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Kim Y, Keogh JB, Clifton PM. Differential Effects of Red Meat/Refined Grain Diet and Dairy/Chicken/Nuts/Whole Grain Diet on Glucose, Insulin and Triglyceride in a Randomized Crossover Study. Nutrients 2016; 8:nu8110687. [PMID: 27809219 PMCID: PMC5133075 DOI: 10.3390/nu8110687] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022] Open
Abstract
Epidemiological studies suggest that a diet high in processed meat, with a high glycemic index is associated with an increased risk of type 2 diabetes. It is not clear if this is due to altered insulin sensitivity or an enhanced postprandial glucose. We aimed to compare the acute metabolic response of two different types of meals after ingestion of the matching diet for four weeks. The study was a randomized, crossover acute meal study. Volunteers consumed either a red meat/refined grain meal or a dairy/chicken/nuts/wholegrain meal after four weeks of the matching diet. After a three-week washout period and four weeks of the alternate diet, they consumed the matching meal. The diets differed with respect to both protein and carbohydrate sources. Blood samples were taken for 180 min for the measurement of glucose, insulin, C-peptide and triglyceride. Fifty-one participants (age: 35.1 ± 15.6 years; body mass index: 27.7 ± 6.9 kg/m2, 17 with normal and 34 with impaired glucose tolerance) completed two meal tests. The area under the curve (p < 0.001) and incremental area under the curve (p = 0.001) for insulin was significantly higher after the red meat/refined grain diet than after the dairy/chicken/nuts/whole grain diet. There was an interaction between meal and glucose tolerance group (p < 0.05) in the area under the curve (AUC) and the incremental area under the curve (iAUC) of glucose; the red meat/refined grain diet increased glucose relative to the dairy/chicken/nuts/whole grain diet only in the normal group (+2.5 mmol/L/3 h). The red meat/refined grain diet increased glucose and insulin responses compared with the dairy/chicken/nuts/whole grain diet. This meal pattern would increase pancreatic stress long term and may account for the increased risk of type 2 diabetes with this diet.
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Affiliation(s)
- Yoona Kim
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| | - Jennifer B Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| | - Peter M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia.
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Schwarz PEH, Riemenschneider H. Slowing Down the Progression of Type 2 Diabetes: We Need Fair, Innovative, and Disruptive Action on Environmental and Policy Levels! Diabetes Care 2016; 39 Suppl 2:S121-6. [PMID: 27440824 DOI: 10.2337/dcs15-3001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany German Center for Diabetes Research, Paul Langerhans Institute Dresden, Dresden, Germany
| | - Henna Riemenschneider
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany Department of General Practice, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Tuomilehto J, Schwarz PEH. Preventing Diabetes: Early Versus Late Preventive Interventions. Diabetes Care 2016; 39 Suppl 2:S115-20. [PMID: 27440823 DOI: 10.2337/dcs15-3000] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There are a number of arguments in support of early measures for the prevention of type 2 diabetes (T2D), as well as for concepts and strategies at later intervention stages. Diabetes prevention is achievable when implemented in a sustainable manner. Sustainability within a T2D prevention program is more important than the actual point in time or disease process at which prevention activities may start. The quality of intervention, as well as its intensity, should vary with the degree of the identified T2D risk. Nevertheless, preventive interventions should start as early as possible in order to allow a wide variety of relatively low- and moderate-intensity programs. The later the disease risk is identified, the more intensive the intervention should be. Public health interventions for diabetes prevention represent an optimal model for early intervention. Late interventions will be targeted at people who already have significant pathophysiological derangements that can be considered steps leading to the development of T2D. These derangements may be difficult to reverse, but the worsening of dysglycemia may be halted, and thus the clinical onset of T2D can be delayed.
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Affiliation(s)
- Jaakko Tuomilehto
- Dasman Diabetes Institute, Dasman, Kuwait Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland Center for Vascular Prevention, Danube University Krems, Krems, Austria Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany German Center for Diabetes Research, Paul Langerhans Institute Dresden, Dresden, Germany
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Meijnikman AS, De Block CEM, Verrijken A, Mertens I, Corthouts B, Van Gaal LF. Screening for type 2 diabetes mellitus in overweight and obese subjects made easy by the FINDRISC score. J Diabetes Complications 2016; 30:1043-9. [PMID: 27217020 DOI: 10.1016/j.jdiacomp.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/29/2016] [Accepted: 05/04/2016] [Indexed: 01/06/2023]
Abstract
AIM To evaluate the use of the FINDRISC score in an overweight and obese population to predict glucose status. METHODS In 651 overweight/obese subjects (M/F: 193/458, age 43±13 y, BMI 38.2±6.1kg/m(2)) glucose status was tested using OGTT and HbA1c. Furthermore, the FINDRISC questionnaire and CT visceral fat (VAT) and subcutaneous fat (SAT) were examined. RESULTS Exactly 50.4% were found to have prediabetes and 11.1% were newly diagnosed with type 2 diabetes (T2DM) (M/F=22.2/8.8%). Subjects without T2DM had a FINDRISC score of 11±3, those with pre-DM 13±4, and subjects with de novo T2DM 15±5. The aROC of the FINDRISC for detecting T2DM was 0.76 (95% CI 0.72-0.82), with 13 as cutoff point. The FINDRISC score correlated with VAT (r=0.34, p<0.001) and VAT/SAT ratio (r=0.39, p<0.001). The aROC of the FINDRISC to detect excess VAT was 0.79 (95%CI 0.72-0.84). CONCLUSIONS In a large group of overweight and obese subjects, 50.4% were found to have pre-DM and 11.1% were newly diagnosed with T2DM. The FINDRISC score increased with worsening of glucose tolerance status and proved to be an independent predictor of T2DM status, as did HOMA-B, HOMA-S and VAT. The FINDRISC can also function as a good tool to predict visceral obesity.
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Affiliation(s)
- A S Meijnikman
- University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium; Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - C E M De Block
- University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium; Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - A Verrijken
- University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium; Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - I Mertens
- Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - B Corthouts
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - L F Van Gaal
- University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium; Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Edegem, Belgium.
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55
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Impact of acculturation and its factors on metabolic syndrome in South Asian American adults from two community health centers. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0726-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cefalu WT, Buse JB, Tuomilehto J, Fleming GA, Ferrannini E, Gerstein HC, Bennett PH, Ramachandran A, Raz I, Rosenstock J, Kahn SE. Update and Next Steps for Real-World Translation of Interventions for Type 2 Diabetes Prevention: Reflections From a Diabetes Care Editors' Expert Forum. Diabetes Care 2016; 39:1186-201. [PMID: 27631469 PMCID: PMC4915559 DOI: 10.2337/dc16-0873] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The International Diabetes Federation estimates that 415 million adults worldwide now have diabetes and 318 million have impaired glucose tolerance. These numbers are expected to increase to 642 million and 482 million, respectively, by 2040. This burgeoning pandemic places an enormous burden on countries worldwide, particularly resource-poor regions. Numerous landmark trials evaluating both intensive lifestyle modification and pharmacological interventions have persuasively demonstrated that type 2 diabetes can be prevented or its onset can be delayed in high-risk individuals with impaired glucose tolerance. However, key challenges remain, including how to scale up such approaches for widespread translation and implementation, how to select appropriately from various interventions and tailor them for different populations and settings, and how to ensure that preventive interventions yield clinically meaningful, cost-effective outcomes. In June 2015, a Diabetes Care Editors' Expert Forum convened to discuss these issues. This article, an outgrowth of the forum, begins with a summary of seminal prevention trials, followed by a discussion of considerations for selecting appropriate populations for intervention and the clinical implications of the various diagnostic criteria for prediabetes. The authors outline knowledge gaps in need of elucidation and explore a possible new avenue for securing regulatory approval of a prevention-related indication for metformin, as well as specific considerations for future pharmacological interventions to delay the onset of type 2 diabetes. They conclude with descriptions of some innovative, pragmatic translational initiatives already under way around the world.
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Affiliation(s)
- William T. Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - John B. Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Dasman Diabetes Institute, Dasman, Kuwait; Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; and Center for Vascular Prevention, Danube University Krems, Krems, Austria
| | | | | | | | | | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, India
| | - Itamar Raz
- Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City and The University of Texas Southwestern Medical Center, Dallas, TX
| | - Steven E. Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
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Lindström J, Uusitupa M, Tuomilehto J, Peltonen M. Following in the Footsteps of the North Karelia Project: Prevention of
Type 2 Diabetes. Glob Heart 2016; 11:223-8. [DOI: 10.1016/j.gheart.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/20/2016] [Indexed: 01/24/2023] Open
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Costa B, Castell C, Cos X, Solé C, Mestre S, Canela M, Boquet A, Cabré JJ, Barrio F, Flores-Mateo G, Ferrer-Vidal D, Lindström J. Rationale and design of the DP-TRANSFERS project: diabetes prevention-transferring findings from European research to society in Catalonia. J Transl Med 2016; 14:103. [PMID: 27118544 PMCID: PMC4847192 DOI: 10.1186/s12967-016-0867-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/13/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Compelling evidence has been accumulated to support the effectiveness of intensive lifestyle intervention in delaying progression to Type 2 diabetes even in people identified as being at high risk determined by the Finnish diabetes risk score. The DE-PLAN-CAT project (diabetes in Europe-prevention using lifestyle, physical activity and nutritional intervention-Catalonia) evidenced that intensive lifestyle intervention was feasible and cost-effective on a short scale in real-life primary care settings, at least over 4 years. However, transferring such lifestyle interventions to society remains the major challenge of research in the field of diabetes prevention. METHODS/DESIGN The derived DP-TRANSFERS (diabetes prevention-transferring findings from European research to society) is a large scale national programme aimed at translating a tailored lifestyle intervention to the maximum of primary care centres where feasible through a core proposal agreed with all the partners. The method is built upon a 3-step (screening, intervention and follow-up) real-life, community-wide structure on the basis of a dual intensity lifestyle intervention (basic and continuity modules) and supported by a 4-channel transfer strategy (institutional relationships, facilitators' workshops, collaborative groupware and programme WEB page). Participation will initially cover nine health departments (7 million inhabitants) through nine coordinating centres located in metropolitan (3.2 million), semi-urban (2.9 million) and rural (0.9 million) areas from which it is expected accessing 25 % of all primary care settings, equivalent to 90 associated centres (1.6-1.8 million people) with an estimate of 0.32 million participants aged 45-75 years at high risk of future development of diabetes. To ascertain sustainability, effect, satisfaction and quality of the translation programme statistical analyses will be performed from both the entire population (facilitators and participants) and a stratified representative sample obtained by collecting data from at least 920 participants. DISCUSSION The DP-TRANSFERS will use a strategy of approach to society consistent with the impact of the disease and the fast accessibility provided by primary care settings in Catalonia. Both the widespread effect of the lifestyle intervention and the translational process itself could be assessed.
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Affiliation(s)
- Bernardo Costa
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Conxa Castell
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
| | - Xavier Cos
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Claustre Solé
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Santiago Mestre
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Marta Canela
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Antoni Boquet
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Joan-Josep Cabré
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
| | - Francisco Barrio
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Gemma Flores-Mateo
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Daniel Ferrer-Vidal
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Lindström
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
| | - The Catalan Diabetes Prevention Research Group
- />Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202 Reus-Barcelona, Spain
- />Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain
- />Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
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Bahijri SM, Jambi HA, Al Raddadi RM, Ferns G, Tuomilehto J. The Prevalence of Diabetes and Prediabetes in the Adult Population of Jeddah, Saudi Arabia--A Community-Based Survey. PLoS One 2016; 11:e0152559. [PMID: 27035920 PMCID: PMC4818101 DOI: 10.1371/journal.pone.0152559] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/16/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Type 2 (T2DM) is believed to be common in Saudi Arabia, but data are limited. In this population survey, we determined the prevalence of T2DM and prediabetes. MATERIALS AND METHODS A representative sample among residents aged ≥ 18 years of the city of Jeddah was obtained comprising both Saudi and non-Saudi families (N = 1420). Data on dietary, clinical and socio-demographic characteristics were collected and anthropometric measurements taken. Fasting plasma glucose and glycated hemoglobin (HbA1c) were used to diagnose diabetes and prediabetes employing American Diabetes Association criteria. Multiple logistic regression analysis was used to identify factors associated with T2DM. RESULTS Age and sex standardized prevalence of prediabetes was 9.0% (95% CI 7.5-10.5); 9.4% (7.1-11.8) in men and 8.6% (6.6-10.6) in women. For DM it was 12.1% (10.7-13.5); 12.9% (10.7-13.5) in men and 11.4% (9.5-13.3) in women. The prevalence based on World Population as standard was 18.3% for DM and 11.9% for prediabetes. The prevalence of DM and prediabetes increased with age. Of people aged ≥50 years 46% of men and 44% of women had DM. Prediabetes and DM were associated with various measures of adiposity. DM was also associated with and family history of dyslipidemia in women, cardiovascular disease in men, and with hypertension, dyslipidemia and family history of diabetes in both sexes. DISCUSSION Age was the strongest predictor of DM and prediabetes followed by obesity. Of people aged 50 years or over almost half had DM and another 10-15% had prediabetes leaving only a small proportion of people in this age group with normoglycemia. Since we did not use an oral glucose tolerance test the true prevalence of DM and prediabetes is thus likely to be even higher than reported here. These results demonstrate the urgent need to develop primary prevention strategies for type 2 diabetes in Saudi Arabia.
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Affiliation(s)
- Suhad M. Bahijri
- Department of Clinical Biochemistry - Faculty of Medicine- King Abdulaziz University, Jeddah, Saudi Arabia
- Saudi Diabetes Study Research Group- King Fahd Medical Research Center - King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hanan A. Jambi
- Saudi Diabetes Study Research Group- King Fahd Medical Research Center - King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Food and Nutrition- Home Economics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rajaa M. Al Raddadi
- Saudi Diabetes Study Research Group- King Fahd Medical Research Center - King Abdulaziz University, Jeddah, Saudi Arabia
- Ministry of Health, Public Health Directorate, Jeddah, Saudi Arabia
| | - Gordon Ferns
- Saudi Diabetes Study Research Group- King Fahd Medical Research Center - King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Medical Education, Brighton and Sussex Medical School, Mayfield House, Falmer, Brighton, United Kingdom
| | - Jaakko Tuomilehto
- Saudi Diabetes Study Research Group- King Fahd Medical Research Center - King Abdulaziz University, Jeddah, Saudi Arabia
- Center for Vascular Prevention, Danube University Krems, Krems, Austria
- Dasman Diabetes Institute, Dasman, Kuwait
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Manios Y, Moschonis G, Mavrogianni C, Tsoutsoulopoulou K, Kogkas S, Lambrinou CP, Efstathopoulou E. Postprandial glucose and insulin levels in type 2 diabetes mellitus patients after consumption of ready-to-eat mixed meals. Eur J Nutr 2016; 56:1359-1367. [PMID: 26919992 DOI: 10.1007/s00394-016-1186-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/08/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the effects of three ready-to-eat mixed meals, with a high fiber content and low glycemic index, on postprandial glycemic and insulinemic response in patients with Type 2 diabetes mellitus (T2DM). METHODS The current study followed a prospective, three-way, cross-over design. Twenty-four patients with T2DM consumed three ready-to-eat mixed meals, i.e., "wild greens pie" (meal 1), "chicken burgers with boiled vegetables" (meal 2) and "vegetable moussaka" (meal 3) and an oral glucose load, all providing 50 g of carbohydrates. Venous blood was collected at 0, 30, 60, 90 and 120 min postprandial. Statistical analyses included repeated measures analysis of variance and calculations of the area under the glucose and insulin curves (AUC) for each one of the test meals and the oral glucose load. RESULTS Patients consuming each one of the three mixed meals showed better postprandial glycemic responses compared to the oral glucose load (P < 0.001). Furthermore, patients consuming meal 3 showed a better insulinemic response compared to the oral glucose load and meal 1, after 60 and 120 min postprandial, respectively (P < 0.05). In addition, the increase observed in HOMA-IR values from T0 to T120 was significantly lower for meal 3, compared to the oral glucose load (P < 0.001). CONCLUSIONS The three ready-to-eat mixed meals examined in the present study were found to elicit significantly lower glycemic responses compared to the oral glucose load in diabetic patients. The mixed meals examined in the present study could be proposed as effective, palatable and practical solutions for diabetics for glucose control.
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Affiliation(s)
- Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70, El.Venizelou Avenue, 17671, Kallithea, Athens, Greece.
| | - George Moschonis
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70, El.Venizelou Avenue, 17671, Kallithea, Athens, Greece.,Envinhealth S.A., Vasilissis Sofias 22, 15124, Marousi, Athens, Greece
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70, El.Venizelou Avenue, 17671, Kallithea, Athens, Greece
| | - Konstantina Tsoutsoulopoulou
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70, El.Venizelou Avenue, 17671, Kallithea, Athens, Greece
| | - Stergios Kogkas
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70, El.Venizelou Avenue, 17671, Kallithea, Athens, Greece
| | - Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70, El.Venizelou Avenue, 17671, Kallithea, Athens, Greece
| | - Eirini Efstathopoulou
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70, El.Venizelou Avenue, 17671, Kallithea, Athens, Greece
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O'Donoghue GM, Kennedy A, Andersen GS, Durkan E, Thybo T, Sinnott M, Nolan JJ, O'Gorman DJ. An evaluation of the DEXLIFE 'self-selected' lifestyle intervention aimed at improving insulin sensitivity in people at risk of developing type 2 diabetes: study protocol for a randomised controlled trial. Trials 2015; 16:529. [PMID: 26581687 PMCID: PMC4652413 DOI: 10.1186/s13063-015-1042-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the global escalation of type 2 diabetes and evidence consistently showing that its onset can be prevented or delayed by changing lifestyle behaviours, there is an urgent need to translate practical, affordable and acceptable interventions from the research setting into the real world. One such approach to lifestyle interventions might be the introduction of a programme in which the individual is provided with choice and facilitated to 'self-select' an exercise programme. Previous research has shown that this is likely to be less resource intensive, an essential requirement for success outside the controlled research environment, while at the same time promoting positive responses relating to adherence, competence and self-efficacy, essential attributes for long-term success. Through a two-group parallel-randomised controlled trial, this study aims to assess the clinical and psychological impact of the DEXLIFE 'self-selected' lifestyle modification programme in adults at risk of developing type 2 diabetes. METHODS/DESIGN A total of 360 subjects at risk of developing type 2 diabetes are randomly assigned in a 1:3 ratio to a control (n = 90) or intervention arm (n = 270). Randomization is stratified by age, sex and body mass index. The control arm receives general information on lifestyle and diabetes risk. The intervention group participate in a 12 week 'self-selected' supervised exercise training programme accompanied with dietary advice to improve food choices. Participants are given access to Dublin City University Sport (an on-campus gym) and asked to perform four exercise classes per week. Dublin City University Sport offers over 50 classes per week, many of which are medically supervised. If weight loss is indicated, reduction in total calorie intake by 600 kcal/day is advised. Common to all food plans is <10% saturated fat intake, as well as a dietary fibre intake of >15 g/1000 kcal. Insulin sensitivity is the primary outcome measure. Secondary outcome measures include glucose function, fitness, body composition, anthropometrics, heart rate variability, lipid profiles, blood pressure, physical activity levels, dietary intake and quality of life. DISCUSSION "Self-selected" lifestyle intervention has not previously been evaluated in type 2 diabetes prevention and if shown to be successful could be implemented in practice immediately. TRIAL REGISTRATION Current Controlled Trials: ISRCTN66987085.
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Affiliation(s)
- Grainne M O'Donoghue
- Centre for Preventive Medicine, School of Health and Human Performance, Dublin City University, Dublin, Ireland. .,Steno Diabetes Center, Gentofte, Denmark.
| | - Aileen Kennedy
- Centre for Preventive Medicine, School of Health and Human Performance, Dublin City University, Dublin, Ireland.
| | | | - Eoin Durkan
- Centre for Preventive Medicine, School of Health and Human Performance, Dublin City University, Dublin, Ireland.
| | | | | | | | - Donal J O'Gorman
- Centre for Preventive Medicine, School of Health and Human Performance, Dublin City University, Dublin, Ireland.
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Chung S, Ha K, Lee HS, Kim CI, Joung H, Paik HY, Song Y. Soft drink consumption is positively associated with metabolic syndrome risk factors only in Korean women: Data from the 2007-2011 Korea National Health and Nutrition Examination Survey. Metabolism 2015; 64:1477-84. [PMID: 26299893 DOI: 10.1016/j.metabol.2015.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/03/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the association between sugar-sweetened beverage consumption and metabolic syndrome risk factors in Korean adults. METHODS We used data from 13,972 participants (5432 men and 8540 women) aged ≥30 years, from the 2007-2011 Korea National Health and Nutrition Examination Survey. The subjects were divided into six groups based on their soft drink consumption levels from a food frequency questionnaire. Dietary sugar intake was compared among groups using 24-hour dietary recall data. RESULTS The highest soft drink consumption frequency category was ≥4 times per week, observed in 4.6% of men and 1.7% of women. The percentage of energy from total sugar and sugar in processed foods increased with increased soft drink consumption in both men and women. In the highest consumption group, the percentage of energy from sugar in processed foods was 8.9% in men and 11.0% in women. After adjusting for potential confounding variables, greater consumption of soft drinks was positively associated with all of the components of metabolic syndrome, except the high density lipoprotein (HDL) cholesterol level, in women only. Women who consumed soft drinks ≥4 times per week had a 74% higher risk of metabolic syndrome compared to those who consumed soft drinks infrequently (OR: 1.74; 95% CI: 1.00-3.03; P for trend <0.0001). CONCLUSION High levels of soft drink consumption might constitute an important determinant of metabolic syndrome and its components only in Korean adult women.
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Affiliation(s)
- Sangwon Chung
- Department of Public Health Nutrition, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Republic of Korea
| | - Kyungho Ha
- Department of Public Health Nutrition, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Republic of Korea
| | - Haeng-Shin Lee
- Nutrition Policy and Promotion Team, Korea Health Industry Development Institute, 187 Osongsaengmyeong2(i)-ro, Gangoe-myeon, Cheongwon-gun, Chungcheongbuk-do 363-951, Republic of Korea
| | - Cho-Il Kim
- Bureau of Health Industry Promotion, Korea Health Industry Development Institute, 187 Osongsaengmyeong2(i)-ro, Gangoe-myeon, Cheongwon-gun, Chungcheongbuk-do 363-951, Republic of Korea
| | - Hyojee Joung
- Department of Public Health Nutrition, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Republic of Korea
| | - Hee-Young Paik
- Department of Food and Nutrition, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Republic of Korea
| | - YoonJu Song
- Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-743, Republic of Korea.
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Ervasti J, Kivimäki M, Dray-Spira R, Head J, Goldberg M, Pentti J, Jokela M, Vahtera J, Zins M, Virtanen M. Socioeconomic gradient in work disability in diabetes: evidence from three occupational cohorts. J Epidemiol Community Health 2015; 70:125-31. [DOI: 10.1136/jech-2015-205943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/04/2015] [Indexed: 01/17/2023]
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Kim Y, Keogh J, Clifton P. A review of potential metabolic etiologies of the observed association between red meat consumption and development of type 2 diabetes mellitus. Metabolism 2015; 64:768-79. [PMID: 25838035 DOI: 10.1016/j.metabol.2015.03.008] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 01/12/2023]
Abstract
Epidemiological studies suggest that red and processed meat consumption is related to an increased risk of type 2 diabetes. However, it is not clearly understood which components of red and processed meat contribute to this increased risk. This review examines potential mechanisms addressing the role of saturated fatty acid, sodium, advanced glycation end products (AGEs), nitrates/nitrites, heme iron, trimethylamine N-oxide (TMAO), branched amino acids (BCAAs) and endocrine disruptor chemicals (EDCs) in the development of type 2 diabetes based on data from published clinical trials and animal models. TMAO which is derived from dietary carnitine and choline by the action of bacterial enzymes followed by oxidation in the liver may be a strong candidate molecule mediating the risk of type 2 diabetes. BCAAs may induce insulin resistance via the mammalian target of rapamycin complex 1 (mTORC1) and ribosomal protein S6 kinase β 1 (S6k1)-associated pathways. The increased risk associated with processed meat compared with red meat suggests that there are interactions between the saturated fat, salt, and nitrates in processed meat and iron, AGEs and TMAO. Intervention studies are required to clarify potential mechanisms and explore interactions among components, in order to make firm recommendations on red and processed meat consumption.
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Affiliation(s)
- Yoona Kim
- School of Pharmacy and Medical Science, University of South Australia, Australia
| | - Jennifer Keogh
- School of Pharmacy and Medical Science, University of South Australia, Australia
| | - Peter Clifton
- School of Pharmacy and Medical Science, University of South Australia, Australia.
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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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Affiliation(s)
- Vanita R Aroda
- a 1 MedStar Health Research Institute, Hyattsville, MD, USA
- b 2 Georgetown University School of Medicine, WA, USA
| | - Asqual Getaneh
- a 1 MedStar Health Research Institute, Hyattsville, MD, USA
- c 3 MedStar Washington Hospital Center, WA, USA
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Memon MS, Shaikh SA, Shaikh AR, Fahim MF, N Mumtaz S, Ahmed N. An assessment of knowledge, attitude and practices (KAP) towards diabetes and diabetic retinopathy in a suburban town of Karachi. Pak J Med Sci 2015; 31:183-8. [PMID: 25878640 PMCID: PMC4386183 DOI: 10.12669/pjms.311.6317] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 08/30/2014] [Accepted: 11/01/2014] [Indexed: 11/25/2022] Open
Abstract
Objective: To assess the Knowledge, Attitude and Practices (KAP) towards diabetes and diabetic retinopathy in the general population of Bin Qasim Town (BQ), Karachi. Methods: An observational, cross-sectional study was approved by Research Ethical Committee of Al-Ibrahim Eye Hospital. It included every third household by stratified sampling in each Union Council of (BQ) Town, in the months of May to July 2013. The interview Questionnaire included 43 questions, of qualitative and quantitative aspects, which were awarded 56 scoring points. SPSS version 20.0 was used to analyze the data. Results: Six hundred ninety two adults one from each household were interviewed. Of the total respondents, 271 (39.2%) had diabetes. Lowest mean knowledge score (5.28 ± 6.09) was seen in illiterate respondents. Male’s Mean Knowledge score (7.61 ± 6.600) was better than female’s (5.46 ± 6.21) with P <0.001. Over all mean score of Attitudes towards diabetes was 5.43 ± 2.57. It was higher (6.62 ± 2.03) in diabetic respondents as compared with non-diabetic respondents (4.70 ± 2.59) with p < 0.000. In Practice module majority of the respondents (69.9%) did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination. Conclusion: Lack of knowledge of diabetes was found in the surveyed community, more marked in females, illiterate and the individuals not having diabetes.
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Affiliation(s)
- Muhammad Saleh Memon
- Dr. Muhammad Saleh Memon, DO, FRCS (Eden), Director Projects, Isra Ophthalmic Research & Development Center
| | - Sikander Ali Shaikh
- Sikander Ali Shaikh, M.A (Sociology), Project Manager, Department of Community Based Projects
| | - Abdul Rashid Shaikh
- Dr. Abdul Rashid Shaikh, MCPS, MS, Assistant Professor, Department of Ophthalmology
| | - Muhammad Faisal Fahim
- Muhammad Faisal Fahim, M.Sc (Statistics), Statistician, Isra Ophthalmic Research & Development Center
| | - Seema N Mumtaz
- Dr. Seema N. Mumtaz, MBBS,M.Phill,MPH,MBA(Health), DCPS(HSCM), Chairperson, Community Medicine, Department of Community Medicine, Al Tibri Medical College, Isra University Karachi Campus, Pakistan
| | - Nadeem Ahmed
- Mr. Nadeem Ahmed, M.A Econ, MES Environmental Studies, Consultant, Isra Ophthalmic Research & Development Center
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Heideman WH, de Wit M, Middelkoop BJC, Nierkens V, Stronks K, Verhoeff AP, Snoek FJ. Diabetes risk reduction in overweight first degree relatives of type 2 diabetes patients: effects of a low-intensive lifestyle education program (DiAlert) A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2015; 98:476-483. [PMID: 25577471 DOI: 10.1016/j.pec.2014.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 11/25/2014] [Accepted: 12/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To test the efficacy of a low-intensive lifestyle education program (DiAlert) for overweight first degree relatives of type 2 diabetes patients aimed at reducing diabetes risk. METHODS Overweight first degree relatives of type 2 diabetes patients were randomly assigned to the DiAlert intervention (N=45) or control group who received leaflets (N=51). DiAlert consists of two group sessions and newsletters. Assessments were scheduled at baseline, three and nine months, with weight loss as primary outcome. Secondary outcomes included anthropometric, metabolic, behavioral and psychological measures. Comparisons were made over time and between groups. RESULTS Both groups showed modest weight loss with no difference between randomization groups. However, after DiAlert significantly more participants lost 5% of their weight compared to controls (P=0.03). Significant improvement of waist circumference sustained after 9 months in the intervention group (intervention: -4.33cm, P<0.01/control: -1.25cm, P=0.08). Systolic blood pressure improved within the intervention group (intervention: -8.77mmHg, P<0.01/control: -1.03mmHg, P=0.60). No effect was observed for biomedical and psychosocial outcomes. CONCLUSIONS Our low-intensive structured lifestyle education program helps overweight relatives to improve waist circumference and supports relevant weight loss. PRACTICE IMPLICATIONS The family approach provides opportunities to reach and engage relatives at risk in diabetes prevention education.
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Affiliation(s)
- Wieke H Heideman
- Department of Medical Psychology, The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Maartje de Wit
- Department of Medical Psychology, The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Barend J C Middelkoop
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Vera Nierkens
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud P Verhoeff
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, The Netherlands; Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Shoaei T, Heidari-Beni M, Tehrani HG, Feizi A, Esmaillzadeh A, Askari G. Effects of Probiotic Supplementation on Pancreatic β-cell Function and C-reactive Protein in Women with Polycystic Ovary Syndrome: A Randomized Double-blind Placebo-controlled Clinical Trial. Int J Prev Med 2015; 6:27. [PMID: 25949777 PMCID: PMC4387688 DOI: 10.4103/2008-7802.153866] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 02/12/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder in women of reproductive age that lead to infertility. The aim of this study was to investigate the effects of probiotic on pancreatic β-cell function and C-reactive protein (CRP) in PCOS patients. Methods: This randomized double-blind placebo-controlled clinical trial was conducted among 72 women aged 15–40 years old diagnosed with PCOS. Participants were randomly assigned to two groups receiving: (1) Probiotic supplements (n = 36), (2) placebo (n = 36) for 8-week. Fasting blood samples were taken at baseline and after 8-week of intervention. Results: Probiotic supplementation, compare with placebo, reduced fasting blood sugar (−4.15 ± 2.87 vs. 2.57 ± 5.66 mg/dL, respectively P = 0.7), serum insulin levels in crude model (−0.49 ± 0.67 vs. 0.34 ± 0.82 μIU/mL, respectively, P = 0.09), homeostasis model of assessment-insulin resistance score (−0.25 ± 0.18 vs. −0.05 ± 0.18, respectively, P = 0.14) nonsignificantly. Serum insulin levels after adjustment with covariates reduced significantly in probiotic group (P = 0.02). We did not found any significant differences in mean changes of CRP between groups (−0.25 ± 0.18 vs. −0.05 ± 0.18, respectively, P = 0.14). Conclusions: A 8-week multispecies probiotics supplementation had nonsignificantly beneficial effect on pancreatic β-cell function and CRP in PCOS patients. After adjustment for some covariates, serum insulin changes were significantly different between groups.
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Affiliation(s)
- Tanaz Shoaei
- Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Motahar Heidari-Beni
- Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hatav Ghasemi Tehrani
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Wikström K, Lindström J, Tuomilehto J, Saaristo T, Helakorpi S, Korpi-Hyövälti E, Oksa H, Vanhala M, Keinänen-Kiukaanniemi S, Uusitupa M, Peltonen M. National diabetes prevention program (DEHKO): awareness and self-reported lifestyle changes in Finnish middle-aged population. Public Health 2015; 129:210-7. [DOI: 10.1016/j.puhe.2014.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/19/2014] [Accepted: 12/28/2014] [Indexed: 11/29/2022]
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Tigges C, Wennehorst K, Saliger B, Englert H. CHIP Deutschland: Das sozial-kognitive Prozessmodell gesundheitlichen Handelns (HAPA) und die Verbesserung des Bewegungsverhaltens durch ein Lebensstilcoaching-Programm zur Primär- und Sekundärprävention des Diabetes mellitus Typ 2. VERHALTENSTHERAPIE 2015. [DOI: 10.1159/000373899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Greaves C, Gillison F, Stathi A, Bennett P, Reddy P, Dunbar J, Perry R, Messom D, Chandler R, Francis M, Davis M, Green C, Evans P, Taylor G. Waste the waist: a pilot randomised controlled trial of a primary care based intervention to support lifestyle change in people with high cardiovascular risk. Int J Behav Nutr Phys Act 2015; 12:1. [PMID: 25592201 PMCID: PMC4304605 DOI: 10.1186/s12966-014-0159-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 12/19/2014] [Indexed: 01/25/2023] Open
Abstract
Background In the UK, thousands of people with high cardiovascular risk are being identified by a national risk-assessment programme (NHS Health Checks). Waste the Waist is an evidence-informed, theory-driven (modified Health Action Process Approach), group-based intervention designed to promote healthy eating and physical activity for people with high cardiovascular risk. This pilot randomised controlled trial aimed to assess the feasibility of delivering the Waste the Waist intervention in UK primary care and of conducting a full-scale randomised controlled trial. We also conducted exploratory analyses of changes in weight. Methods Patients aged 40–74 with a Body Mass Index of 28 or more and high cardiovascular risk were identified from risk-assessment data or from practice database searches. Participants were randomised, using an online computerised randomisation algorithm, to receive usual care and standardised information on cardiovascular risk and lifestyle (Controls) or nine sessions of the Waste the Waist programme (Intervention). Group allocation was concealed until the point of randomisation. Thereafter, the statistician, but not participants or data collectors were blinded to group allocation. Weight, physical activity (accelerometry) and cardiovascular risk markers (blood tests) were measured at 0, 4 and 12 months. Results 108 participants (22% of those approached) were recruited (55 intervention, 53 controls) from 6 practices and 89% provided data at both 4 and 12 months. Participants had a mean age of 65 and 70% were male. Intervention participants attended 72% of group sessions. Based on last observations carried forward, the intervention group did not lose significantly more weight than controls at 12 months, although the difference was significant when co-interventions and co-morbidities that could affect weight were taken into account (Mean Diff 2.6Kg. 95%CI: −4.8 to −0.3, p = 0.025). No significant differences were found in physical activity. Conclusions The Waste the Waist intervention is deliverable in UK primary care, has acceptable recruitment and retention rates and produces promising preliminary weight loss results. Subject to refinement of the physical activity component, it is now ready for evaluation in a full-scale trial. Trial registration Current Controlled Trials ISRCTN10707899. Electronic supplementary material The online version of this article (doi:10.1186/s12966-014-0159-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colin Greaves
- University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
| | | | | | - Paul Bennett
- University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Prasuna Reddy
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - James Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, VIC, 3280, Australia.
| | - Rachel Perry
- University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Daniel Messom
- Bath, Gloucester, Swindon, Wiltshire Area Public Health Team, Public Health England, 1st Floor Bewley House, Marshfield Road, Chippenham, Wiltshire, SN15 1JW, UK.
| | - Roger Chandler
- Waste the Waist Service User Advisory Group, c/o Colin Greaves, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2PU, UK.
| | - Margaret Francis
- Waste the Waist Service User Advisory Group, c/o Colin Greaves, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2PU, UK.
| | - Mark Davis
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.
| | - Colin Green
- University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
| | - Philip Evans
- University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
| | - Gordon Taylor
- University of Bath, Claverton Down, Bath, BA2 7AY, UK.
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Malo JA, Versace VL, Janus ED, Laatikainen T, Peltonen M, Vartiainen E, Coates MJ, Dunbar JA. Evaluation of AUSDRISK as a screening tool for lifestyle modification programs: international implications for policy and cost-effectiveness. BMJ Open Diabetes Res Care 2015; 3:e000125. [PMID: 26468399 PMCID: PMC4600182 DOI: 10.1136/bmjdrc-2015-000125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/02/2015] [Accepted: 09/07/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the current use of Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) as a screening tool to identify individuals at high risk of developing type 2 diabetes for entry into lifestyle modification programs. RESEARCH DESIGN AND METHODS AUSDRISK scores were calculated from participants aged 40-74 years in the Greater Green Triangle Risk Factor Study, a cross-sectional population survey in 3 regions of Southwest Victoria, Australia, 2004-2006. Biomedical profiles of AUSDRISK risk categories were determined along with estimates of the Victorian population included at various cut-off scores. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and receiver operating characteristics were calculated for AUSDRISK in determining fasting plasma glucose (FPG) ≥6.1 mmol/L. RESULTS Increasing AUSDRISK scores were associated with an increase in weight, body mass index, FPG, and metabolic syndrome. Increasing the minimum cut-off score also increased the proportion of individuals who were obese and centrally obese, had impaired fasting glucose (IFG) and metabolic syndrome. An AUSDRISK score of ≥12 was estimated to include 39.5% of the Victorian population aged 40-74 (916 000), while a score of ≥20 would include only 5.2% of the same population (120 000). At AUSDRISK≥20, the PPV for detecting FPG≥6.1 mmol/L was 28.4%. CONCLUSIONS AUSDRISK is powered to predict those with IFG and undiagnosed type 2 diabetes, but its effectiveness as the sole determinant for entry into a lifestyle modification program is questionable given the large proportion of the population screened-in using the current minimum cut-off of ≥12. AUSDRISK should be used in conjunction with oral glucose tolerance testing, fasting glucose, or glycated hemoglobin to identify those individuals at highest risk of progression to type 2 diabetes, who should be the primary targets for lifestyle modification.
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Affiliation(s)
- Jonathan A Malo
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Vincent L Versace
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Edward D Janus
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- Western Centre for Health Research and Education, Western Health, University of Melbourne, St. Albans, Victoria, Australia
| | - Tiina Laatikainen
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Health Sciences, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Vartiainen
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- National Institute for Health and Welfare, Helsinki, Finland
| | - Michael J Coates
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - James A Dunbar
- Faculty of Health, Deakin Population Health Strategic Research Centre, Deakin University, Burwood, Australia
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Dunbar JA, Hernan AL, Janus ED, Vartiainen E, Laatikainen T, Versace VL, Reynolds J, Best JD, Skinner TC, O'Reilly SL, Mc Namara KP, Stewart E, Coates M, Bennett CM, Carter R. Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study. BMJ Open Diabetes Res Care 2015; 3:e000131. [PMID: 26464804 PMCID: PMC4597415 DOI: 10.1136/bmjdrc-2015-000131] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed. RESULTS PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013). CONCLUSIONS MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention.
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Affiliation(s)
- James A Dunbar
- Faculty of Health, Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Andrea L Hernan
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Edward D Janus
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- Western Academic Centre, Western Centre for Health Research and Education, Western Health, University of Melbourne, St. Albans, Victoria, Australia
| | - Erkki Vartiainen
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Health Sciences, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Vincent L Versace
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - James D Best
- Lee Kong Chian School of Medicine, Nanyang Technological University and Imperial College London, Singapore, Singapore
| | - Timothy C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sharleen L O'Reilly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Kevin P Mc Namara
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Elizabeth Stewart
- Faculty of Health, Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Michael Coates
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Catherine M Bennett
- Faculty of Health, Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Rob Carter
- Faculty of Health, Deakin Health Economics, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
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Dasgupta K, Jarvandi S, De Civita M, Pillay S, Hajna S, Gougeon R, Bader A, Da Costa D. Participants' perceptions of a group based program incorporating hands-on meal preparation and pedometer-based self-monitoring in type 2 diabetes. PLoS One 2014; 9:e114620. [PMID: 25536068 PMCID: PMC4275207 DOI: 10.1371/journal.pone.0114620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 11/12/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nutrition education (portion sizes, balanced meals) is a cornerstone of diabetes management; however, moving from information to behavior change is challenging. Through a single arm intervention study, we recently demonstrated that combining education with group-based meal preparation training has measureable effects on weight, eating behaviour, and glycemic control in adults with type 2 diabetes. In the present study, we conducted an in-depth examination of participants' perceptions of this strategy, through focus group discussion, to delineate effective elements of the strategy from participants' perspectives. METHODS Participants who had completed the nutrition education/meal preparation training program were invited to attend one of four focus group discussions. These were led by experienced facilitators and guided by questions addressing experiences during the intervention and their perceived impact. Audiotapes were transcribed and qualitative content analysis of transcripts was performed. We report herein themes that achieved saturation across the four discussions. RESULTS Twenty-nine (80.6%, 29/36) attended a focus group discussion. The program elements perceived as effective by participants included the hands-on interactive learning approach to meal preparation, the grocery store tour, pedometer-based self-monitoring, experiencing the link between food consumption/physical activity and glucose changes during the program, and peer support. Discussants reported changes in eating and walking behaviour, greater confidence in ability to self-manage diabetes, reductions in glucose levels and/or need for glucose-lowering medications, and, in some cases, weight loss. Family members and friends were facilitators for some and barriers for others in terms of achieving health behavior changes. CONCLUSIONS Among adults with type 2 diabetes, a group based program that included hands-on meal preparation and pedometer-based self-monitoring was perceived as effective in conveying information, developing skills, building confidence, and changing health behaviors.
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Affiliation(s)
- Kaberi Dasgupta
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Soghra Jarvandi
- School of Medicine, Division of Health Behavior Research, Washington University, St. Louis, Missouri, United States of America
| | - Mirella De Civita
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sabrina Pillay
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Samantha Hajna
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rejeanne Gougeon
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abeer Bader
- Community Diabetes Education Program of Ottawa, Ottawa, Ontario, Canada
| | - Deborah Da Costa
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Blüher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood - Does weight status alone matter? Metabolism 2014; 63:1084-92. [PMID: 25038727 DOI: 10.1016/j.metabol.2014.06.009] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/13/2014] [Accepted: 06/14/2014] [Indexed: 11/23/2022]
Abstract
Up to 30% of obese people do not display the "typical" metabolic obesity-associated complications. For this group of patients, the term "metabolically healthy obese (MHO)" has been established during the past years and has been the focus of research activities. The development and severity of insulin resistance as well as (subclinical) inflammations seems to play a key role in distinguishing metabolically healthy from metabolically non-healthy individuals. However, an internationally consistent and accepted classification that might also include inflammatory markers as well as features of non-alcoholic fatty liver disease is missing to date, and available data - in terms of prevalence, definition and severity - are heterogeneous, both during childhood/adolescence and during adulthood. In addition, the impact of MHO on future morbidity and mortality compared to obese, metabolically non-healthy as well as normal weight, metabolically healthy individuals is absolutely not clear to date and even conflicting. This review summarizes salient literature related to that topic and provides insight into our current understanding of MHO, covering all age spans from childhood to adulthood.
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Affiliation(s)
- Susann Blüher
- Leipzig University Medical Center, IFB Adiposity Diseases, University of Leipzig, Germany.
| | - Peter Schwarz
- Technical University Dresden, Department of Prevention and Care of Diabetes, Germany; Paul Langerhans Institute Dresden, German Center for Diabetes Research (DZD), Germany
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76
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New insight into improvement of cardiovascular outcomes with intensive glycemic control in patients with metabolic syndrome and type 2 diabetes mellitus included. Cell Biochem Biophys 2014; 71:9-15. [PMID: 25113641 DOI: 10.1007/s12013-014-0175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The epidemiology of metabolic syndrome (MetS) is very concerning since this is a widespread chronic disease in adult and elderly population. Different epidemiological studies confirmed strong relationship between type 2 diabetes mellitus (DM2) inclusive MetS and the occurrence of microvascular and macrovascular complications in these patients. Therefore, we are discussing molecular mechanisms and pathways recently introduced and intensively researched. These molecules have been held responsible for direct and indirect correlative trends important in the assessment of potential benefit of intensive glycemic control. Novel substances may improve patient's outcome in recent future regarding cardiovascular complications though their acting mechanisms have not been completely elucidated. We are reviewing whether it would intensive glycemic control be a reasonable approach in patients with MetS when DM2 is included and which recommendations are currently widely applied. The aim was therefore to emphasize current need for further investigations in the field since the utility of intensive glycemic control in all DM/MetS patients as mean for reduction of cardiovascular complications still remains controversial.
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Virtanen M, Ferrie JE, Tabak AG, Akbaraly TN, Vahtera J, Singh-Manoux A, Kivimäki M. Psychological distress and incidence of type 2 diabetes in high-risk and low-risk populations: the Whitehall II Cohort Study. Diabetes Care 2014; 37:2091-7. [PMID: 24784831 PMCID: PMC4113169 DOI: 10.2337/dc13-2725] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined whether psychological distress predicts incident type 2 diabetes and if the association differs between populations at higher or lower risk of type 2 diabetes. RESEARCH DESIGN AND METHODS This was a prospective cohort of 5,932 diabetes-free adults (4,189 men and 1,743 women, mean age 54.6 years) with three 5-year data cycles (1991-2009): a total of 13,207 person-observations. Participants were classified into four groups according to their prediabetes status and Framingham Offspring Type 2 Diabetes Risk Score: normoglycemia with a risk score of 0-9, normoglycemia with a risk score of 10-19, prediabetes with a risk score of 10-19, and prediabetes with a risk score of >19. Psychological distress was assessed by the General Health Questionnaire. Incident type 2 diabetes was ascertained by 2-h oral glucose tolerance test, doctor diagnosis, or use of antihyperglycemic medication at the 5-year follow-up for each data cycle. Adjustments were made for age, sex, ethnicity, socioeconomic status, antidepressant use, smoking, and physical activity. RESULTS Among participants with normoglycemia and among those with prediabetes combined with a low risk score, psychological distress did not predict type 2 diabetes. Diabetes incidence in these groups varied between 1.6 and 15.6%. Among participants with prediabetes and a high risk score, 40.9% of those with psychological distress compared with 28.5% of those without distress developed diabetes during the follow-up. The corresponding adjusted odds ratio for psychological distress was 2.07 (95% CI 1.19-3.62). CONCLUSIONS These data suggest that psychological distress is associated with an accelerated progression to manifest diabetes in a subpopulation with advanced prediabetes.
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Affiliation(s)
| | - Jane E Ferrie
- Department of Epidemiology and Public Health, University College, London, U.K.School of Community and Social Medicine, University of Bristol, Bristol, U.K
| | - Adam G Tabak
- Department of Epidemiology and Public Health, University College, London, U.K.1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tasnime N Akbaraly
- Institut National de la Santé et de la Recherche Médicale, U1061, Montpellier, France
| | - Jussi Vahtera
- Finnish Institute of Occupational Health, Helsinki, FinlandUniversity of Turku and Turku University Hospital, Turku, Finland
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College, London, U.K.Institut National de la Santé et de la Recherche Médicale, U1018, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College, London, U.K
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Obesity and associated lifestyle in a large sample of multi-morbid German primary care attendees. PLoS One 2014; 9:e102587. [PMID: 25036102 PMCID: PMC4103827 DOI: 10.1371/journal.pone.0102587] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 06/20/2014] [Indexed: 01/08/2023] Open
Abstract
Background Obesity and the accompanying increased morbidity and mortality risk is highly prevalent among older adults. As obese elderly might benefit from intentional weight reduction, it is necessary to determine associated and potentially modifiable factors on senior obesity. This cross-sectional study focuses on multi-morbid patients which make up the majority in primary care. It reports on the prevalence of senior obesity and its associations with lifestyle behaviors. Methods A total of 3,189 non-demented, multi-morbid participants aged 65–85 years were recruited in primary care within the German MultiCare-study. Physical activity, smoking, alcohol consumption and quantity and quality of nutritional intake were classified as relevant lifestyle factors. Body Mass Index (BMI, general obesity) and waist circumference (WC, abdominal obesity) were used as outcome measures and regression analyses were conducted. Results About one third of all patients were classified as obese according to BMI. The prevalence of abdominal obesity was 73.5%. Adjusted for socio-demographic variables and objective and subjective disease burden, participants with low physical activity had a 1.6 kg/m2 higher BMI as well as a higher WC (4.9 cm, p<0.001). Current smoking and high alcohol consumption were associated with a lower BMI and WC. In multivariate logistic regression, using elevated WC and BMI as categorical outcomes, the same pattern in lifestyle factors was observed. Only for WC, not current but former smoking was associated with a higher probability for elevated WC. Dietary intake in quantity and quality was not associated with BMI or WC in either model. Conclusions Further research is needed to clarify if the huge prevalence discrepancy between BMI and WC also reflects a difference in obesity-related morbidity and mortality. Yet, age-specific thresholds for the BMI are needed likewise. Encouraging and promoting physical activity in older adults might a starting point for weight reduction efforts.
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Can physical activity interventions for adults with type 2 diabetes be translated into practice settings? A systematic review using the RE-AIM framework. Transl Behav Med 2014; 4:60-78. [PMID: 24653777 DOI: 10.1007/s13142-013-0235-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Despite the strong evidence base for the efficacy of physical activity in the management of type 2 diabetes, a limited number of physical activity interventions have been translated and evaluated in everyday practice. This systematic review aimed to report the findings of studies in which an intervention, containing physical activity promotion as a component, has been delivered within routine diabetes care. A comprehensive search was conducted for articles reporting process data relating to components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and/or Maintenance) framework. Twelve studies met the selection criteria. Of the nine studies which measured physical activity as an outcome, eight reported an increase in physical activity levels, five of which were significant. Tailoring recruitment, resources and intervention delivery to the target population played a positive role, in addition to the use of external organisations and staff training. Many interventions were of short duration and lacked long-term follow-up data. Findings revealed limited and inconsistent reporting of useful process data.
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The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice. ATHEROSCLEROSIS SUPP 2014; 15:1-15. [DOI: 10.1016/j.atherosclerosissup.2014.04.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD - summary. Diab Vasc Dis Res 2014; 11:133-73. [PMID: 24800783 DOI: 10.1177/1479164114525548] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Maindal HT, Bonde A, Aagaard-Hansen J. Action research led to a feasible lifestyle intervention in general practice for people with prediabetes. Prim Care Diabetes 2014; 8:23-29. [PMID: 24361372 DOI: 10.1016/j.pcd.2013.11.007] [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: 03/27/2013] [Revised: 11/07/2013] [Accepted: 11/28/2013] [Indexed: 11/28/2022]
Abstract
AIM To develop and pilot a feasible lifestyle intervention for people with prediabetes tailored for general practice. The study was designed to explore (i) what resources and competencies would be required and (ii) which intervention components should be included. METHODS In the first of two action research cycles various interventions were explored in general practice. The second cycle tested the intervention described by the end of the first cycle. In total, 64 patients, 8 GPs and 10 nurses participated. RESULTS An intervention comprising six consultations to be delivered during the first year after identified prediabetes was found feasible by the general practice staff in terms of resources. Practice nurses possessed the adequate competences to undertake the core part of the intervention. The intervention comprised fixed elements according to structure, time consumption and educational principles, and flexible elements according to educational material and focus points for behaviour change. Clinical relevant reductions in patients' BMI and HbA1c were found. CONCLUSION A prediabetes lifestyle intervention for Danish general practice with potential for diabetes prevention was developed based on action research. The transferability of the developed intervention to other general practices depends on the GPs priorities, availability of practice nurses to deliver the core part, and the remuneration system for general practice. The long-term feasibility in larger patient populations is unknown.
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Affiliation(s)
- Helle Terkildsen Maindal
- Section for Health Promotion and Health Services and Section of General Practice, Department of Public Health, Aarhus University, Denmark.
| | - Ane Bonde
- Steno Health Promotion Centre, Steno Diabetes Centre, Gentofte, Denmark.
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Portero McLellan KC, Wyne K, Villagomez ET, Hsueh WA. Therapeutic interventions to reduce the risk of progression from prediabetes to type 2 diabetes mellitus. Ther Clin Risk Manag 2014; 10:173-88. [PMID: 24672242 PMCID: PMC3964168 DOI: 10.2147/tcrm.s39564] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Clinical trials have demonstrated that it is possible to prevent diabetes through lifestyle modification, pharmacological intervention, and surgery. This review aims to summarize the effectiveness of these various therapeutic interventions in reducing the risk of progression of prediabetes to diabetes, and address the challenges to implement a diabetes prevention program at a community level. Strategies focusing on intensive lifestyle changes are not only efficient but cost-effective and/or cost-saving. Indeed, lifestyle intervention in people at high risk for type 2 diabetes mellitus (T2DM) has been successful in achieving sustained behavioral changes and a reduction in diabetes incidence even after the counseling is stopped. Although prediabetes is associated with health and economic burdens, it has not been adequately addressed by interventions or regulatory agencies in terms of prevention or disease management. Lifestyle intervention strategies to prevent T2DM should be distinct for different populations around the globe and should emphasize sex, age, ethnicity, and cultural and geographical considerations to be feasible and to promote better compliance. The translation of diabetes prevention research at a population level, especially finding the most effective methods of preventing T2DM in various societies and cultural settings remains challenging, but must be accomplished to stop this worldwide epidemic.
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Affiliation(s)
| | - Kathleen Wyne
- Division of Diabetes, Obesity and Lipids, Department of Medicine, The Methodist Hospital Diabetes and Metabolism Institute, and the Houston Methodist Research Institute, Weill Cornell Medical College, Houston, TX, USA
| | - Evangelina Trejo Villagomez
- Division of Diabetes, Obesity and Lipids, Department of Medicine, The Methodist Hospital Diabetes and Metabolism Institute, and the Houston Methodist Research Institute, Weill Cornell Medical College, Houston, TX, USA
| | - Willa A Hsueh
- Division of Diabetes, Obesity and Lipids, Department of Medicine, The Methodist Hospital Diabetes and Metabolism Institute, and the Houston Methodist Research Institute, Weill Cornell Medical College, Houston, TX, USA
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Blüher S, Petroff D, Wagner A, Warich K, Gausche R, Klemm T, Wagner M, Keller A. The one year exercise and lifestyle intervention program KLAKS: Effects on anthropometric parameters, cardiometabolic risk factors and glycemic control in childhood obesity. Metabolism 2014; 63:422-30. [PMID: 24405751 DOI: 10.1016/j.metabol.2013.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/08/2013] [Accepted: 11/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Regular physical exercise within structured lifestyle programs may improve weight status and minimize metabolic risk factors in childhood obesity. The aim of this study was to evaluate the effect of the one-year combined physical exercise/lifestyle program KLAKS on anthropometric and metabolic parameters and glycemic control in childhood obesity. MATERIALS AND METHODS 142 overweight/obese (BMI>90th percentile) candidates (7-18years) were enrolled, 115 participants completed the program. Anthropometrics and biochemical parameters were obtained at beginning and completion. An oral glucose tolerance test (OGTT) was performed in a subgroup of participants. Course of glucose and insulin levels within OGTT was correlated with several parameters and is reported here for those who completed the program. RESULTS The mean standard deviation scores (SDS) decreased significantly for BMI, waist circumference, waist-to-height ratio (WHtR) and percentage body fat (all p≤0.01). Improved metabolic risk markers included mean glucose levels within an OGTT at follow-up compared to baseline (p<0.0001) and HbA1c (p=0.05) as well as indications of improvement for gamma-glutamyl-transferase and free fatty acids. CONCLUSIONS The one-year combined exercise/lifestyle program KLAKS significantly improves markers of obesity and glycemic control. Impaired cardiometabolic risk markers, even subclinical, are also favorably influenced by program participation.
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Affiliation(s)
- Susann Blüher
- Leipzig University Medical Center, IFB AdiposityDiseases, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany.
| | - David Petroff
- Leipzig University Medical Center, IFB AdiposityDiseases, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany; Center for Clinical Studies, University of Leipzig, Härtelstrasse 16 - 18, 04107 Leipzig, Germany
| | - Antje Wagner
- KLAKS e.V., Lessingstrasse 2, 04109 Leipzig, Germany
| | - Katja Warich
- KLAKS e.V., Lessingstrasse 2, 04109 Leipzig, Germany
| | - Ruth Gausche
- CrescNet gGmbH, University of Leipzig, Philipp-Rosenthal-Str. 27b, 04103 Leipzig, Germany
| | - Thorsten Klemm
- MVZ Labor Dr. Reising-Ackermann & Colleagues, Strümpellstraße 40, 04289 Leipzig, 04289, Leipzig, Germany
| | - Mario Wagner
- Gesundheitssportverein Leipzig e.V., Lessingstrasse 2, 04109 Leipzig, Germany
| | - Alexandra Keller
- CrescNet gGmbH, University of Leipzig, Philipp-Rosenthal-Str. 27b, 04103 Leipzig, Germany; Pediatric Medical Center, Johannisplatz 1, 04103 Leipzig, Germany
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Venditti EM, Wylie-Rosett J, Delahanty LM, Mele L, Hoskin MA, Edelstein SL. Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence. Int J Behav Nutr Phys Act 2014; 11:16. [PMID: 24521153 PMCID: PMC4015875 DOI: 10.1186/1479-5868-11-16] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts. Methods Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 ± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic characteristics. Results Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time management (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having any type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were significantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness and access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle coaches used problem-solving with most participants (≥75% short-term; > 90% long term) and regularly reviewed self-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (≤10%) but increased over 3.2 years. Conclusion Behavioral problem solving approaches have short and long term dissemination potential for many kinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the consistent use of these approaches appears warranted.
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Affiliation(s)
- Elizabeth M Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Guía de práctica clínica de la ESC sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Sato N, Htun NC, Daimon M, Tamiya G, Kato T, Kubota I, Ueno Y, Yamashita H, Fukao A, Kayama T, Muramatsu M. Likelihood ratio-based integrated personal risk assessment of type 2 diabetes. Endocr J 2014; 61:967-88. [PMID: 25069673 DOI: 10.1507/endocrj.ej14-0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To facilitate personalized health care for multifactorial diseases, risks of genetic and clinical/environmental factors should be assessed together for each individual in an integrated fashion. This approach is possible with the likelihood ratio (LR)-based risk assessment system, as this system can incorporate manifold tests. We examined the usefulness of this system for assessing type 2 diabetes (T2D). Our system employed 29 genetic susceptibility variants, body mass index (BMI), and hypertension as risk factors whose LRs can be estimated from openly available T2D association data for the Japanese population. The pretest probability was set at a sex- and age-appropriate population average of diabetes prevalence. The classification performance of our LR-based risk assessment was compared to that of a non-invasive screening test for diabetes called TOPICS (with score based on age, sex, family history, smoking, BMI, and hypertension) using receiver operating characteristic analysis with a community cohort (n = 1263). The area under the receiver operating characteristic curve (AUC) for the LR-based assessment and TOPICS was 0.707 (95% CI 0.665-0.750) and 0.719 (0.675-0.762), respectively. These AUCs were much higher than that of a genetic risk score constructed using the same genetic susceptibility variants, 0.624 (0.574-0.674). The use of ethnically matched LRs is necessary for proper personal risk assessment. In conclusion, although LR-based integrated risk assessment for T2D still requires additional tests that evaluate other factors, such as risks involved in missing heritability, our results indicate the potential usability of LR-based assessment system and stress the importance of stratified epidemiological investigations in personalized medicine.
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Affiliation(s)
- Noriko Sato
- Department of Epigenetic Epidemiology/ Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo 101-0062, Japan
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Hoppert K, Mai R, Zahn S, Schwarz PE, Hoffmann S, Rohm H. Is there a fit in cognitive and sensory evaluation of yogurt? The moderating role of nutrition training. Food Qual Prefer 2014. [DOI: 10.1016/j.foodqual.2013.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barros CRD, Cezaretto A, Salvador EP, Santos TCD, Siqueira-Catania A, Ferreira SRG. [Implementation of a structured healthy lifestyle program to reduce cardiometabolic risk]. ACTA ACUST UNITED AC 2013; 57:7-18. [PMID: 23440094 DOI: 10.1590/s0004-27302013000100002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 11/13/2012] [Indexed: 11/22/2022]
Abstract
The objective this study was to describe the methodology and implementation of lifestyle change program in individuals at cardiometabolic risk seen at the public health system in Sao Paulo. The Programa de Prevenção de Diabetes Mellitus (PDM) aims at improving the overall metabolic profile of individuals with prediabetes or metabolic syndrome without diabetes; its goals were > 5% weight loss, dietary fiber intake > 20 g per day, saturated fatty acids intake < 10% per day, and > 150 minutes of physical activity per week. The first edition of the PDM lasted 18 months and involved an interdisciplinary team (endocrinologist, psychologist, nutritionist, and physical educator) to plan and conduct group sessions with the participants. The structure and systematic of the sessions were planned using a psychoeducative approach in order to facilitate the process of lifestyle changes. Based on the Experience with the PDM, some reflections and recommendations are made. This study may indicate ways for health professionals to tailor local care conditions and promote a healthy lifestyle, working with a new perspective.
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Affiliation(s)
- Camila Risso de Barros
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo, SP, Brasil
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90
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Müller G, Parfentyeva E, Olschewsky J, Bornstein SR, Schwarz PEH. Assessment of small fiber neuropathy to predict future risk of type 2 diabetes. Prim Care Diabetes 2013; 7:269-273. [PMID: 24076379 DOI: 10.1016/j.pcd.2013.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/20/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Sudomotor dysfunction due to small fiber neuropathy can be observed very early in pre-diabetes. The aim of this study was to assess the predictive power of EZSCAN, a non invasive, quick and simple measurement of sudomotor function to identify glucose impairment. RESEARCH DESIGN AND METHODS The study was performed in 76 German subjects at risk of diabetes. Glucose metabolism was assessed by using, oral glucose tolerance test (OGTT) at baseline and after 2 year follow-up. Sudomotor function was evaluated by measuring hand and foot electrochemical sweat conductances to calculate a risk score. RESULTS At baseline, 38 patients had normal glucose tolerance (NGT), 34 had pre-diabetes (impaired fasting glucose, IFG and/or impaired glucose tolerance, IGT) and 4 had newly diagnosed type 2 diabetes. The AUC values for FPG, 2h-OGTT glucose, 1h-OGTT glucose, HbA1C and EZSCAN score to predict pre-diabetes were 0.50, 0.65, 0.64, 0.72 and 0.76, respectively. Subjects having a moderate or high EZSCAN score (>50) at baseline had a substantially increased risk for having IFG and/or IGT at follow-up visit presented by an odds ratio of 12.0 [1.4-100.5], the OR for having 1h-OGTT ≥ 8.6mmol/L at follow-up was 9.8 [1.0-92.8] and for having HbA1C ≥ 5.7% was 15.7 [1.9-131.5] compared to subjects with low EZSCAN risk. CONCLUSIONS This preliminary study, which must be confirmed in a larger population, shows that EZSCAN risk score is associated with diabetes progression which have implications for prevention and disease management.
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Affiliation(s)
- G Müller
- Institute for Medical Informatics and Biometry, Medical Faculty at the Technical University Dresden, Germany
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91
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Penn L, Ryan V, White M. Feasibility, acceptability and outcomes at a 12-month follow-up of a novel community-based intervention to prevent type 2 diabetes in adults at high risk: mixed methods pilot study. BMJ Open 2013; 3:e003585. [PMID: 24227871 PMCID: PMC3831101 DOI: 10.1136/bmjopen-2013-003585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES AND DESIGN Lifestyle interventions can prevent type 2 diabetes (T2D) in adults with impaired glucose tolerance. In a mixed methods pilot study, we aimed to assess the feasibility, acceptability and outcomes at a 12-month follow-up of a behavioural intervention for adults at risk of T2D. PARTICIPANTS Adults aged 45-65 years with a Finnish Diabetes Risk Score (FINDRISC) ≥11. SETTING The intervention was delivered in leisure and community settings in a local authority that ranks in the 10 most socioeconomically deprived in England. INTERVENTION A 10-week supported programme to promote increased physical activity (PA), healthy eating and weight loss was delivered by fitness trainers as twice-weekly group PA or cookery sessions, each followed by behavioural counselling with support to 12 months. OUTCOME MEASURES We assessed feasibility and acceptability of the intervention, and change in behavioural and health-related outcomes at 6 and 12 months. RESULTS From 367 registers of interest, 218 participants were recruited to the programme with baseline mean (SD): age 53.6 (6) years, FINDRISC 13.9 (3.1), body mass index 33.5 (5.9) kg/m(2), waist circumference 108.1 (13.7) cm, PA levels (self-report): daily total 49.1 (5.9) metabolic-equivalent (MET) h/day. Follow-up at 12 months was completed by 134 (61%) participants, with an estimated mean (95% CI) change from baseline in weight -5.7 (-7.8 to -2.8); -2.8 (-3.8 to -1.9) kg, waist circumference -7.2 (-9.2 to -5.2); -6.0 (-7.1 to -5.0) cm, and PA level 7.9 (5.8 to 10.1); 6.7 (5.2 to 8.2) MET h/day equivalent, for men and women, respectively (from covariance pattern mixed models). Participants reported an enjoyable, sociable and supportive intervention experience. CONCLUSIONS Participants' views indicated a high level of intervention acceptability. High retention and positive outcomes at 12 months provide encouraging indications of the feasibility and potential effectiveness of the intervention. A definitive trial of this intervention is warranted.
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Affiliation(s)
- Linda Penn
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse, UKCRC Centre for Translational Research in Public Health
| | - Vicky Ryan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Martin White
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse, UKCRC Centre for Translational Research in Public Health
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92
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Prevalence of overweight and obesity and their associations with socioeconomic status in a rural Han Chinese adult population. PLoS One 2013; 8:e79946. [PMID: 24224024 PMCID: PMC3818265 DOI: 10.1371/journal.pone.0079946] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 09/28/2013] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this study is to describe the prevalence of overweight, general obesity, and abdominal obesity and examine their associations with socioeconomic status in a rural Chinese adult population. Methods This cross-sectional study was performed on 15,236 participants ≥ 35 years of age (6,313 men [41.4%] and 8,923 women [58.6%]). Each participant’s weight, height, waist circumference (WC), and hipline circumference (HC) were measured, and demographic and socioeconomic data were collected using questionnaires. Results The mean body mass index (BMI) values were 23.31 ± 2.96 and 23.89 ± 3.23 kg m-2 and the mean WC values were 79.13 ± 8.43 and 79.54 ± 8.27 cm for men and women, respectively. The age-standardized prevalence rates of overweight (BMI ≥ 24.0 kg m-2), general obesity (BMI ≥ 28.0 kg m-2), and abdominal obesity (WC ≥ 85 cm for men and ≥ 80 cm for women) were 32.0%, 6.7%, and 27.0% for men and 35.1%, 9.7%, and 48.3% for women, respectively. All gender differences were statistically significant (p < 0.001). In addition, the age-specific prevalence rates of general and abdominal obesity slowly decreased among men but sharply increased among women as age increased (p < 0.001). In subsequent logistic regression analysis, educational level was negatively associated with both general obesity and abdominal obesity among women but positively associated with abdominal obesity among men. No significant correlation was found between obesity and income. Conclusions These results suggest a high prevalence of obesity which might differ by gender and age, and an inverse association among women and a mixed association among men noted between education and obesity in our locality. Preventive and therapeutic programs are warranted to control this serious public health problem. The gender-specific characteristics of populations at high-risk of developing obesity should be taken into consideration when designing interventional programs.
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93
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Heianza Y, Arase Y, Kodama S, Hsieh SD, Tsuji H, Saito K, Shimano H, Hara S, Sone H. Association of living alone with the presence of undiagnosed diabetes in Japanese men: the role of modifiable risk factors for diabetes: Toranomon Hospital Health Management Center Study 13 (TOPICS 13). Diabet Med 2013; 30:1355-9. [PMID: 23756249 DOI: 10.1111/dme.12255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2013] [Indexed: 11/28/2022]
Abstract
AIMS To investigate whether living alone was associated with the presence of undiagnosed diabetes and whether this association could be attenuated by modifiable lifestyle habits. METHODS This cross-sectional study included 6400 Japanese men without a history of diagnosed diabetes. Individuals with currently undiagnosed diabetes were identified through fasting glucose concentration ≥7.0 mmol/l or HbA1c concentration ≥ 48 mmol⁄mol (≥ 6.5%). Effect modification was examined using body mass index, hypertension, history of dyslipidaemia, drinking habits, smoking habits, physical activity, vegetable intake, emotional stress and depressed mood. RESULTS Men who lived alone (n = 1098) had a significantly elevated odds ratio for having undiagnosed diabetes in an age-adjusted model (odds ratio 1.45, 95% CI 1.07, 1.96; P = 0.018). After adjustment for lifestyle factors, the association was slightly attenuated (odds ratio 1.40, 95% CI 1.02, 1.91; P = 0.036). After further adjustment for all factors mentioned above, living alone was still marginally significantly associated with the presence of undiagnosed diabetes (odds ratio 1.38, 95% CI 1.003, 1.90; P = 0.048). A significant association of living alone with the presence of undetected diabetes was particularly observed among men who were overweight, currently smoked and were physically inactive, or had any one of those three factors. CONCLUSIONS The association between undiagnosed diabetes and living alone can be partially influenced by modifiable lifestyle factors. Men who lived alone, especially those who did not engage in favourable lifestyle habits, were more likely to have undiagnosed diabetes. Such individuals have a higher probability of having undetected diabetic hyperglycaemia and would need to undergo glucose tests to identify the disease.
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Affiliation(s)
- Y Heianza
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata; Health Management Center, Toranomon Hospital, Tokyo; Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Ibaraki
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94
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Neumann A, Norberg M, Schoffer O, Norström F, Johansson I, Klug SJ, Lindholm L. Risk equations for the development of worsened glucose status and type 2 diabetes mellitus in a Swedish intervention program. BMC Public Health 2013; 13:1014. [PMID: 24502249 PMCID: PMC3871001 DOI: 10.1186/1471-2458-13-1014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 09/25/2013] [Indexed: 12/21/2022] Open
Abstract
Background Several studies investigated transitions and risk factors from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2D). However, there is a lack of information on the probabilities to transit from normal glucose tolerance (NGT) to different pre-diabetic states and from these states to T2D. The objective of our study is to estimate these risk equations and to quantify the influence of single or combined risk factors on these transition probabilities. Methods Individuals who participated in the VIP program twice, having the first examination at ages 30, 40 or 50 years of age between 1990 and 1999 and the second examination 10 years later were included in the analysis. Participants were grouped into five groups: NGT, impaired fasting glucose (IFG), IGT, IFG&IGT or T2D. Fourteen potential risk factors for the development of a worse glucose state (pre-diabetes or T2D) were investigated: sex, age, education, perceived health, triglyceride, blood pressure, BMI, smoking, physical activity, snus, alcohol, nutrition and family history. Analysis was conducted in two steps. Firstly, factor analysis was used to find candidate variables; and secondly, logistic regression was employed to quantify the influence of the candidate variables. Bootstrap estimations validated the models. Results In total, 29 937 individuals were included in the analysis. Alcohol and perceived health were excluded due to the results of the factor analysis and the logistic regression respectively. Six risk equations indicating different impacts of different risk factors on the transition to a worse glucose state were estimated and validated. The impact of each risk factor depended on the starting or ending pre-diabetes state. High levels of triglyceride, hypertension and high BMI were the strongest risk factors to transit to a worsened glucose state. Conclusions The equations could be used to identify individuals with increased risk to develop any of the three pre-diabetic states or T2D and to adapt prevention strategies.
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Affiliation(s)
- Anne Neumann
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå 901 85, SE, Sweden.
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95
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Hassali MA, Ching MW, Yusoff ZM, Hussein Z, Alrasheedy AA, AL-Tamimi SK, Saleem F, ul Haq N, Aljadhey H, Khan T. ‘Why I do not want to take insulin shots’: Findings from a qualitative study among diabetic patients in Malaysia. J Public Health (Oxf) 2013. [DOI: 10.1007/s10389-013-0594-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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96
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Saha S, Leijon M, Gerdtham U, Sundquist K, Sundquist J, Arvidsson D, Bennet L. A culturally adapted lifestyle intervention addressing a Middle Eastern immigrant population at risk of diabetes, the MEDIM (impact of Migration and Ethnicity on Diabetes In Malmö): study protocol for a randomized controlled trial. Trials 2013; 14:279. [PMID: 24006857 PMCID: PMC3844588 DOI: 10.1186/1745-6215-14-279] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/30/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies have shown that lifestyle interventions are effective in preventing or delaying the onset of type 2 diabetes in high-risk patients. However, research on the effectiveness of lifestyle interventions in high-risk immigrant populations with different cultural and socioeconomic backgrounds is scarce. The aim was to design a culturally adapted lifestyle intervention for an immigrant population and to evaluate its effectiveness and cost-effectiveness. METHODS/DESIGN In this randomized controlled trial, 308 participants (born in Iraq, living in Malmö, Sweden and at high risk of type 2 diabetes) will be allocated to either a culturally adapted intervention or a control group. The intervention will consist of 10 group counseling sessions focusing on diet, physical activity and behavioral change over 6 months, and the offer of exercise sessions. Cultural adaptation includes gender-specific exercise sessions, and counseling by a health coach community member. The control group will receive the information about healthy lifestyle habits provided by the primary health care center. The primary outcome is change in fasting glucose level. Secondary outcomes are changes in body mass index, insulin sensitivity, physical activity, food habits and health-related quality of life. Measurements will be taken at baseline, after 3 and 6 months. Data will be analyzed by the intention-to-treat approach. The cost-effectiveness during the trial period and over the longer term will be assessed by simulation modeling from patient, health care and societal perspectives. DISCUSSION This study will provide a basis to measure the effectiveness of a lifestyle intervention designed for immigrants from the Middle East in terms of improvement in glucose metabolism, and will also assess its cost-effectiveness. Results from this trial may help health care providers and policy makers to adapt and implement lifestyle interventions suitable for this population group that can be conducted in the community. TRIAL REGISTRATION ClinicalTrials.gov, NCT01420198.
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Affiliation(s)
- Sanjib Saha
- Department of Clinical Sciences, Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Building 60, floor 12 Jan Waldenströms gata 37, 205 02 Malmö, Sweden.
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97
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schächinger V, Scheen A, Schirmer H, Strömberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 2013; 34:3035-87. [PMID: 23996285 DOI: 10.1093/eurheartj/eht108] [Citation(s) in RCA: 1409] [Impact Index Per Article: 128.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
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- The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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De Feo P, Schwarz P. Is physical exercise a core therapeutical element for most patients with type 2 diabetes? Diabetes Care 2013; 36 Suppl 2:S149-54. [PMID: 23882040 PMCID: PMC3920782 DOI: 10.2337/dcs13-2024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Pierpaolo De Feo
- Healthy Lifestyle Institute CURIAMO, University of Perugia, Perugia, Italy.
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99
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Alokail MS, Sabico S, Al-Saleh Y, Al-Daghri NM, Alkharfy KM, Vanhoutte PM, McTernan PG. Effects of probiotics in patients with diabetes mellitus type 2: study protocol for a randomized, double-blind, placebo-controlled trial. Trials 2013. [PMID: 23822518 DOI: 10.1186/1745-6215-14-195.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low grade chronic inflammation is observed in patients with type 2 diabetes mellitus (T2DM). Endotoxin derived from gut bacteria may act as a potent inflammatory stimulant. Probiotics, which are believed to contain health promoting live microorganisms, may influence circulating endotoxin levels. Ingestion of live probiotic cultures may alter gut microbiota in a beneficial manner to reduce inflammation; no information is available whether or not they do so in patients with T2DM. Therefore, the aim of this study is to characterize the beneficial effects of probiotics on circulating endotoxin levels and other biomarkers related to systemic low-grade inflammation in patients with T2DM. METHODS One hundred and twenty consenting adult Saudi T2DM patients (naïve or newly diagnosed and without co-morbidities) will be enrolled in this clinical trial and randomized to receive daily placebo or probiotics (Ecologic®Barrier) for 26 weeks in a double-blind manner. Inflammatory and metabolic markers will be measured and fecal samples analyzed. Measurements/samples will be obtained at baseline and after 4, 8, 12/13 and 26 weeks of treatment. DISCUSSION It is expected that the probiotic product will induce beneficial changes in gut microbiota, reduce the systemic inflammatory state through altering systemic endotoxin levels and, as such, reduce the systemic inflammatory response observed in T2DM subjects. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01765517.
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Affiliation(s)
- Majed S Alokail
- Biomarkers Research Program, King Saud University, Riyadh 11451, Saudi Arabia.
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100
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Alokail MS, Sabico S, Al-Saleh Y, Al-Daghri NM, Alkharfy KM, Vanhoutte PM, McTernan PG. Effects of probiotics in patients with diabetes mellitus type 2: study protocol for a randomized, double-blind, placebo-controlled trial. Trials 2013; 14:195. [PMID: 23822518 PMCID: PMC3708777 DOI: 10.1186/1745-6215-14-195] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 06/21/2013] [Indexed: 02/06/2023] Open
Abstract
Background Low grade chronic inflammation is observed in patients with type 2 diabetes mellitus (T2DM). Endotoxin derived from gut bacteria may act as a potent inflammatory stimulant. Probiotics, which are believed to contain health promoting live microorganisms, may influence circulating endotoxin levels. Ingestion of live probiotic cultures may alter gut microbiota in a beneficial manner to reduce inflammation; no information is available whether or not they do so in patients with T2DM. Therefore, the aim of this study is to characterize the beneficial effects of probiotics on circulating endotoxin levels and other biomarkers related to systemic low-grade inflammation in patients with T2DM. Methods One hundred and twenty consenting adult Saudi T2DM patients (naïve or newly diagnosed and without co-morbidities) will be enrolled in this clinical trial and randomized to receive daily placebo or probiotics (Ecologic®Barrier) for 26 weeks in a double-blind manner. Inflammatory and metabolic markers will be measured and fecal samples analyzed. Measurements/samples will be obtained at baseline and after 4, 8, 12/13 and 26 weeks of treatment. Discussion It is expected that the probiotic product will induce beneficial changes in gut microbiota, reduce the systemic inflammatory state through altering systemic endotoxin levels and, as such, reduce the systemic inflammatory response observed in T2DM subjects. Trial registration ClinicalTrials.gov Identifier: NCT01765517
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Affiliation(s)
- Majed S Alokail
- Biomarkers Research Program, King Saud University, Riyadh 11451, Saudi Arabia.
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