If they’re not strongly embedded in a faith community or extended family, it causes tremendous suffering, because meaning comes through relationship. The fear of death is about the loss of relationship with the world and the people in it.

At this stage of your career, are there aspects of the human experience of chronic illness or pain that used to be mysterious to you that you now understand? It has to do with trauma. Trauma is widespread. In wealthy families and poor families; individual and family trauma; community trauma and societal trauma. We have so much of that here — just start with racism and go on. It is repressed and treated with denial. That doesn’t make it go away. It’s controlling how people respond to new trauma, whether it’s a diagnosis or a pandemic or a January 6th. So my perspective on trauma has a bigger scale than it used to — a species-level and tribal-level scale. And as I read the news, I don’t know whether we’re going to evolve our way out of this. The need to hate and kill the other is a determinative human characteristic and it informs so many aspects of our society. I also don’t see a disconnect between what has happened to the practice of medicine and that reality, because what’s happened to medicine is being driven by a societal commitment to profit above all else. And what is that? It’s trauma.

You could imagine somebody rolling their eyes at you, saying “You’re saying capitalism is trauma?” What has happened to the practice of medicine is that the public perception is that it has become totally transactional. That we do things either to make money or to avoid spending money. So, for example, many people of color fear that a conversation about whether or not they want cardiopulmonary resuscitation is not about what’s best for that patient; it’s about saving money for the hospital. Those perceptions are not wrong. That’s the problem. And there’s more than a kernel of truth in the perceptions of people feeling as if they or their loved one is being put through a marketplace of M.R.I.s and P.E.T. scans and specialists and subspecialists, and everybody is billing. The visibility of the extraction mind-set of the practice of medicine — it’s not subtle, and the public knows it. I’m worried about blowing the hard-earned trust that our profession worked toward over hundreds of years through, essentially, the commercialization of health care delivery.

Can you tease out the link you suggested earlier between trauma and killing the other? The analogy is post-traumatic stress disorder: an overreaction to new traumas because the prior traumas were never addressed, never expressed, never worked through. So everything that happens re-triggers it. There’s a book called “The Body Keeps the Score,” and that’s what it’s about: Things that happened to you years ago don’t ever go away. They are embedded in your mind and body and inform how you react to things that happen today. In my typical mechanistic doctor manner, I will tell you that there are things to do about it: It’s called trauma-informed care. It’s literally as simple as asking people what happened to them. What happened during your childhood? Because people know. They’ve just never been asked. And until it is unearthed and respected for the power that it had in that person’s life, it is controlling. The only way to take back control is to bring it to consciousness and name it.

Have you found that there are common positive meanings people find in life when they’re seriously ill that are applicable to those who aren’t? Yes. You may have read people talking about how while they would not wish their diagnosis on anyone, they are grateful for it. Because it made them stop worrying about things that aren’t important and focus on the things that are. That might be putting the garden in or spending time with grandchildren. Or my colleague — she’s 60 — said she’s going to become a bat mitzvah. She’s not sick, but the pandemic focused her on things she had put off. And she realized, What am I waiting for? That process of reflection requires pausing the racing in circles that our normal life tends to be: Get up at 6, go to the gym, go to work, etc. Whether we’re pausing because it has been forced on us by the pandemic or because we have a new diagnosis that requires us to reorganize our days — the busy-ness that has characterized everyday life for most people gets in the way of reflection. But it is a very common phenomenon for people to take the time and reflect about what’s important. People are trying desperately to make room for one’s inner life.

This interview has been edited and condensed for clarity from two conversations.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesBoris Johnson is expected to speak to his EU counterparts this week as a row over Covid vaccine supplies continues.EU leaders will hold a virtual meeting on Thursday to discuss a ban on Oxford-AstraZeneca vaccine exports to the UK – but the PM aims to put the UK’s case in one-on-one phone calls before that.The European Commission president says the EU can “forbid” vaccines made on the continent being sent to the UK.The latest flashpoint appears to be over doses made in a Dutch factory.Meanwhile, the long-awaited results of the US trial of the Oxford-AstraZeneca vaccine, which involved more than 32,000 volunteers, show that the jab is safe and highly effective.Several European leaders paused rollout of the vaccine amid concerns of a possible link with blood clots. UK and EU regulators said there was no evidence the vaccine causes blood clots.The dispute over vaccine exports from the EU and a potential ban comes after European leaders have faced criticism for the slow pace of the vaccine rollout on the continent.Less than 12% of the EU’s population is reported to have received the vaccine, compared with nearly 40% in the UK.PM hails record-breaking day with 844,285 jabsEU should not ‘build walls’ around vaccinesWhy is the EU having vaccine problems?The EU has encountered production problems with the Pfizer-BioNTech, Moderna and Oxford-AstraZeneca vaccines. British-Swedish manufacturer AstraZeneca said the fact that EU contracts were signed later than with the UK caused problems with supplying their vaccine.Downing Street has previously said that it does not believe that vaccine supply issues will affect the current road map for easing lockdown restrictions or the targets for administering jabs.But the Guardian says a report by data analysts Airfinity suggests that if an export ban was applied to all vaccines – including those from Moderna and Johnson & Johnson that have yet to be deployed in the UK – it would see the offer of a first vaccine to every adult completed in late August rather than the target date of 31 July.European Commission President Ursula von der Leyen said that 41 million vaccine doses have been exported from the bloc to 33 countries in six weeks, with more than 10 million jabs going to the UK.She has said that, in contrast, the EU is still waiting for vaccine exports from the UK and she warned last week that if supplies in Europe do not improve, the bloc “will reflect whether exports to countries who have higher vaccination rates than us are still proportionate”.image copyrightReutersArticle 122 of the EU treaty allows measures to be taken “if severe difficulties arise in the supply of certain products”. Those measures could in theory include export bans and the waiving of patent and intellectual property rights on vaccines.Mrs von der Leyen said this weekend that the bloc has the power to “forbid” exports, adding: “That is the message to AstraZeneca.”A government source has described the latest reports from the EU as “concerning”.The latest point of contention between the UK and the EU appears to be over vaccine doses being manufactured at a plant in the Netherlands, with an EU official telling Reuters that those doses should be distributed among member states, and not sent to Britain.Mr Johnson is expected to use his calls to European leaders in the first half of this week to persuade them to veto any proposal that would prevent vaccine exports from entering the UK.French president Emmanuel Macron and German Chancellor Angela Merkel are among those likely to be on the PM’s list, according to British officials quoted by the Financial Times.SUPPORT BUBBLES: What are they and who can be in yours?FACE MASKS: When do I need to wear one?SCHOOLS: What will happen if children catch coronavirus?TESTING: What tests are available?JOBS: How will I be kept safe at work?Defence Secretary Ben Wallace said on Sunday that the EU should not “build walls” around the distribution of vaccines and should seek to meet its contractual “obligations”.Mr Wallace told the BBC that the language being used by the European Commission was “counterproductive”, adding: “Trying to… build walls around this would only damage both EU citizens and United Kingdom.”EU commissioner Mairead McGuinness has said that no decisions had been made over any possible export ban and urged all sides to “calm down”.The EU row over vaccines also comes as speculation continues over whether summer holidays abroad will be permitted for those in the UK this year.Mr Wallace said an extension on the ban on foreign holidays cannot be ruled out. Currently, international travel will not be allowed for those in England, Scotland and Wales before 17 May.His comments came after a scientist on a government advisory body said summer holidays overseas are “extremely unlikely” because of the risk of travellers bringing variants to the UK.Meanwhile, the prime minister hailed a “record-breaking day” for the UK’s vaccine rollout, after a combined total of 844,285 first or second doses were given on Saturday, up from 711,157 on Friday.It means that more than 27.6 million people in the UK – more than half the adult population – have now received at least one dose of a vaccine.”I WAS SO SICK, IN SO MUCH PAIN”: Understanding endometriosisYOUR QUESTIONS ANSWERED: Covid vaccine trials for children

SharecloseShare pageCopy linkAbout sharingimage copyrightReutersResults from the long-awaited US trial of the Oxford-AstraZeneca Covid vaccine are out and confirm that the shot is both safe and highly effective. More than 32,000 volunteers took part, mostly in America, but also in Chile and Peru. The vaccine was 79% effective against stopping symptomatic Covid disease and 100% effective at preventing people from falling seriously ill. And there were no safety issues regarding blood clots.That should further reassure some EU countries that recently paused rollout of the vaccine amid concerns about a possible link. Some are already starting to use it again now that Europe’s medicines regulator has completed its review and has also concluded the vaccine is safe and effective.UK and EU clot review confirms safety of vaccineThis new trial data may also prove useful in reassuring people about how well the vaccine works to protect the elderly against Covid-19 illness.Several countries initially would not authorise the use of the vaccine in adults over 65, citing lack of evidence. Around a fifth of the volunteers in this trial were over 65 and the vaccine – given as two doses, four weeks apart – provided as much protection to them as to younger age groups. Hundreds of thousands of people in the UK are already receiving the AstraZeneca vaccine every day, so these numbers are tiny by comparison. But the results are vital for the US and should clear the way for the vaccine to be approved by regulators there within the next month or two.Lead investigator of the Oxford University trial of the vaccine, Prof Andrew Pollard said: “‘These results are great news as they show the remarkable efficacy of the vaccine in a new population and are consistent with the results from Oxford-led trials. “We can expect strong impact against Covid-19 across all ages and for people of all different backgrounds from widespread use of the vaccine.”Prof Sarah Gilbert, co-designer of the vaccine, said: “In many different countries and across age groups, the vaccine is providing a high level of protection against Covid-19 and we hope this will lead to even more widespread use of the vaccine in the global attempts to bring the pandemic to an end.”Prof Gilbert said there were always cases of people falling ill after receiving a vaccine, particularly when very large numbers of were receiving a jab, but that did not mean that the vaccine was responsible for the problems. Meanwhile thousands of people a day were now dying across Europe from Covid-19.She said: “It is really important that we get the chance to protect people as quickly as possible. This vaccine will save lives.”

Higher levels of the stomach-derived hormone ghrelin, which stimulates appetite, predict a greater preference for smaller immediate monetary rewards over larger delayed financial rewards, a new study finds. The study results will be presented at ENDO 2021, the Endocrine Society’s annual meeting.
This research presents novel evidence in humans that ghrelin, the so-called “hunger hormone,” affects monetary decision making, said co-investigator Franziska Plessow, Ph.D., assistant professor of medicine at Massachusetts General Hospital and Harvard Medical School, Boston. She said recent research findings in rodents suggested that ghrelin may play a part in impulsive choices and behaviors.
“Our results indicate that ghrelin might play a broader role than previously acknowledged in human reward-related behavior and decision making, such as monetary choices,” Plessow said. “This will hopefully inspire future research into its role in food-independent human perception and behavior.”
Ghrelin signals the brain for the need to eat and may modulate brain pathways that control reward processing. Levels of ghrelin fluctuate throughout the day, depending on food intake and individual metabolism.
This study included 84 female participants ages 10 to 22 years: 50 with a low-weight eating disorder, such as anorexia nervosa, and 34 healthy control participants. Plessow’s research team tested blood levels of total ghrelin before and after a standardized meal that was the same for all participants, who had fasted beforehand. After the meal, participants took a test of hypothetical financial decisions, called the delay discounting task. They were asked to make a series of choices to indicate their preference for a smaller immediate monetary reward or a larger delayed amount of money, for instance, $20 today or $80 in 14 days.
Healthy girls and young women with higher ghrelin levels were more likely to choose the immediate but smaller monetary reward rather than waiting for a larger amount of money, the researchers reported. This preference indicates more impulsive choices, Plessow said.
The relationship between ghrelin level and monetary choices was absent in age-matched participants with a low-weight eating disorder. People with this eating disorder are known to have ghrelin resistance, and Plessow said their finding might be another indicator of a disconnect between ghrelin signaling and behavior in this population.
The study received funding from the National Institutes of Health and a Charles A. King Trust Research Fellowship Award to Plessow. Naila Shiraliyeva, M.D., a research fellow at Massachusetts General Hospital, will present the study findings at the meeting.
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Materials provided by The Endocrine Society. Note: Content may be edited for style and length.

A new once-weekly basal insulin injection demonstrated similar efficacy and safety and a lower rate of low blood sugar episodes compared with a daily basal insulin, according to a phase 2 clinical trial. The study results, which will be presented at ENDO 2021, the Endocrine Society’s annual meeting, compared an investigational drug called basal insulin Fc (BIF) with insulin degludec, a commercially available long-lasting daily insulin, in patients with type 2 diabetes.
“These study results demonstrate that BIF has promise as a once-weekly basal insulin and could be an advancement in insulin therapy,” said Juan Frias, M.D., the study’s principal investigator and the medical director of the National Research Institute in Los Angeles, Calif.
The reduced number of injections with weekly insulin may improve adherence to insulin therapy, which could result in better patient outcomes than for daily basal insulins, Frias said. Once-weekly dosing also may increase the willingness of patients with type 2 diabetes to start insulin therapy when oral medication alone no longer gives adequate blood glucose control, he added.
The 32-week clinical trial was conducted in 399 patients and sponsored by Eli Lilly and Company. All patients had type 2 diabetes and were previous users of basal insulin combined with oral antidiabetic medications.
The patients received random assignments to one of three treatment groups: once-weekly injections of BIF at one of two different dosing algorithms (with different goals for fasting blood glucose levels) or the standard once-daily injections of insulin degludec. One fasting glucose target for patients receiving BIF was 140 milligrams per deciliter (mg/dL) or less, and the other was at or below 120 mg/dL. The fasting glucose target for insulin degludec was 100 mg/dL or less.
Compared with insulin degludec, patients taking BIF achieved similar long-term blood glucose control, as measured by hemoglobin A1c, the researchers reported. Study participants had an average A1c of 8.1 percent at the beginning of the study and at the end of the study had an average improvement in A1c of 0.6 percent for BIF and 0.7 percent for insulin degludec, the data showed.
Additionally, BIF use resulted in significantly lower rates of hypoglycemia, or low blood sugar (less than 70 mg/dL). Severe untreated hypoglycemia is a dangerous complication that can cause seizures, loss of consciousness and death. Frias said BIF has “the potential of a flatter and more predictable action than the current daily basal insulins, which may have contributed to the lower rates of hypoglycemia.”
Regarding safety, BIF had a generally comparable adverse event profile to that of insulin degludec, he said.
“Based on our promising data, further research with BIF has been initiated in patients with type 1 diabetes and other type 2 diabetes patient populations,” Frias said.
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Hearing loss and other auditory problems are strongly associated with Covid-19 according to a systematic review of research evidence led by University of Manchester and NIHR Manchester Biomedical Research Centre (BRC) scientists.
Professor Kevin Munro and PhD researcher Ibrahim Almufarrij found 56 studies that identified an association between COVID-19 and auditory and vestibular problems.
They pooled data from 24 of the studies to estimate that the prevalence of hearing loss was 7.6%, tinnitus was 14.8% and vertigo was 7.2%.
They publish their findings in the International Journal of Audiology.
However, the team — who followed up their review carried out a year ago — described the quality of the studies as fair.
Their data primarily used self-reported questionnaires or medical records to obtain COVID- 7 19-related symptoms, rather than the more scientifically reliable hearing tests.

Scientists from the University’s Nutritional Epidemiology Group used data from 500,000 people, discovering that consuming a 25g serving of processed meat a day, the equivalent to one rasher of bacon, is associated with a 44% increased risk of developing the disease.
But their findings also show eating some unprocessed red meat, such as beef, pork or veal, could be protective, as people who consumed 50g a day were 19% less likely to develop dementia. 
The researchers were exploring whether there is a link between consumption of meat and development of dementia, a health condition which affects 5%-8% of over 60s worldwide.
Their results, titled Meat consumption and risk of incident dementia: cohort study of 493,888 UK Biobank participants, are published today in the American Journal of Clinical Nutrition.
Lead researcher Huifeng Zhang, a PhD student from Leeds’ School of Food Science and Nutrition, said: “Worldwide, the prevalence of dementia is increasing and diet as a modifiable factor could play a role.
“Our research adds to the growing body of evidence linking processed meat consumption to increased risk of a range of non-transmissible diseases.” 
The research was supervised by Professors Janet Cade and Laura Hardie, both at Leeds.

Mr. Taylor died by suicide after suffering from post-Covid-19 symptoms, including severe tinnitus, the company said.Kent Taylor, the founder and chief executive of the Texas Roadhouse restaurant chain, died by suicide on Thursday after suffering from post-Covid-19 symptoms, the company and his family said in a statement. He was 65.“After a battle with post-Covid-related symptoms, including severe tinnitus, Kent Taylor took his own life this week,” the statement said.Mr. Taylor fought the condition, but “the suffering that greatly intensified in recent days became unbearable,” the statement said. It added that Mr. Taylor had recently committed to funding “a clinical study to help members of the military who also suffer with tinnitus,” which causes ringing and other noises in the ear.His body was found in a field on his property near Louisville, Ky., the Kentucky State Police told The Louisville Courier Journal. The State Police and the Oldham County coroner did not immediately respond to requests for comment on Sunday.Mr. Taylor, who was also the chairman of the company’s board of directors, founded Texas Roadhouse in 1993. He sought to create an “affordable, Texas-style” restaurant but was turned down more than 80 times as he tried to find investors, according to a biography provided by the company.Eventually, he raised $300,000 from three doctors from Elizabethtown, Ky., and sketched out the design for the first Texas Roadhouse on a cocktail napkin for the investors.The first Texas Roadhouse opened in Clarksville, Ind., in 1993. Three of the chain’s first five restaurants failed, but it went on to open 611 locations in 49 states, and 28 international locations in 10 countries.Until his death, Mr. Taylor had been active in Texas Roadhouse’s day-to-day operations, the company said. He oversaw decisions about the menu, selected the murals for the restaurants and personally picked songs for the jukeboxes.Kent Taylor was born on Sept. 27, 1955. He grew up in Louisville and graduated from the University of North Carolina, where he received a track scholarship, the company said.He is survived by his parents, Powell and Marilyn Taylor; his children, Michelle, Brittney and Max; and five grandchildren. He was married twice; both marriages ended in divorce.Greg Moore, the lead director of the company’s board, said in a statement that Mr. Taylor gave up his compensation package during the coronavirus pandemic to support frontline workers in the company.Jerry Morgan, the company’s president, will succeed Mr. Taylor as chief executive. Texas Roadhouse will announce its next chairman at a later date, a spokesman for the company said.Senator Mitch McConnell, a Republican from Kentucky and the minority leader, said in a statement that Mr. Taylor “didn’t fit the mold of a big-time C.E.O.”“Kent built a billion-dollar company with creativity, grit and a lot of bold risks,” Mr. McConnell said. “As Texas Roadhouse stretched around the globe, Kent kept his heart and his headquarters in Louisville.”If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesAmerica has three vaccines approved for distribution, and now people are getting choosy about which they want.All three have been shown to be effective at preventing Covid-19 disease and, crucially, hospital admissions and death – and health officials have said the best vaccine is the one you’re offered. Still, there appears to be a preference growing for the Pfizer and Moderna jabs over the Johnson & Johnson option.In early March, Detroit mayor Mike Duggan rejected the Johnson & Johnson vaccine for city residents, suggesting that the other two jabs available in the US were superior. “I am going to do everything I can to make sure the residents of the City of Detroit get the best,” he said in a press conference. After widespread outcry from the public health community, the mayor did an about-face, saying he had “full confidence” that the jab was safe and effective. But like Mr Duggan, some Americans have also shown concerns about the Johnson & Johnson vaccine and its overall efficacy rates – even though health officials have cautioned those numbers don’t tell the whole story. Some say they’d rather delay their vaccination than take Johnson & Johnson at all, potentially throwing a wrench into the distribution plans of community health officials. “I had an appointment for a vaccine this week, and I cancelled it because I heard they were giving out Johnson & Johnson. I’m not taking [that vaccine] at all,” one Washington DC resident told the BBC. Now, health officials like Dr Michele Andrasik are trying to reassure Americans that any authorised vaccine offered to them is a good one to take. “On one hand, people are excited that there’s just one shot [for Johnson & Johnson], and on the other, there’s a lot of confusion with regard to what the efficacy results actually say and does this mean it’s not as good,” Dr Andrasik, senior staff scientist for the Vaccine and Infectious Disease Division at Fred Hutch, told the BBC. How will we know Covid vaccines are safe?How is the world’s biggest vaccine drive going?Covid vaccines: How fast is worldwide progress?In February, US regulators formally approved the single-shot Johnson & Johnson coronavirus vaccine – the latest to get the green light. Unlike Pfizer and Moderna vaccines, which use new mRNA vaccine technology and require two shots, the Johnson & Johnson vaccine uses a common cold virus that has been engineered to make it harmless.It then safely carries part of the coronavirus’s genetic code into the body. This is enough for the body to recognise the threat and then learn to fight coronavirus.President Joe Biden has shown confidence in the vaccine. This month, he announced that the US will order 100 million more doses of Johnson & Johnson, doubling the amount available to Americans.Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has said that all the vaccines available in the US were good vaccines, and stressed that the Johnson & Johnson jab is “not the weaker vaccine”.The concern comes down varying to efficacy data released from clinical trials – but those figures aren’t all they appear to be, say experts.Health officials have stressed that the most important statistic in fighting the pandemic is that all three vaccines have 100% prevention of hospital admissions and death from the virus. The Pfizer and Moderna drugs were also tested before newer, more contagious variants were widespread, making a difference in trials. “They were not compared head-to-head. They were compared under different circumstances,” Dr Fauci has said. Additionally, the CDC explains that all the vaccines are more effective than the annual flu shot. “The bottom line is that Johnson, Moderna and Pfizer are all incredibly effective at preventing severe disease progression, hospitalisation, winding up in the ICU or on ventilation, or death,” says Dr Andrasik. Another positive of the Johnson & Johnson vaccine, community health advocates say, is that it is the only single-shot vaccine available in the US. Why Hispanic and black Americans lag in US vaccinations WATCH: Johnson & Johnson: Billion Covid-19 jabs in course of a yearThe invention that made mass vaccinations possibleIt may also be more convenient when it comes to distribution – especially in harder-to-reach places like some poor or rural regions. But there is concern that sending just that vaccine to those areas might increase stigma. “Equity involves choice,” says Dr Andrasik.”So, if you only have one choice and you are a disenfranchised population, I think that fuels the idea of inequity, uncertainty and questioning of why we only have this one choice.”image copyrightLightRocket via Getty ImagesShe adds: “I think that all the vaccines should be available for everyone. I think the rationale of sending Johnson & Johnson to rural [and poorer] communities is because of access to care.”Community leaders and health professionals like Dr Andrasik are making efforts to spread awareness about the vaccine and combat misinformation.When over half a million people have died from Covid in the US, “as soon as it’s my turn, I will take whatever vaccine is available to me at that time”, she says. What are other concerns?The Johnson & Johnson vaccine was also recently in the news after the US Conference of Catholic Bishops – which represents the church in the US – and others expressed “moral concerns” with the jab. The concern is over how it is produced with abortion-derived cell lines – cells taken in the 1980s “originally isolated from fetal tissue, some of which were originally derived from an aborted fetus” – like a number of other vaccines available today. Johnson & Johnson used a similar method in developing its Ebola vaccine – and no Covid-19 vaccine contains human tissue of any kind. The conference advised that, given a choice, Catholics should take an alternate vaccine.image copyrightNurPhoto via Getty ImagesThe advice given by the US conference seemed to contradict the Vatican’s own stance, which is that such vaccines are “morally acceptable”.Other Catholic leaders have come out to reject the idea that church members should avoid this vaccine. In Connecticut, the Archbishop of Hartford and other local clergy declared in a statement that all residents “should feel free in good conscience to receive any of the vaccines currently available …for the sake of their own health and the common good”.Is the Oxford-AstraZeneca vaccine safe?While many other vaccines, such as those used for chicken pox and rubella, were developed similarly, the latest concerns from Catholic leaders for the Johnson & Johnson vaccine has added to scepticism among some Americans.Johnson & Johnson isn’t the only vaccine facing concerns. Oxford-AstraZeneca – which the US is considering authorising – has been suspended in more than a dozen European countries over concerns with blood clots. The EU’s medicine regulator has since come out saying that the vaccine is “safe and effective” and Germany, France, Italy and Spain have said they would resume using the jab.