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Howells L, McKay AJ, Hussain S, Majeed A. Management of a patient at high risk of type 2 diabetes. LONDON JOURNAL OF PRIMARY CARE 2017; 8:76-79. [PMID: 28250838 PMCID: PMC5330347 DOI: 10.1080/17571472.2016.1203509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Rates of type 2 diabetes mellitus have risen rapidly over the past three to four decades. This article describes a typical patient presenting with intermediate hyperglycaemia in primary care. We suggest the appropriate action to reduce the risk of diabetes developing. Population-level preventive interventions, and adequate recognition and early management of those at risk of developing diabetes, could mitigate the impact of this evolving health epidemic.
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Rehm CD, Marquez ME, Spurrell-Huss E, Hollingsworth N, Parsons AS. Lessons from Launching the Diabetes Prevention Program in a Large Integrated Health Care Delivery System: A Case Study. Popul Health Manag 2017; 20:262-270. [PMID: 28075695 PMCID: PMC5564042 DOI: 10.1089/pop.2016.0109] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There is urgent need for health systems to prevent diabetes. To date, few health systems have implemented the evidence-based Diabetes Prevention Program (DPP), and the few that have mostly partnered with community-based organizations to implement the program. Given the recent decision by the Centers for Medicare & Medicaid Services to reimburse for diabetes prevention, there is likely much interest in how such programs can be implemented within large health systems or how community partnerships can be expanded to support DPP implementation. Beginning in 2010, Montefiore Health System (MHS), a large health care system in the Bronx, NY, partnered with the Young Men's Christian Association (YMCA) of Greater New York to deliver the YMCA's DPP. Over 4 years, 1390 referrals to YMCA's DPP were made; 287 participants attended ≥3 classes, and average weight loss was 3.4%. Because of increased patient demand and internal capacity, MHS assumed responsibility for DPP implementation in May 2015. Fully integrating the program within the health system took 5–6 months, including configuring electronic health record templates/reports, hiring a coordinator, and creating clinical referral workflows/training guides. Billing workflows were designed for risk-based contracts. In the first 11 months of implementation, 1277 referrals were made, and referrals increased over time. Twenty-four class cycles were initiated, and 282 patients began attending classes. Average weight loss among 61 graduates from the Summer/Fall 2015 wave of MDPP classes was 3.8%. Additional opportunities for expansion include training allied health staff, providing patient incentives, increasing master trainer capacity, offering DPP to employees, and securing reimbursement.
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Cezaretto A, de Barros CR, de Almeida-Pititto B, Siqueira-Catania A, Monfort-Pires M, Folchetti LGD, Ferreira SRG. Lifestyle intervention using the psychoeducational approach is associated with greater cardiometabolic benefits and retention of individuals with worse health status. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:36-44. [PMID: 28273202 PMCID: PMC10522123 DOI: 10.1590/2359-3997000000185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to compare the effects of two lifestyle intervention programs for type 2 diabetes mellitus (T2DM) prevention - traditional or interdisciplinary psychoeducation-based intervention - in daily habits and cardiometabolic risk factors and investigate the role of the psychoeducational approach for the retention of individuals in the program. SUBJECTS AND METHODS Between 2008 and 2010, in a public health service, 183 pre-diabetic individuals were allocated to two 18-month interventions involving diet and physical activity. Physical activity, diet, quality of life (QOL) and depression and biochemical measurements were obtained. Linear mixed-effect models were used to assess the effect of the interventions. A student t test was used to compare dropouts versus non-dropouts. RESULTS Improvements in energy intake and physical activity were greater in the interdisciplinary than the traditional intervention. A decrease in fat mass and blood pressure was more pronounced with interdisciplinary intervention. Dropouts from the traditional intervention only had higher BMI and lower fiber intake and QOL than non-dropouts. CONCLUSION The interdisciplinary psychoeducation-based intervention revealed useful for reducing cardiometabolic risk and retaining individuals with worse health profiles. This approach represents a feasible strategy for motivating high-risk individuals to adopt a long-term healthy lifestyle.
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Page RM, Stones E, Taylor O, Braudt K. Awareness and Perceptions of Type 2 Diabetes Risk Factors, Preventability, and Complications Among College Students in Visakhapatnam, India. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 37:27-32. [PMID: 28024454 DOI: 10.1177/0272684x16685250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In India, often referred to as the "diabetes capital of the world," it is imperative to establish the level of knowledge among Asian Indians of Type 2 Diabetes (DM2) in order to plan effective public health programs aimed at prevention of DM2. Using an original survey of 983 college students in Visakhapatnam, Andhra Pradesh, we evaluated individuals' knowledge of DM2 including prevalence, risk factors, and prevention. To date, there are only a few studies that look at awareness of diabetes on the community level, and no previous studies have involved sampling college students. Our findings show that although awareness of diabetes is high, only half of the students sampled were aware that DM2 could be prevented and 60% were unaware that little or no exercise was a risk factor. The results suggest that diabetes awareness programs are needed among the college age population in India to prevent DM2.
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Stull AJ. Lifestyle Approaches and Glucose Intolerance. Am J Lifestyle Med 2016; 10:406-416. [PMID: 30202302 PMCID: PMC6124975 DOI: 10.1177/1559827614554186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 01/13/2023] Open
Abstract
Glucose intolerance is a global health concern that encompasses glucose metabolism abnormalities such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes (T2D). There is an urgent need to focus on the prediabetes (ie, IGT and IFG) stage before the disease actually occurs. The progression from IGT to T2D can be prevented or delayed by modifying the lifestyles in high-risk individuals, and these health benefits are well documented in various ethnicities with prediabetes across the world. Specifically, consuming a healthy diet (high in polyunsaturated fatty acids, monounsaturated fatty acids, fiber, and whole grains), losing weight, quitting smoking, consuming alcohol in moderation, and increasing physical activity can improve glucose tolerance and reduce the risk of T2D. Also, pharmacological agents and botanicals can be used to manage glucose intolerance if the implementation of lifestyle changes is challenging. Pharmacological treatments have been successful in managing glucose intolerance; however, they have adverse effects. Also, more research on botanicals is warranted before a definitive recommendation can be made for their use in managing glucose intolerance. To make progress on this worldwide problem, efforts are needed to improve the awareness of prediabetes, increase promotion of healthy behaviors, and improve the availability of evidence-based lifestyle intervention programs to the community.
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Woodard LJ, McKennon S, Danielson J, Knuth J, Odegard P. An Elective Course to Train Student Pharmacists to Deliver a Community-based Group Diabetes Prevention Program. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2016; 80:106. [PMID: 27667843 PMCID: PMC5023977 DOI: 10.5688/ajpe806106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/09/2015] [Indexed: 05/22/2023]
Abstract
Objective. To develop and assess the impact of an elective course aimed at improving student knowledge of and confidence in delivering a group diabetes prevention program. Design. Two colleges of pharmacy collaborated to develop a 2-credit elective course using didactic and active-learning strategies to prepare students to serve as lifestyle coaches offering a proven group diabetes prevention program. Assessment. Students' confidence in their ability to deliver a group diabetes prevention program increased as a result of the class. However, their knowledge of diabetes prevention facts was unchanged from baseline. Conclusion. A diabetes prevention elective course improved students' confidence in their ability to teach a diabetes prevention program.
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Stuckey MI, Kiviniemi A, Gill DP, Shoemaker JK, Petrella RJ. Associations between heart rate variability, metabolic syndrome risk factors, and insulin resistance. Appl Physiol Nutr Metab 2016; 40:734-40. [PMID: 26140416 DOI: 10.1139/apnm-2014-0528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to examine differences in heart rate variability (HRV) in metabolic syndrome (MetS) and to determine associations between HRV parameters, MetS risk factors, and insulin resistance (homeostasis model assessment for insulin resistance (HOMA-IR)). Participants (n = 220; aged 23-70 years) were assessed for MetS risk factors (waist circumference, blood pressure, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol) and 5-min supine HRV (time and frequency domain and nonlinear). HRV was compared between those with 3 or more (MetS+) and those with 2 or fewer MetS risk factors (MetS-). Multiple linear regression models were built for each HRV parameter to investigate associations with MetS risk factors and HOMA-IR. Data with normal distribution are presented as means ± SD and those without as median [interquartile range]. In women, standard deviation of R-R intervals 38.0 [27.0] ms, 44.5 [29.3] ms; p = 0.020), low-frequency power (5.73 ± 1.06 ln ms(2), 6.13 ± 1.05 ln ms(2); p = 0.022), and the standard deviation of the length of the Poincaré plot (46.8 [31.6] ms, 58.4 [29.9] ms; p = 0.014) were lower and heart rate was higher (68 [13] beats/min, 64 [12] beats/min; p = 0. 018) in MetS+ compared with MetS-, with no differences in men. Waist circumference was most commonly associated with HRV, especially frequency domain parameters. HOMA-IR was associated with heart rate. In conclusion, MetS+ women had a less favourable HRV profile than MetS- women, but there were no differences in men. HOMA-IR was associated with heart rate, not HRV.
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Rezai S, LoBue S, Henderson CE. Diabetes prevention: Reproductive age women affected by insulin resistance. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:427-32. [PMID: 27638898 PMCID: PMC5373272 DOI: 10.1177/1745505716653691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/01/2016] [Indexed: 01/20/2023]
Abstract
In the United States, 29.1 million people are affected by diabetes, of which 95% have type 2 diabetes. There has been a fivefold increase in type 2 diabetes in the latter half of the 20th century, an increase strongly linked to the obesity epidemic in the United States. In addition, insulin resistance affects 86 million Americans, or more than one-third of the adult population, as manifested by impaired fasting glucose tolerance with random glucose values ranging from ⩾100 to <126 mg/dL. In all, 90% of those affected by impaired fasting glucose tolerance or pre-diabetes are unaware of their metabolic derangement. Although impaired fasting glucose tolerance increases one's risk of developing type 2 diabetes, once identified, application of lifestyle changes by affected individuals may avoid or delay the onset of type 2 diabetes. For reproductive age women who are found to have impaired fasting glucose tolerance, lifestyle changes may be an effective tool to diminish the reproductive health consequences of insulin resistance related diseases.
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Liu HY, Wang J, Ma J, Zhang YQ. Interference effect of oral administration of mulberry branch bark powder on the incidence of type II diabetes in mice induced by streptozotocin. Food Nutr Res 2016; 60:31606. [PMID: 27257845 PMCID: PMC4891971 DOI: 10.3402/fnr.v60.31606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 12/04/2022] Open
Abstract
Background Diabetes is a group of metabolic diseases that has become a global health problem worldwide. Many researchers have found that mulberry branches have a hypoglycemic effect, but there have been few studies or investigations regarding the use of mulberry branches to prevent the incidence of diabetes. Objective This study aimed to investigate the potential preventive effect of mulberry branch bark powder (MBBP) from Morus multicaulis L against type II diabetes in mice induced by streptozotocin (STZ). Design The normal mice were fed a diet containing 2.5, 5.0, and 10.0%, MBBP, respectively, for 2 weeks. After that, STZ (100 mg/kg) was injected into the caudal vein of these mice. These mice continued to be fed the same diet, and the fasting blood glucose (FBG) levels were monitored on the 17th and 21st days. Results Oral administration of MBBP could effectively inhibit weight loss and maintain the FBG level. The incidence of diabetes in mice was almost inhibited by treatment with 10% MBBP. MBBP could also maintain the original antioxidant capacity and regulate the lipid metabolism in mice. An immunohistochemical assay showed that MBBP could prevent the injury of the insulin-secreting islet beta cells induced by STZ. RT-PCR also confirmed that the mRNA expression of the genes PI3K, Pdk1, Akt, and FoxO1, which were involved in the PI3K/Akt signaling pathway, hardly suffered from STZ in the 10% MBBP-dose group. Conclusions Our results indicate that powdered mulberry branch bark has a powerful anti-diabetic effect. These results clearly illustrated that MBBP has a potential use as a health food additive in the prevention of diabetes.
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Samson SL, Garber AJ. Prevention of type 2 Diabetes Mellitus: Potential of pharmacological agents. Best Pract Res Clin Endocrinol Metab 2016; 30:357-71. [PMID: 27432071 DOI: 10.1016/j.beem.2016.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
People with impaired glucose tolerance or impaired fasting glucose, or "pre-diabetes", are at high risk for progression to type 2 diabetes, as are those with metabolic syndrome or a history of gestational diabetes. Both glucose-lowering and anti-obesity pharmacotherapies have been studied to determine if the onset of type 2 diabetes can be delayed or prevented. Here we review the available data in the field. The most common theme is the reduction in insulin resistance, such as with weight loss, decreasing demands on the beta cell to improve insulin secretion and prolong its function. Overall, therapies which decrease diabetes incidence in high-risk populations delay the onset of diabetes but do not correct the underlying beta cell defect.
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Miller CK, Weinhold KR, Nagaraja HN. Impact of a Worksite Diabetes Prevention Intervention on Diet Quality and Social Cognitive Influences of Health Behavior: A Randomized Controlled Trial. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:160-9.e1. [PMID: 26787601 PMCID: PMC4788518 DOI: 10.1016/j.jneb.2015.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the impact of a worksite diabetes prevention intervention on secondary outcomes regarding the change in diet quality and components of the Health Action Process Approach (HAPA) theoretical framework. DESIGN Pretest-posttest control group design with 3-month follow-up. SETTING University worksite. PARTICIPANTS Employees aged 18-65 years with prediabetes (n = 68). INTERVENTION A 16-week group-based intervention adapted from the Diabetes Prevention Program. MAIN OUTCOME MEASURES Diet quality was assessed using the Alternative Healthy Eating Index 2010; HAPA components were assessed via written questionnaire. ANALYSIS Repeated-measures ANOVA compared the between- and within-group change in outcomes across time. RESULTS Significant difference occurred between groups for the change in consumption of nuts/legumes and red/processed meats postintervention and for fruits at 3-month follow-up (all P < .05); a significant increase in total Alternative Healthy Eating Index 2010 score occurred postintervention in the experimental group (P = .002). The changes in action planning, action self-efficacy, and coping self-efficacy from HAPA were significantly different between groups after the intervention; the change in outcome expectancies was significantly different between groups at 3-month follow-up (all P < .05). CONCLUSIONS AND IMPLICATIONS The worksite intervention facilitated improvement in diet quality and in planning and efficacious beliefs regarding diabetes prevention. Further research is needed to evaluate the long-term impact of the intervention.
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Vangeepuram N, Carmona J, Arniella G, Horowitz CR, Burnet D. Use of Focus Groups to Inform a Youth Diabetes Prevention Model. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:532-539.e1. [PMID: 26420055 PMCID: PMC4668804 DOI: 10.1016/j.jneb.2015.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 08/04/2015] [Accepted: 08/10/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To explore minority adolescents' perceptions of their diabetes risk, barriers and facilitators to adopting lifestyle changes, and ideas for adapting a youth diabetes prevention model. METHODS The study was conducted at collaborating community sites in East Harlem, NY. Trained moderators facilitated focus groups, which were audio taped and transcribed. Participants were 21 Latino and African American adolescents aged 14-18 years with a family history of diabetes and no reported personal history of diabetes. The phenomenon of interest was youth input in adapting a diabetes prevention model. Two researchers independently coded transcripts, identified major themes, compared findings, and resolved differences through discussion and consensus. RESULTS Dominant themes included (1) the impact of diabetes on quality of life within adolescents' personal networks; (2) conflict between changing diet and activity and their current lifestyle; (3) lifestyle choices being dictated by cost, mood, body image, and environment, not health; and (4) family, social, and environmental pressures reinforcing sedentary behaviors and unhealthy diets. CONCLUSIONS AND IMPLICATIONS Themes from youth focus groups were framed in the context of an existing youth diabetes prevention conceptual model, with results informing expansion of the model and identification and organization of potential intervention components.
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Troughton J, Chatterjee S, Hill SE, Daly H, Martin Stacey L, Stone MA, Patel N, Khunti K, Yates T, Gray LJ, Davies MJ. Development of a lifestyle intervention using the MRC framework for diabetes prevention in people with impaired glucose regulation. J Public Health (Oxf) 2015; 38:493-501. [PMID: 26311822 PMCID: PMC5072159 DOI: 10.1093/pubmed/fdv110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background We report development of a group-based lifestyle intervention, Let's Prevent, using the UK Medical Research Council (MRC) framework, and delivered by structured education to prevent type 2 diabetes mellitus (T2DM) in people with impaired glucose regulation (IGR) in a UK multi-ethnic population. Methods Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) is the first national T2DM programme that meets National Institute for Health and Care Excellence criteria and formed the basis for Let's Prevent. An iterative cycle of initial development, piloting, collecting and collating qualitative and quantitative data, and reflection and modification, was used to inform and refine lifestyle intervention until it was fit for evaluation in a definitive randomized controlled trial (RCT). The programme encouraged IGR self-management using simple, non-technical language and visual aids. Results Qualitative and quantitative data suggested that intervention resulted in beneficial short-term behaviour change such as healthier eating patterns, improved health beliefs and greater participant motivation and empowerment. We also demonstrated that recruitment strategy and data collection methods were feasible for RCT implementation. Conclusions Let's Prevent was developed following successful application of MRC framework criteria and the subsequent RCT will determine whether it is feasible, reliable and transferable from research into a real-world NHS primary healthcare setting. Trial Registration ISRCTN80605705.
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Kahn SE, Buse JB. Medications for type 2 diabetes: how will we be treating patients in 50 years? Diabetologia 2015; 58:1735-9. [PMID: 25773402 PMCID: PMC4499484 DOI: 10.1007/s00125-015-3541-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/16/2015] [Indexed: 12/15/2022]
Abstract
The past 50 years have seen the development of many new options for treating and preventing type 2 diabetes. Despite this success, the individual and societal burden of the disease continues unabated. Thus, the next 50 years will be critical if we are going to quell the major non-communicable disease of our time. The knowledge we will gain in the next few years from clinical studies will inform treatment guidelines with regard to which agents to use in whom and whether more aggressive approaches can slow the development of hyperglycaemia in those at high risk. Beyond that, we anticipate identification of novel targets and techniques for therapeutic intervention. These advances will lead to more personalised approaches to treatment. Most importantly, we will need to focus our political and economic efforts on enhancing and implementing public health approaches aimed at prevention of diabetes and its co-morbidities. This is one of a series of commentaries under the banner '50 years forward', giving personal opinions on future perspectives in diabetes, to celebrate the 50th anniversary of Diabetologia (1965-2015).
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Aroda VR, Getaneh A. Guiding diabetes screening and prevention: rationale, recommendations and remaining challenges. Expert Rev Endocrinol Metab 2015; 10:381-398. [PMID: 30293496 DOI: 10.1586/17446651.2015.1054280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advances made in diabetes management are not sufficient to reduce morbidity, mortality and cost without making prevention efforts at various levels imperative for substantial impact. Research has demonstrated the efficacy of lifestyle intervention and medications in preventing type 2 diabetes among diverse high-risk groups commonly identified with oral glucose tolerance testing. Efficacy, sustainability and safety data are most comprehensive for lifestyle and metformin, with other medications also demonstrating efficacy and potential in the pharmacoprevention of diabetes. Subsequent implementation studies have demonstrated feasibility of lifestyle intervention programs at health centers, communities, and at local and national government levels. Challenges remain in widespread translation and reaching and engaging at-risk individuals and populations.
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Courtney MR, Moler EJ, Osborne JA, Whitney G, Conard SE. An exploratory retrospective assessment of a quantitative measure of diabetes risk: medical management and patient impact in a primary care setting. Diabetes Metab Syndr Obes 2015; 8:447-53. [PMID: 26425102 PMCID: PMC4583107 DOI: 10.2147/dmso.s78810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Primary care providers with limited time and resources bear a heavy responsibility for chronic disease prevention or progression. Reliable clinical tools are needed to risk stratify patients for more targeted care. This exploratory study examined the care of patients who had been risk stratified regarding their likelihood of clinically progressing to type 2 diabetes. METHODS This was a retrospective chart review pilot study conducted to assess a primary care provider's use of a risk screening test. In this quality improvement project, the result of the risk screening was examined in relation to its influence on medical management and clinical impact on patients at risk for diabetes. All providers were board certified in family medicine and had more than 10 years clinical experience in managing diabetes and prediabetes. No specific clinical practice guidelines were mandated for patient care in this pilot study. Physicians in the practice group received an orientation to the diabetes risk measure and its availability for use in a pilot study to be conducted over a 6-month period. We identified the 696 nondiabetic adults in family practices who received a risk screening test (PreDx(®), a multi-marker blood test that estimates the 5-year likelihood of conversion to type 2 diabetes) between June and November 2011 for a 6-month sample. A comparison group of 2,002 patients from a total database of 3.2 million patients who did not receive the risk test was randomly selected from the same clinical database after matching for age, sex, selected diagnoses, and metabolic risk factors. Patient groups were compared for intensity of care provided and clinical impact. RESULTS Compared to patients with a similar demographic and diagnostic profile, patients who had the risk test received more intensive primary care and had better clinical outcome than comparison patients. Risk-tested patients were more likely to return for follow-up visits, be monitored for relevant cardio-metabolic risk factors, and receive prescription medications with P<0.001. Further, intensity of care was associated with the level of risk test result: patients with moderate or high scores were more likely to return for follow-up visits and receive prescription medications than patients with low scores. All P-values for comparison patients between the low and moderate groups, low and high groups, and moderate and high groups resulted in P<0.001. Risk-tested patients were more likely than their comparison group counterparts to achieve weight reduction, lowered blood pressure, and improved blood glucose and cholesterol as demonstrated by P-values of <0.001. CONCLUSION Use of a risk stratification test in primary care may help providers to more effectively identify high risk patients, manage diabetes risk, increase patient involvement in diabetes risk management, and improve clinical outcomes. A randomized controlled study is the next step to investigate the impact of diabetes risk stratification in primary care.
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O'Reilly SL. Prevention of Diabetes after Gestational Diabetes: Better Translation of Nutrition and Lifestyle Messages Needed. Healthcare (Basel) 2014; 2:468-91. [PMID: 27429288 PMCID: PMC4934570 DOI: 10.3390/healthcare2040468] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/14/2014] [Accepted: 11/10/2014] [Indexed: 12/16/2022] Open
Abstract
Type 2 Diabetes Mellitus (T2DM) and Gestational Diabetes (GDM) are important and escalating problems worldwide. GDM increases the risk of complications in pregnancy and birth, as well as a 1 in 2 chance of developing T2DM later in life. The burden of GDM extends to offspring, who have an increased risk of obesity and diabetes-further perpetuating the cycle of diabetes within families. Clinical trial evidence demonstrates T2DM incidence reduced by up to 50% for women with GDM with nutrition and physical activity changes and the economic modeling suggests cost effectiveness. The key diet-related changes to reduce T2DM risk are reviewed, in addition to breastfeeding. The difficulties associated with the delivery of dietary and lifestyle behaviour change to women after GDM are discussed and focus on: complex healthcare system interactions needed for care delivery; women finding postpartum self-care challenging; and low levels of awareness being present across the board. In addition, studies currently underway to improve care provision in this important area will be examined.
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Dawes D, Ashe M, Campbell K, Cave D, Elley CR, Kaczorowski J, Sohal P, Ur E, Dawes M. Preventing diabetes in primary care: a feasibility cluster randomized trial. Can J Diabetes 2014; 39:111-6. [PMID: 25439501 DOI: 10.1016/j.jcjd.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/24/2014] [Accepted: 08/26/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the feasibility of implementing a large-scale primary care-based diabetes prevention trial. METHODS A feasibility cluster randomized controlled trial was conducted in British Columbia, Canada, amongst adults with prediabetes using the Facilitated Lifestyle Intervention Prescription (FLIP) vs. usual care. FLIP included lifestyle advice, a pedometer, and telephone support from a lifestyle facilitator for 6 months. Indicators of feasibility included recruitment rates of family practices, participants and facilitators, as well as feasibility and retention rates in the FLIP program and study protocols. RESULTS Six family practices participated; 59 patients were enrolled between October 2012 and March 2013. The trial protocol was acceptable to practices and participants and had a 95% participant retention rate over the 6 months (56/59). Adherence to the intervention was high (97%), with 34 of 35 patients continuing to receive telephone calls from the facilitator for 6 months. The mean cost of the intervention was C$144 per person. Compared with control, intervention participants significantly reduced weight by 3.2 kg (95% CI, 1.7 to 4.6); body mass index by 1.2 (95% CI, 0.7 to 1.7) and waist circumference by 3 cm (95% CI, 0.3 to 5.7). CONCLUSIONS It is feasible to implement FLIP and to conduct a trial to assess effectiveness. A larger trial with longer follow up to assess progression to diabetes is warranted.
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Brito E, Patrick DL, Konopken YP, Keller CS, Barroso CS, Shaibi GQ. Effects of a diabetes prevention programme on weight-specific quality of life in Latino youth. Pediatr Obes 2014; 9:e108-11. [PMID: 24903526 PMCID: PMC4163087 DOI: 10.1111/ijpo.240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 01/31/2014] [Accepted: 02/28/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the effects of a diabetes prevention programme on weight-specific Quality of Life (QOL) in obese Latino youth. METHODS Fifteen obese Latino adolescents (body mass index % = 96.4 ± 1.2; age = 15.0 ± 1.0) completed a 12-week culturally grounded, community-based intervention designed to improve physical and psychosocial health. Weight-specific QOL was assessed by the Youth Quality of Life-Weight module and compared with age, sex and ethnicity-matched lean youth. RESULTS At baseline, intervention youth exhibited significantly lower weight-specific QOL compared with lean youth (70.8 ± 5.4 vs. 91.2 ± 2.2, P = 0.002). However, following the intervention, total weight-specific QOL increased by 21.8% among obese youth (70.8 ± 5.4 to 86.2 ± 4.3, P < 0.001) and was no longer different from lean controls. Significant increases in weight-specific QOL were noted across all subdomains including self (45.7%), social (11.9%) and environmental (36.2%) despite the fact that weight did not change (90.6 ± 6.8 to 89.9 ± 7.2, P = 0.44). The improvements in QOL were maintained for up to 12 months after the intervention. CONCLUSION Weight-specific QOL among obese Latino youth can be improved through lifestyle interventions to a level similar to lean peers. Further, weight loss may not be necessary to observe improvements in QOL.
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O’Brien MJ, Shuman SJ, Barrios DM, Alos VA, Whitaker RC. A qualitative study of acculturation and diabetes risk among urban immigrant Latinas: implications for diabetes prevention efforts. THE DIABETES EDUCATOR 2014; 40:616-25. [PMID: 24872386 PMCID: PMC4169339 DOI: 10.1177/0145721714535992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this qualitative study was to understand how acculturation influences diabetes risk among urban immigrant Latinas (Hispanic women). METHODS Five focus groups were conducted with 26 urban immigrant Latinas who were at high clinical risk for developing diabetes. The focus group sessions were audiotaped and transcribed verbatim. The authors independently analyzed transcripts using an inductive method of open coding and established themes by consensus. RESULTS All participants were foreign born and had low levels of acculturation. During the acculturation process, they noted changes in their lifestyle behaviors and the family context in which those behaviors are shaped. They reported that since living in the United States, their improved economic circumstances led to increased consumption of less healthy foods and beverages and a more sedentary lifestyle. They also described changing family roles and responsibilities, including working outside the home, which constrained healthy food choices. However, they perceived that their position of influence within the family offered opportunities to help family members prevent diabetes. CONCLUSIONS Lifestyle interventions to prevent diabetes in Latinas should address their acculturation experiences, which affect family functioning and health behaviors related to diabetes risk. For example, given the perceived link between Latinas' improved economic circumstances and their diabetes risk, prevention programs should incorporate strategies to help Latinas avoid adopting less healthy lifestyle behaviors that become affordable during the acculturation process.
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Teufel-Shone NI, Jiang L, Beals J, Henderson WG, Zhang L, Acton KJ, Roubideaux Y, Manson SM. Demographic characteristics and food choices of participants in the Special Diabetes Program for American Indians Diabetes Prevention Demonstration Project. ETHNICITY & HEALTH 2014; 20:327-40. [PMID: 24954106 PMCID: PMC5108238 DOI: 10.1080/13557858.2014.921890] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE American Indians and Alaska Natives (AI/ANs) suffer a disproportionate burden of diabetes. Identifying food choices of AI/ANs at risk of type 2 diabetes, living in both rural and urban settings, is critical to the development of culturally relevant, evidence-based education strategies designed to reduce morbidity and mortality in this population. DESIGN At baseline, 3135 AI/AN adults participating in the Special Diabetes Program for American Indians Diabetes Prevention Demonstration Project (SDPI-DP) completed a socio-demographic survey and a 27-item food frequency questionnaire (FFQ). The primary dietary behavior goal of SDPI-DP education sessions and lifestyle coaching is changes in food choices, i.e., increased fruits, vegetables and whole grains, decreased high sugar beverages, red meat, and processed foods. Subsequently, program assessment focuses on changes in food types. Foods were delineated using a 'healthy' and 'unhealthy' classification as defined by the educators advising participants. Urban and rural differences were examined using χ(2) tests and two sample t-tests. Multiple linear regressions and linear mixed models were used to assess the association between socio-demographic factors and food choice. RESULTS Retired participants, those living in urban areas and with high income and education selected healthy foods most frequently. Young males, those with low income and education consumed unhealthy foods most frequently. Selection of unhealthy foods did not differ by urban and rural setting. CONCLUSIONS The ubiquitous nature of unhealthy food choices makes them hard to avoid. Food choice differences by gender, age, income, and setting suggest that nutrition education should more effectively target and meets the needs of young AI/AN males.
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Walford GA, Ma Y, Christophi CA, Goldberg RB, Jarolim P, Horton E, Mather KJ, Barrett-Connor E, Davis J, Florez JC, Wang TJ. Circulating natriuretic peptide concentrations reflect changes in insulin sensitivity over time in the Diabetes Prevention Program. Diabetologia 2014; 57:935-9. [PMID: 24554005 PMCID: PMC4158711 DOI: 10.1007/s00125-014-3183-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS We aimed to study the relationship between measures of adiposity, insulin sensitivity and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the Diabetes Prevention Program (DPP). METHODS The DPP is a completed clinical trial. Using stored samples from this resource, we measured BMI, waist circumference (WC), an insulin sensitivity index (ISI; [1/HOMA-IR]) and NT-proBNP at baseline and at 2 years of follow-up in participants randomised to placebo (n = 692), intensive lifestyle intervention (n = 832) or metformin (n = 887). RESULTS At baseline, log NT-proBNP did not differ between treatment arms and was correlated with baseline log ISI (p < 0.0001) and WC (p = 0.0003) but not with BMI (p = 0.39). After 2 years of treatment, BMI decreased in the lifestyle and metformin groups (both p < 0.0001); WC decreased in all three groups (p < 0.05 for all); and log ISI increased in the lifestyle and metformin groups (both p < 0.001). The change in log NT-proBNP did not differ in the lifestyle or metformin group vs the placebo group (p > 0.05 for both). In regression models, the change in log NT-proBNP was positively associated with the change in log ISI (p < 0.005) in all three study groups after adjusting for changes in BMI and WC, but was not associated with the change in BMI or WC after adjusting for changes in log ISI. CONCLUSION/INTERPRETATION Circulating NT-proBNP was associated with a measure of insulin sensitivity before and during preventive interventions for type 2 diabetes in the DPP. This relationship persisted after adjustment for measures of adiposity and was consistent regardless of whether a participant was treated with placebo, intensive lifestyle intervention or metformin.
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Florez H, Temprosa MG, Orchard TJ, Mather KJ, Marcovina SM, Barrett-Connor E, Horton E, Saudek C, Pi-Sunyer XF, Ratner RE, Goldberg RB. Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance. Diabetes Obes Metab 2014; 16:326-33. [PMID: 24118860 PMCID: PMC3943638 DOI: 10.1111/dom.12220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 12/28/2022]
Abstract
AIMS To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence. METHODS We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2 years. RESULTS In an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3-2.3), 1.7 (1.2-2.3) and 2.0 (1.3-3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk. CONCLUSIONS MetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.
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Pozzilli P, Fallucca F. Diet and diabetes: a cornerstone for therapy. Diabetes Metab Res Rev 2014; 30 Suppl 1:1-3. [PMID: 24353260 DOI: 10.1002/dmrr.2512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/18/2013] [Indexed: 11/07/2022]
Abstract
An appropriate diet represents the cornerstone for diabetes therapy. Diets that differ in their carbohydrate, lipid and protein content are used but the evidence of their effects on the long term is missing. Several confounding factors and compliance to diet render difficult the evaluation of the 'best diet' for diabetes. On a short run, however, useful indications can be obtained regarding the effective diets capable to optimize metabolic control in type 2 diabetes.
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Esposito K, Giugliano D. Mediterranean diet and type 2 diabetes. Diabetes Metab Res Rev 2014; 30 Suppl 1:34-40. [PMID: 24357346 DOI: 10.1002/dmrr.2516] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/19/2013] [Indexed: 12/13/2022]
Abstract
Consumption of selected dietary components is favourably associated with prevention of type 2 diabetes, but discordant results for some foods or single nutrients continue to appear. The study of complete dietary patterns represents the most adequate approach to assess the role of diet on the risk of diabetes. The term 'Mediterranean diet' essentially refers to a primarily plant-based dietary pattern whose greater consumption has been associated with higher survival for lower all-cause mortality. At least five large prospective studies report a substantially lower risk of type 2 diabetes in healthy people or at risk patients with the highest adherence to a Mediterranean diet. Five randomized controlled trials have evaluated the effects of a Mediterranean diet, as compared with other commonly used diets, on glycaemic control in subjects with type 2 diabetes. Improvement of HbA1c levels was greater with a Mediterranean diet and ranged from 0.1% to 0.6% for HbA1c . No trial reported worsening of glycaemic control with a Mediterranean diet. Although no controlled trial specifically assessed the role of a Mediterranean diet in reducing cardiovascular events in type 2 diabetes, there is evidence that post-infarct or high-risk patients, including diabetic patients, may have cardiovascular benefits from a Mediterranean diet. The evidence so far accumulated suggests that adopting a Mediterranean diet may help prevent type 2 diabetes; moreover, a lower carbohydrate, Mediterranean-style diet seems good for HbA1c reduction in persons with established diabetes.
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