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Doumbia L, Findley S, Ba HO, Maiga B, Ba A, Béréthé RK, Sangaré HM, Kachur SP, Besançon S, Doumbia S. Formative research to adapt the 'Diabetes Prevention Program- Power to Prevent' for implementation in Bamako, Mali. BMC Health Serv Res 2024; 24:61. [PMID: 38212794 PMCID: PMC10785539 DOI: 10.1186/s12913-023-10515-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND There are few community-level behaviors change interventions for reducing diabetes and hypertension risk in Africa, despite increasing cases of type 2 diabetes and cardiovascular diseases. Thus, this study was designed to adapt the United States Centers for Disease Control and Prevention's "Diabetes Prevention Program Power to Prevent" (DPP-P2P) for use in low-income urban communities of Bamako, Mali. METHODS Feedback was elicited on an initial French PowerPoint adaptation of the DPP-P2P session guidelines from stakeholders at the ministry of health, organizational partners, and medical care providers. Two community health centers in districts with high levels of diabetes or hypertension were selected to assist in developing the Malian adaptation. Focus groups were conducted with 19 community health workers (CHWs) of these centers. Based on feedback from these discussions, more graphics, demonstrations, and role plays were added to the PowerPoint presentations. The 19 CHWs piloted the proposed 12 sessions with 45 persons with diabetes or at-risk patients over a one-month period. Feedback discussions were conducted after each session, and changes in dietary and exercise habits were assessed pre and post participation in the program. This feedback contributed to finalization of a 14-session sequence. RESULTS The DPP-P2P session guidelines were adapted for use by low-literacy CHWs, converting the written English guidelines into French PowerPoint presentations with extensive use of pictures, role plays and group discussions to introduce diabetes, diet, and exercise concepts appropriately for the Bamako context. CHWs recommendations for a strong family-oriented program led to expanded sessions on eliciting support from all adults in the household. The 45 participants in the pilot adaptation were enthusiastic about the program. At the end of the program, there were significant increases in the frequency of daily exercise, efforts to limit fat intake, and goals for more healthy diets and exercise levels. CONCLUSION This study documents how an iterative process of developing the DPP-P2P adaptation led to the development of a culturally appropriate set of materials welcomed by participants and having promise for reaching the low-income, low-literacy population with or at risk for diabetes in Bamako, Mali.
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Affiliation(s)
- Lancina Doumbia
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali.
| | - Sally Findley
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hamidou Oumar Ba
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Bonkana Maiga
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Aissata Ba
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Rokiatou Koné Béréthé
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - Hadja Madjè Sangaré
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
| | - S Patrick Kachur
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Seydou Doumbia
- University Clinical Research Center, Université des Sciences, des Techniques et des Technologies de Bamako, Point-G, Bamako, Bamako, Po Box 5445, Mali
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Gulanski BI, Goulet JL, Radhakrishnan K, Ko J, Li Y, Rajeevan N, Lee KM, Heberer K, Lynch JA, Streja E, Mutalik P, Cheung KH, Concato J, Shih MC, Lee JS, Aslan M. Metformin prescription for U.S. veterans with prediabetes, 2010-2019. J Investig Med 2024; 72:139-150. [PMID: 37668313 DOI: 10.1177/10815589231201141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Affecting an estimated 88 million Americans, prediabetes increases the risk for developing type 2 diabetes mellitus (T2DM), and independently, cardiovascular disease, retinopathy, nephropathy, and neuropathy. Nevertheless, little is known about the use of metformin for diabetes prevention among patients in the Veterans Health Administration, the largest integrated healthcare system in the U.S. This is a retrospective observational cohort study of the proportion of Veterans with incident prediabetes who were prescribed metformin at the Veterans Health Administration from October 2010 to September 2019. Among 1,059,605 Veterans with incident prediabetes, 12,009 (1.1%) were prescribed metformin during an average 3.4 years of observation after diagnosis. Metformin prescribing was marginally higher (1.6%) among those with body mass index (BMI) ≥35 kg/m2, age <60 years, HbA1c≥6.0%, or those with a history of gestational diabetes, all subgroups at a higher risk for progression to T2DM. In a multivariable model, metformin was more likely to be prescribed for those with BMI ≥35 kg/m2 incidence rate ratio [IRR] 2.6 [95% confidence intervals (CI): 2.1-3.3], female sex IRR, 2.4 [95% CI: 1.8-3.3], HbA1c≥6% IRR, 1.93 [95% CI: 1.5-2.4], age <60 years IRR, 1.7 [95% CI: 1.3-2.3], hypertriglyceridemia IRR, 1.5 [95% CI: 1.2-1.9], hypertension IRR, 1.5 [95% CI: 1.1-2.1], Major Depressive Disorder IRR, 1.5 [95% CI: 1.1-2.0], or schizophrenia IRR, 2.1 [95% CI: 1.2-3.8]. Over 20% of Veterans with prediabetes attended a comprehensive structured lifestyle modification clinic or program. Among Veterans with prediabetes, metformin was prescribed to 1.1% overall, a proportion that marginally increased to 1.6% in the subset of individuals at highest risk for progression to T2DM.
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Affiliation(s)
- Barbara I Gulanski
- Department of Medicine, Endocrinology, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Endocrinology, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph L Goulet
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- Pain, Research, Informatics, Multi-morbidities and Education Center (PRIME), West Haven, CT, USA
| | - Krishnan Radhakrishnan
- National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | - John Ko
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Yuli Li
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Nallakkandi Rajeevan
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kyung Min Lee
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Kent Heberer
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie A Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elani Streja
- Department of Medicine, Nephrology, Hypertension and Transplant, University of California-Irvine School of Medicine, Long Beach, CA, USA
| | - Pradeep Mutalik
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kei-Hoi Cheung
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - John Concato
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Mei-Chiung Shih
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer S Lee
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mihaela Aslan
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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Ouyang A, Hu K, Chen L. Trends and risk factors of diabetes and prediabetes in US adolescents, 1999-2020. Diabetes Res Clin Pract 2024; 207:111022. [PMID: 37981123 DOI: 10.1016/j.diabres.2023.111022] [Citation(s) in RCA: 2] [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: 10/10/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
AIMS To assess the national trends in prevalence of diabetes and prediabetes and their major risk factors among adolescents in the US. METHODS We analyzed data on 6,936 adolescents aged 12 to 19 years from the National Health and Nutrition Examination Surveys (NHANES) between 1999 and 2020. Diabetes was defined by self-reported physician-diagnosis (diagnosed) and by fasting plasma glucose and HbA1c levels (undiagnosed). Prediabetes was identified by fasting plasma glucose and HbA1c levels. Logistic regression was performed to estimate the associations of major risk factors with diabetes and prediabetes. RESULTS The prevalence of prediabetes in adolescents increased from 11.5% in 1999-2002 to 36.3% in 2015-2020. The prevalence of diabetes increased from 0.82% (0.62% of diagnosed and 0.20% of undiagnosed) in 1999-2002 to 1.14% (0.76% of diagnosed and 0.38% of undiagnosed) in 2015-2020, but the increase was not statistically significant (P value = 0.69). Obesity was significantly associated with higher odds of diabetes and prediabetes while boys and Mexican Americans had a significantly higher risk of prediabetes than their counterparts. CONCLUSIONS The prevalence of prediabetes among adolescents in the US has more than tripled from 1999 to 2020. Obese adolescents are at the greatest risk for diabetes and prediabetes.
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Affiliation(s)
- Anthony Ouyang
- Thomas S. Wootton High School, 2100 Wootton Pkwy, Rockville, MD 20850, USA
| | - Kathy Hu
- Episcopal School of Baton Rouge, 3200 Woodland Ridge Blvd, Baton Rouge, LA 70816, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA 90095, USA.
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Almuraikhy S, Doudin A, Domling A, Althani AAJF, Elrayess MA. Molecular regulators of exercise-mediated insulin sensitivity in non-obese individuals. J Cell Mol Med 2024; 28:e18015. [PMID: 37938877 PMCID: PMC10805515 DOI: 10.1111/jcmm.18015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
Insulin resistance is a significant contributor to the development of type 2 diabetes (T2D) and is associated with obesity, physical inactivity, and low maximal oxygen uptake. While intense and prolonged exercise may have negative effects, physical activity can have a positive influence on cellular metabolism and the immune system. Moderate exercise has been shown to reduce oxidative stress and improve antioxidant status, whereas intense exercise can increase oxidative stress in the short term. The impact of exercise on pro-inflammatory cytokine production is complex and varies depending on intensity and duration. Exercise can also counteract the harmful effects of ageing and inflamm-ageing. This review aims to examine the molecular pathways altered by exercise in non-obese individuals at higher risk of developing T2D, including glucose utilization, lipid metabolism, mitochondrial function, inflammation and oxidative stress, with the potential to improve insulin sensitivity. The focus is on understanding the potential benefits of exercise for improving insulin sensitivity and providing insights for future targeted interventions before onset of disease.
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Affiliation(s)
- Shamma Almuraikhy
- Biomedical Research CenterQatar UniversityDohaQatar
- Groningen Research Institute of Pharmacy, Drug DesignGroningen UniversityGroningenThe Netherlands
| | - Asmaa Doudin
- Biomedical Research CenterQatar UniversityDohaQatar
| | - Alexander Domling
- Groningen Research Institute of Pharmacy, Drug DesignGroningen UniversityGroningenThe Netherlands
| | - Asmaa Ali J. F. Althani
- Biomedical Research CenterQatar UniversityDohaQatar
- Department of Biomedical Sciences, College of Health Science, QU HealthQatar UniversityDohaQatar
| | - Mohamed A. Elrayess
- Biomedical Research CenterQatar UniversityDohaQatar
- College of Pharmacy, QU HealthQatar UniversityDohaQatar
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Zou X, Luo Y, Huang Q, Zhu Z, Li Y, Zhang X, Zhou X, Ji L. Differential effect of interventions in patients with prediabetes stratified by a machine learning-based diabetes progression prediction model. Diabetes Obes Metab 2024; 26:97-107. [PMID: 37779358 DOI: 10.1111/dom.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
AIM To investigate whether stratifying participants with prediabetes according to their diabetes progression risks (PR) could affect their responses to interventions. METHODS We developed a machine learning-based model to predict the 1-year diabetes PR (ML-PR) with the least predictors. The model was developed and internally validated in participants with prediabetes in the Pinggu Study (a prospective population-based survey in suburban Beijing; n = 622). Patients from the Beijing Prediabetes Reversion Program cohort (a multicentre randomized control trial to evaluate the efficacy of lifestyle and/or pioglitazone on prediabetes reversion; n = 1936) were stratified to low-, medium- and high-risk groups using ML-PR. Different effect of four interventions within subgroups on prediabetes reversal and diabetes progression was assessed. RESULTS Using least predictors including fasting plasma glucose, 2-h postprandial glucose after 75 g glucose administration, glycated haemoglobin, high-density lipoprotein cholesterol and triglycerides, and the ML algorithm XGBoost, ML-PR successfully predicted the 1-year progression of participants with prediabetes in the Pinggu study [internal area under the curve of the receiver operating characteristic curve 0.80 (0.72-0.89)] and Beijing Prediabetes Reversion Program [external area under the curve of the receiver operating characteristic curve 0.80 (0.74-0.86)]. In the high-risk group pioglitazone plus intensive lifestyle therapy significantly reduced diabetes progression by about 50% at year l and the end of the trial in the high-risk group compared with conventional lifestyle therapy with placebo. In the medium- or low-risk group, intensified lifestyle therapy, pioglitazone or their combination did not show any benefit on diabetes progression and prediabetes reversion. CONCLUSIONS This study suggests personalized treatment for prediabetes according to their PR is necessary. ML-PR model with simple clinical variables may facilitate personal treatment strategies in participants with prediabetes.
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Affiliation(s)
- Xiantong Zou
- Peking University People's Hospital, Beijing, China
| | - Yingying Luo
- Peking University People's Hospital, Beijing, China
| | - Qi Huang
- Peking University People's Hospital, Beijing, China
| | - Zhanxing Zhu
- School of Mathematical Sciences, Peking University, Beijing, China
- Center for Data Science, Peking University, Beijing, China
- Beijing Institute of Big Data Research, Beijing, China
| | - Yufeng Li
- Department of Endocrinology, Beijing Friendship Hospital Pinggu Campus, Capital Medical University, Beijing, China
| | | | | | - Linong Ji
- Peking University People's Hospital, Beijing, China
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Liu D, Gao X, Huang X, Fan Y, Wang YE, Zhang Y, Chen X, Wen J, He H, Hong Y, Liang Y, Zhang Y, Liu Z, Chen S, Li X. Moderate altitude exposure impacts host fasting blood glucose and serum metabolome by regulation of the intestinal flora. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 905:167016. [PMID: 37714338 DOI: 10.1016/j.scitotenv.2023.167016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023]
Abstract
Moderate altitude exposure has shown beneficial effects on diabetes incidence but the underlying mechanisms are not understood. Our study aimed to investigate how the human gut microbiome impacted the serum metabolome and associated with glucose homeostasis in healthy Chinese individuals upon moderate-altitude exposure. Faecal microbiome composition was assessed using shotgun metagenomic sequencing. Serum metabolome was acquired by untargeted metabolomics technology, and amino acids (AAs) and propionic acid in serum were quantified by targeted metabolomics technology. The results indicated that the moderate-altitude exposed individuals presented lowered fasting blood glucose (FBG) and propionic acid, increased circulating L-Glutamine but decreased L-Glutamate and L-Valine, which correlated with enriched Bacteroidetes and decreased Proteobacteria. Additionally, the silico causality associations among gut microbiota, serum metabolome and host FBG were analyzed by mediation analysis. It showed that increased Bacteroides ovatus (B. ovatus) and decreased Escherichia coli (E. coli) were identified as the main antagonistic species driving the association between L-Glutamate and FBG in silico causality. Furthermore, the high-fat diet (HFD) fed mice subjected to faecal microbiota transplantation (FMT) were applied to validate the cause-in-fact effects of gut microbiota on the beneficial glucose response. We found that microbiome in the moderate-altitude exposed donor could predict the extent of the FBG response in recipient mice, which showed lowered FBG, L-Glutamate and Firmicutes/Bacteroidetes ratio. Our findings suggest that moderate-altitude exposure targeting gut microbiota and circulating metabolome, may pave novel avenues to counter dysglycemia.
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Affiliation(s)
- Dan Liu
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Nyingchi People's Hospital, Tibet, China
| | - Xiaoyan Gao
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaoran Huang
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yanqun Fan
- Biotree Metabolomics Technology Research Center, Shanghai, China
| | - Yu-E Wang
- Nyingchi People's Hospital, Tibet, China
| | - Yuelin Zhang
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xuanfu Chen
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Emergency Medicine Department of Guangdong Cardiovascular Institute, Guangzhou, China
| | - Jielu Wen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-Sen Memorial Hospital, Foshan, China
| | - Haiwei He
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yimei Hong
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ying Liang
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Nyingchi People's Hospital, Tibet, China
| | - Yuxiao Zhang
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhipeng Liu
- Biotree Metabolomics Technology Research Center, Shanghai, China.
| | - Sifan Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-Sen Memorial Hospital, Foshan, China.
| | - Xin Li
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Nyingchi People's Hospital, Tibet, China.
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Eldakhakhny B, Enani S, Jambi H, Ajabnoor G, Al-Ahmadi J, Al-Raddadi R, Alsheikh L, Abdulaal WH, Gad H, Borai A, Bahijri S, Tuomilehto J. Prevalence and Factors Associated with Metabolic Syndrome among Non-Diabetic Saudi Adults: A Cross-Sectional Study. Biomedicines 2023; 11:3242. [PMID: 38137464 PMCID: PMC10740949 DOI: 10.3390/biomedicines11123242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Introduction: given the high prevalence of metabolic syndrome (MetS) in Saudi Arabia, especially in Jeddah, this study aims to understand the dietary and lifestyle-related risk factors among Jeddah's non-diabetic adults. (2) Material and Methods: Employing a cross-sectional design, non-diabetic adults were sourced from public healthcare centers. Demographics, lifestyle, and dietary habits were surveyed. Blood pressure, anthropometrics, and fasting blood samples measuring plasma glucose, serum triglycerides, and HDL cholesterol were collected. The age cut-off for MetS was ascertained using the receiver operating characteristic curve. Variables influencing MetS were evaluated using univariate logistic regression, and consequential factors underwent multivariate analysis, adjusted for age and sex. (3) Results: Among 1339 participants, 16% had MetS, with age being the strongest predictor (p < 0.001). The optimal age cut-off was 32 years. For those <32, elevated BP in men and waist circumference (WC) in women were most prevalent. For those >32, elevated WC was dominant in both sexes. Univariate logistic regression revealed that higher income and education correlated with lower MetS prevalence, while marriage and smoking were risk factors. Adjusting for age and sex, only very high income had a significant low-risk association (p = 0.034). (4) Conclusion: MetS is notable in the studied group, with age as the pivotal predictor. High income reduces MetS risk, while marital status and smoking could increase it. Since this was a cross-sectional study, cohort studies are needed to validate our findings.
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Affiliation(s)
- Basmah Eldakhakhny
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (G.A.); (H.G.); (S.B.)
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- Food, Nutrition, and Lifestyle Research Unit, King Fahd for Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Sumia Enani
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- Food, Nutrition, and Lifestyle Research Unit, King Fahd for Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Hanan Jambi
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- Food, Nutrition, and Lifestyle Research Unit, King Fahd for Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Ghada Ajabnoor
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (G.A.); (H.G.); (S.B.)
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- Food, Nutrition, and Lifestyle Research Unit, King Fahd for Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Jawaher Al-Ahmadi
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- Food, Nutrition, and Lifestyle Research Unit, King Fahd for Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Rajaa Al-Raddadi
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- Food, Nutrition, and Lifestyle Research Unit, King Fahd for Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Lubna Alsheikh
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (L.A.); (W.H.A.)
| | - Wesam H. Abdulaal
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (L.A.); (W.H.A.)
| | - Hoda Gad
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (G.A.); (H.G.); (S.B.)
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Alexandria University, Alexandria 21561, Egypt
| | - Anwar Borai
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah 22384, Saudi Arabia
| | - Suhad Bahijri
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (G.A.); (H.G.); (S.B.)
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- Food, Nutrition, and Lifestyle Research Unit, King Fahd for Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Jaakko Tuomilehto
- Saudi Diabetes Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22252, Saudi Arabia; (S.E.); (H.J.); (J.A.-A.); (R.A.-R.); (A.B.); (J.T.)
- Department of Public Health, University of Helsinki, FI-00014 Helsinki, Finland
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, FI-00271 Helsinki, Finland
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Shakya P, Shrestha A, Bajracharya M, Shrestha A, Kulseng BE, Karmacharya BM, Shrestha S, Das S, Shrestha IB, Barun K, Shrestha N, Skovlund E, Sen A. Effectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in Nepal. BMJ Nutr Prev Health 2023; 6:253-263. [PMID: 38264365 PMCID: PMC10800278 DOI: 10.1136/bmjnph-2023-000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024] Open
Abstract
Background Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted recently. The study aimed to evaluate the effect of DiPEP in glycated haemoglobin (HbA1c), weight, waist circumference, physical activity and diet among population with pre-diabetes. Method A two-arm cluster randomised controlled trial was conducted in 12 clusters of two urban areas in Nepal. The DiPEP was a 6 month intervention (four 1-hour weekly educational sessions and 5 months of follow-up by community health workers/volunteers (CHW/Vs)). A postintervention assessment was done after 6 months. Linear mixed model was used to estimate the mean difference in primary outcome (HbA1c) and secondary outcomes (weight, waist circumference, physical activity and diet) between intervention and control arms, adjusted for baseline measure. Results In intention-to-treat analysis with a total of 291 participants, the estimated mean difference in HbA1c was found to be 0.015 percentage point (95% CI -0.074 to 0.104) between the intervention arm and the control arm, while it was -0.077 (95% CI -0.152 to -0.002) among those who attended at least 3 out of 4 educational sessions. The estimated mean difference in weight (in participants who attended ≥1 educational session) was -1.6 kg (95% CI -3.1 to -0.1). A significantly lower grain consumption was found in intervention arm (-39 g/day, 95% CI -65 to -14) compared with the control arm at postintervention assessment. Conclusion Although compliance was affected by COVID-19, individuals who participated in ≥3 educational sessions had significant reduction in HbA1c and those who attended ≥1 educational session had significant weight reduction. Grain intake was significantly reduced among the intervention arm than the control arm. Hence, group-based lifestyle intervention programmes involving CHW/vs is recommended for diabetes prevention. Trial registration number NCT04074148.
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Affiliation(s)
- Pushpanjali Shakya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Archana Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute for Implementation Science and Health, Kathmandu, Bagmati Province, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Monish Bajracharya
- Department of Business and IT, University of South-Eastern Norway, Bo, Norway
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati Province, Nepal
| | - Bård Erik Kulseng
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Biraj Man Karmacharya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Smriti Shrestha
- Research and Development Division/Department of Community Programs, Dhulikhel Hospital, Dhulikhel, Bagmati Province, Nepal
- ECA College of Health Sciences, Sydney, New South Wales, Australia
| | - Seema Das
- Research and Development Division/Department of Community Programs, Dhulikhel Hospital, Dhulikhel, Bagmati Province, Nepal
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Ishwori Byanju Shrestha
- Research and Development Division/Department of Community Programs, Dhulikhel Hospital, Dhulikhel, Bagmati Province, Nepal
| | - Krishnaa Barun
- Research and Development Division/Department of Community Programs, Dhulikhel Hospital, Dhulikhel, Bagmati Province, Nepal
- Department of Public Health, Nobel College, Pokhara University, Kathmandu, Bagmati Province, Nepal
| | - Nistha Shrestha
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati Province, Nepal
- Epidemiology and Disease Control Division, Department of Health Services, Government of Nepal Ministry of Health and Population, Kathmandu, Bagmati Province, Nepal
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Centre for Oral Health Services and Research (TkMidt), Trondheim, Norway
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Stumpf MAM, Cercato C, de Melo ME, Santos RD, Mancini MC. Down the rabbit hole: reviewing the evidence for primary prevention of cardiovascular disease in people with obesity. Eur J Prev Cardiol 2023; 30:1895-1905. [PMID: 37648659 DOI: 10.1093/eurjpc/zwad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
Obesity is a prevalent chronic disorder and a well-known risk factor for cardiovascular disease. However, the evidence of treating obesity for primary prevention of major cardiovascular events is still scarce and controversial. In this review, we provided a comprehensive description of the current evidence in treating obesity regarding cardiovascular protection. Bariatric surgery appears to be the most robust method to reduce events in people without established cardiovascular disease. High compliance to lifestyle interventions can further reduce cardiovascular risk. Concerning pharmacological therapies, a post hoc analysis from SUSTAIN-6 and a meta-analysis from STEP trials suggest that semaglutide, a GLP-1 receptor agonist, could reduce cardiovascular events in people without established cardiovascular disease. The first study addressed specifically a high-risk population with diabetes and, the second, low- or intermediary-risk individuals without diabetes. Tirzepatide, a novel dual GIP/GLP-1 agonist, although not yet tested in specific cardiovascular outcomes trials, could be an alternative since it induces loss in weight similar to the achieved by bariatric surgery. Therefore, extrapolated data in distinct baseline cardiovascular risk populations suggest that these two drugs could be used in primary prevention with the aim of preventing cardiovascular events, but the grade of this evidence is still low. Specifically designed studies are needed to address this specific topic.
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Affiliation(s)
- Matheo A M Stumpf
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Cintia Cercato
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Maria E de Melo
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcio C Mancini
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
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60
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Liu J, Yao C, Wang Y, Zhao J, Luo H. Non-drug interventions of traditional Chinese medicine in preventing type 2 diabetes: a review. Chin Med 2023; 18:151. [PMID: 37964315 PMCID: PMC10644617 DOI: 10.1186/s13020-023-00854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023] Open
Abstract
Traditional Chinese medicine (TCM) is increasingly used to manage type 2 diabetes and its nonpharmacological interventions are showing potential for preventing type 2 diabetes. This study mainly reviews relevant research. The most mentioned non-drug treatments for preventing type 2 diabetes in TCM are healthy diet, physical activity, emotional therapy, and acupuncture. In most studies, blood glucose status in patients with prediabetes and type 2 diabetes was significantly improved after TCM non-drug interventions, and there was no significant difference between the adverse effect of TCM and control groups or other intervention groups, while the methodological quality of the clinical trials involving TCM generally kept a low level. The effectiveness of TCM in preventing type 2 diabetes has yet to be validated in large randomized controlled trials and the underlying mechanism also needs further exploration.
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Affiliation(s)
- Jingying Liu
- Macau Centre for Research and Development in Chinese Medicine, State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, 999078, People's Republic of China
| | - Chun Yao
- Guangxi University of Chinese Medicine, Nanning, 530001, People's Republic of China
| | - Yitao Wang
- Macau Centre for Research and Development in Chinese Medicine, State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, 999078, People's Republic of China
| | - Jinmin Zhao
- College of Pharmacy, Guangxi Medical University, Nanning, 530021, People's Republic of China.
| | - Hua Luo
- Macau Centre for Research and Development in Chinese Medicine, State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, 999078, People's Republic of China.
- College of Pharmacy, Guangxi Medical University, Nanning, 530021, People's Republic of China.
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61
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Zhang L, Gong Q, Sun N, Ji L, Li G. Explaining the high rate of progression from prediabetes to type 2 diabetes in China - Authors' reply. Lancet Diabetes Endocrinol 2023; 11:794-795. [PMID: 37884323 DOI: 10.1016/s2213-8587(23)00283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Lihui Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Qiuhong Gong
- Department of Endocrinology, Fuwai Hospital and Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Ningling Sun
- Department of Hypertension, Peking University People's Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Guangwei Li
- Department of Endocrinology, Fuwai Hospital and Chinese Academy of Medical Sciences, Beijing 100037, China.
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62
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Chu N, He J, Leung KHT, Chan JCN, Chow E. Explaining the high rate of progression from prediabetes to type 2 diabetes in China. Lancet Diabetes Endocrinol 2023; 11:794. [PMID: 37884324 DOI: 10.1016/s2213-8587(23)00282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Natural Chu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jie He
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kathy H T Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Phase 1 Clinical Trial Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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63
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Ma E, Fukasawa M, Ohira T, Yasumura S, Suzuki T, Furuyama A, Kataoka M, Matsuzaki K, Sato M, Hosoya M. Lifestyle behaviour patterns in the prevention of type 2 diabetes mellitus: the Fukushima Health Database 2015-2020. Public Health 2023; 224:98-105. [PMID: 37742586 DOI: 10.1016/j.puhe.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Lifestyle behaviours associated with the incidence of type 2 diabetes mellitus (T2DM) need further clarification using health insurance data. STUDY DESIGN This is a cohort study. METHODS In 2015, 193,246 participants aged 40-74 years attended the specific health checkups and were observed up to 2020 in Fukushima, Japan. Using the principal component analysis, we identified two patterns from ten lifestyle behaviour questions, namely, the "diet-smoking" pattern (including smoking, alcohol drinking, skipping breakfast, eating fast, late dinner, and snacking) and the "physical activity-sleep" pattern (including physical exercise, walking equivalent activity, walking fast, and sufficient sleep). Then, individual pattern scores were calculated; the higher the scores, the healthier the behaviours. RESULTS The accumulative incidence rate of T2DM was 630.5 in men and 391.9 in women per 100,000 person-years in an average of 4 years of follow-up. Adjusted for the demographic and cardiometabolic factors at the baseline, the hazard ratio (95% confidence interval) of the highest versus lowest quartile scores of the "diet-smoking" pattern for T2DM risk was 0.82 (0.72, 0.92; P for trend = 0.002) in men and 0.87 (0.76, 1·00; P for trend = 0.034) in women; that of the "physical activity-sleep" pattern was 0.92 (0.82, 1·04; P for trend = 0.0996) in men and 0.92 (0.80, 1·06; P for trend = 0.372) in women. The "physical activity-sleep" pattern showed a significant inverse association in non-overweight men. CONCLUSIONS Lifestyle behaviour associated with a healthy diet and lack of smoking may significantly lower the risk of T2DM in middle-aged Japanese adults.
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Affiliation(s)
- E Ma
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - M Fukasawa
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - T Ohira
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - S Yasumura
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - T Suzuki
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Computer Science and Engineering, The University of Aizu, Fukushima 965-8580, Japan
| | - A Furuyama
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - M Kataoka
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - K Matsuzaki
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - M Sato
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - M Hosoya
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Cauwenberghs N, Sente J, Sabovčik F, Ntalianis E, Hedman K, Claes J, Goetschalckx K, Cornelissen V, Kuznetsova T. Cardiorespiratory fitness components in relation to clinical characteristics, disease state and medication intake: A patient registry study. Clin Physiol Funct Imaging 2023; 43:441-452. [PMID: 37317062 DOI: 10.1111/cpf.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/24/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Interpretation of cardiopulmonary exercise testing (CPET) results requires thorough understanding of test confounders such as anthropometrics, comorbidities and medication. Here, we comprehensively assessed the clinical determinants of cardiorespiratory fitness and its components in a heterogeneous patient sample. METHODS We retrospectively collected medical and CPET data from 2320 patients (48.2% females) referred for cycle ergometry at the University Hospital Leuven, Belgium. We assessed clinical determinants of peak CPET indexes of cardiorespiratory fitness (CRF) and its hemodynamic and ventilatory components using stepwise regression and quantified multivariable-adjusted differences in indexes between cases and references. RESULTS Lower peak load and peak O2 uptake were related to: higher age, female sex, lower body height and weight, and higher heart rate; to the intake of beta blockers, analgesics, thyroid hormone replacement and benzodiazepines; and to diabetes mellitus, chronic kidney disease, non-ST elevation myocardial infarction and atrial fibrillation (p < 0.05 for all). Lower peak load also correlated with obstructive pulmonary diseases. Stepwise regression revealed associations of hemodynamic and ventilatory indexes (including heart rate, O2 pulse, systolic blood pressure and ventilation at peak exercise and ventilatory efficiency) with age, sex, body composition and aforementioned diseases and medications. Multivariable-adjusted differences in CPET metrics between cases and controls confirmed the associations observed. CONCLUSION We described known and novel associations of CRF components with demographics, anthropometrics, cardiometabolic and pulmonary diseases and medication intake in a large patient sample. The clinical implications of long-term noncardiovascular drug intake for CPET results require further investigation.
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Affiliation(s)
- Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Josephine Sente
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Evangelos Ntalianis
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jomme Claes
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Research Unit Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Valabhji J. The journey towards implementation of the NHS Diabetes Prevention Programme: A personal perspective. Diabet Med 2023; 40:e15238. [PMID: 37846928 DOI: 10.1111/dme.15238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Jonathan Valabhji
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- NHS England, London, UK
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Franceschi R, Fintini D, Ravà L, Mariani M, Aureli A, Inzaghi E, Pedicelli S, Deodati A, Bizzarri C, Cappa M, Cianfarani S, Manco M. Insulin Clearance at the Pubertal Transition in Youth with Obesity and Steatosis Liver Disease. Int J Mol Sci 2023; 24:14963. [PMID: 37834412 PMCID: PMC10573227 DOI: 10.3390/ijms241914963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
No data are available on insulin clearance (ClI) trends during the pubertal transition. The aim of this study was to investigate in 973 youths with obesity whether ClI in fasting and post-oral glucose challenge (OGTT) conditions varies at the pubertal transition in relation to the severity of obesity and the presence of steatosis liver disease (SLD). The severity of obesity was graded according to the Centers for Disease Control. SLD was graded as absent, mild and severe based on alanine amino transferase levels. ClI was defined as the molar ratio of fasting C-peptide to insulin and of the areas under the insulin to glucose curves during an OGTT. In total, 35% of participants were prepubertal, 72.6% had obesity class II, and 52.6% had mild SLD. Fasting ClI (nmol/pmol × 10-2) was significantly lower in pubertal [0.11 (0.08-0.14)] than in prepubertal individuals [0.12 (0.09-0.16)] and higher in class III [0.15 (0.11-0.16)] than in class I obesity [0.11 (0.09-0.14)]. OGTT ClI was higher in boys [0.08 (0.06-0.10)] than in girls [0.07 (0.06-0.09)]; in prepubertal [0.08 (0.06-0.11)] than in pubertal individuals [0.07 (0.05-0.09)]; in class III [0.14 (0.08-0.17)] than in class I obesity [0.07 (0.05-0.10)]; and in severe SLD [0.09 (0.04-0.14)] than in no steatosis [0.06 (0.04-0.17)]. It was lower in participants with prediabetes [0.06 (0.04-0.07)]. OGTT ClI was lower in youths with obesity at puberty along with insulin sensitivity and greater secretion. The findings suggest that the initial increase in ClI in youth with severe obesity and SLD is likely to compensate for hyperinsulinemia and its subsequent decrease at the onset of prediabetes and other metabolic abnormalities.
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Affiliation(s)
- Roberto Franceschi
- Pediatric Department, S. Chiara Hospital of Trento, APSS, 38121 Trento, Italy;
| | - Danilo Fintini
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Lucilla Ravà
- Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy
| | - Michela Mariani
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Alessia Aureli
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Elena Inzaghi
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Stefania Pedicelli
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Annalisa Deodati
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Carla Bizzarri
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Marco Cappa
- Research Unit, Innovative Therapies for Endocrinopathies, Scientific Directorate, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy;
| | - Stefano Cianfarani
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
- Department of Systems Medicine, University of Rome ‘Tor Vergata’, 00168 Rome, Italy
- Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Melania Manco
- Research Unit of Predictive and Preventive Medicine, Bambino Gesù Children’s Hospital, 00146 Rome, Italy
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Bodhini D, Morton RW, Santhakumar V, Nakabuye M, Pomares-Millan H, Clemmensen C, Fitzpatrick SL, Guasch-Ferre M, Pankow JS, Ried-Larsen M, Franks PW, Tobias DK, Merino J, Mohan V, Loos RJF. Impact of individual and environmental factors on dietary or lifestyle interventions to prevent type 2 diabetes development: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:133. [PMID: 37794109 PMCID: PMC10551013 DOI: 10.1038/s43856-023-00363-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The variability in the effectiveness of type 2 diabetes (T2D) preventive interventions highlights the potential to identify the factors that determine treatment responses and those that would benefit the most from a given intervention. We conducted a systematic review to synthesize the evidence to support whether sociodemographic, clinical, behavioral, and molecular factors modify the efficacy of dietary or lifestyle interventions to prevent T2D. METHODS We searched MEDLINE, Embase, and Cochrane databases for studies reporting on the effect of a lifestyle, dietary pattern, or dietary supplement interventions on the incidence of T2D and reporting the results stratified by any effect modifier. We extracted relevant statistical findings and qualitatively synthesized the evidence for each modifier based on the direction of findings reported in available studies. We used the Diabetes Canada Clinical Practice Scale to assess the certainty of the evidence for a given effect modifier. RESULTS The 81 publications that met our criteria for inclusion are from 33 unique trials. The evidence is low to very low to attribute variability in intervention effectiveness to individual characteristics such as age, sex, BMI, race/ethnicity, socioeconomic status, baseline behavioral factors, or genetic predisposition. CONCLUSIONS We report evidence, albeit low certainty, that those with poorer health status, particularly those with prediabetes at baseline, tend to benefit more from T2D prevention strategies compared to healthier counterparts. Our synthesis highlights the need for purposefully designed clinical trials to inform whether individual factors influence the success of T2D prevention strategies.
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Affiliation(s)
| | - Robert W Morton
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Tuborg Havnevej 19, 2900, Hellerup, Denmark
| | - Vanessa Santhakumar
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mariam Nakabuye
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hugo Pomares-Millan
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Christoffer Clemmensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephanie L Fitzpatrick
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Marta Guasch-Ferre
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute for Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Paul W Franks
- Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Tuborg Havnevej 19, 2900, Hellerup, Denmark
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, Malmo, Sweden
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jordi Merino
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ruth J F Loos
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Rahim NE, Flood D, Marcus ME, Theilmann M, Aung TN, Agoudavi K, Aryal KK, Bahendeka S, Bicaba B, Bovet P, Diallo AO, Farzadfar F, Guwatudde D, Houehanou C, Houinato D, Hwalla N, Jorgensen J, Kagaruki GB, Mayige M, Wong-McClure R, Larijani B, Saeedi Moghaddam S, Mwalim O, Mwangi KJ, Sarkar S, Sibai AM, Sturua L, Wesseh C, Geldsetzer P, Atun R, Vollmer S, Bärnighausen T, Davies J, Ali MK, Seiglie JA, Manne-Goehler J. Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: a cross-sectional analysis of nationally representative, individual-level survey data. Lancet Glob Health 2023; 11:e1576-e1586. [PMID: 37734801 PMCID: PMC10560068 DOI: 10.1016/s2214-109x(23)00348-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodemographic variation in these activities across LMICs. METHODS We performed a pooled, cross-sectional analysis of individual-level data from nationally representative, population-based surveys conducted in 44 LMICs between October, 2009, and May, 2019. Our sample included all participants older than 25 years who did not have diabetes and were not pregnant. We defined the population at high risk of diabetes on the basis of either the presence of impaired fasting glucose (or prediabetes in countries with a haemoglobin A1c available) or overweight or obesity, consistent with the WHO Package of Essential Noncommunicable Disease Guidelines for type 2 diabetes management. We estimated the proportion of survey participants that were at high risk of developing diabetes based on this definition. We also estimated the proportion of the population at high risk that reported each of four fundamental diabetes prevention activities: physical activity counselling, weight loss counselling, dietary counselling, and blood glucose screening, overall and stratified by World Bank income group. Finally, we used multivariable Poisson regression models to evaluate associations between sociodemographic characteristics and these activities. FINDINGS The final pooled sample included 145 739 adults (86 269 [59·2%] of whom were female and 59 468 [40·4%] of whom were male) across 44 LMICs, of whom 59 308 (40·6% [95% CI 38·5-42·8]) were considered at high risk of diabetes (20·6% [19·8-21·5] in low-income countries, 38·0% [37·2-38·9] in lower-middle-income countries, and 57·5% [54·3-60·6] in upper-middle-income countries). Overall, the reach of diabetes prevention activities was low at 40·0% (38·6-41·4) for physical activity counselling, 37·1% (35·9-38·4) for weight loss counselling, 42·7% (41·6-43·7) for dietary counselling, and 37·1% (34·7-39·6) for blood glucose screening. Diabetes prevention varied widely by national-level wealth: 68·1% (64·6-71·4) of people at high risk of diabetes in low-income countries reported none of these activities, whereas 49·0% (47·4-50·7) at high risk in upper-middle-income countries reported at least three activities. Educational attainment was associated with diabetes prevention, with estimated increases in the predicted probability of receipt ranging between 6·5 (3·6-9·4) percentage points for dietary fruit and vegetable counselling and 21·3 (19·5-23·2) percentage points for blood glucose screening, among people with some secondary schooling compared with people with no formal education. INTERPRETATION A large proportion of individuals across LMICs are at high risk of diabetes but less than half reported receiving fundamental prevention activities overall, with the lowest receipt of these activities among people in low-income countries and with no formal education. These findings offer foundational evidence to inform future global targets for diabetes prevention and to strengthen policies and programmes to prevent continued increases in diabetes worldwide. FUNDING Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program and the EU's Research and Innovation programme Horizon 2020.
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Affiliation(s)
- Nicholas Errol Rahim
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Maja E Marcus
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Behavioral Science for Disease Prevention and Health Care, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Taing N Aung
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Silver Bahendeka
- Diabetes and Endocrinology, Saint Francis Hospital Nsambya, Kampala, Uganda
| | - Brice Bicaba
- National Institute of Public Health, Ouagadougou, Burkina Faso
| | - Pascal Bovet
- University Center for General Medicine and Public Health (Unisanté), Lausanne, Switzerland; Ministry of Health, Victoria, Seychelles
| | - Alpha Oumar Diallo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Nahla Hwalla
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jutta Jorgensen
- Institute of Global Health, Department of Public Health and Epidemiology, Copenhagen University, Copenhagen, Denmark
| | | | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Kiel Institute for the World Economy, Kiel, Germany
| | | | - Kibachio Joseph Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya; World Health Organization Country Office, Pretoria, South Africa
| | - Sudipa Sarkar
- Division of Endocrinology, Diabetes, and Metabolism, John Hopkins University, Baltimore, MD, USA
| | - Abla M Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA; Chan Zuckerberg Biohub-San Francisco, San Francisco, CA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Africa Health Research Institute, Somkhele, South Africa
| | - Justine Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Prevention Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jennifer Manne-Goehler
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Garrib A, Kivuyo S, Bates K, Ramaiya K, Wang D, Majaliwa E, Simbauranga R, Charles G, van Widenfelt E, Luo H, Alam U, Nyirenda MJ, Jaffar S, Mfinanga S. Metformin for the prevention of diabetes among people with HIV and either impaired fasting glucose or impaired glucose tolerance (prediabetes) in Tanzania: a Phase II randomised placebo-controlled trial. Diabetologia 2023; 66:1882-1896. [PMID: 37460828 PMCID: PMC10474205 DOI: 10.1007/s00125-023-05968-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/12/2023] [Indexed: 09/02/2023]
Abstract
AIMS/HYPOTHESIS In sub-Saharan Africa (SSA), 5% of adults are living with type 2 diabetes and this is rising sharply, with a greater increase among people with HIV. Evidence on the efficacy of prevention strategies in this cohort is scarce. We conducted a Phase II double-blind placebo-controlled trial that aimed to determine the impact of metformin on blood glucose levels among people with prediabetes (defined as impaired fasting glucose [IFG] and/or impaired glucose tolerance [IGT]) and HIV in SSA. METHODS Adults (≥18 years old) who were stable in HIV care and found to have prediabetes (IFG and/or IGT) and who were attending hospitals in Dar es Salaam, Tanzania, were randomised to receive sustained-release metformin, 2000 mg daily, or matching placebo between 4 November 2019 and 21 July 2020. Randomisation used permuted blocks. Allocation was concealed in the trial database and made visible only to the Chief Pharmacist after consent was taken. All participants, research and clinical staff remained blinded to the allocation. Participants were provided with information on diet and lifestyle and had access to various health information following the start of the coronavirus disease 2019 (COVID-19) pandemic. Participants were followed up for 12 months. The primary outcome measure was capillary blood glucose measured 2 h following a 75 g glucose load. Analyses were by intention-to-treat. RESULTS In total, 364 participants (182 in each arm) were randomised to the metformin or placebo group. At enrolment, in the metformin and placebo arms, mean fasting glucose was 6.37 mmol/l (95% CI 6.23, 6.50) and 6.26 mmol/l (95% CI 6.15, 6.36), respectively, and mean 2 h glucose levels following a 75 g oral glucose load were 8.39 mmol/l (95% CI 8.22, 8.56) and 8.24 mmol/l (95% CI 8.07, 8.41), respectively. At the final assessment at 12 months, 145/182 (79.7%) individuals randomised to metformin compared with 158/182 (86.8%) randomised to placebo indicated that they had taken >95% of their medicines in the previous 28 days (p=0.068). At this visit, in the metformin and placebo arms, mean fasting glucose levels were 6.17 mmol/l (95% CI 6.03, 6.30) and 6.30 mmol/l (95% CI 6.18, 6.42), respectively, and mean 2 h glucose levels following a 75 g oral glucose load were 7.88 mmol/l (95% CI 7.65, 8.12) and 7.71 mmol/l (95% CI 7.49, 7.94), respectively. Using a linear mixed model controlling for respective baseline values, the mean difference between the metformin and placebo group (metformin-placebo) was -0.08 mmol/l (95% CI -0.37, 0.20) for fasting glucose and 0.20 mmol/l (95% CI -0.17, 0.58) for glucose levels 2 h post a 75 g glucose load. Weight was significantly lower in the metformin arm than in the placebo arm: using the linear mixed model adjusting for baseline values, the mean difference in weight was -1.47 kg (95% CI -2.58, -0.35). In total, 16/182 (8.8%) individuals had a serious adverse event (Grade 3 or Grade 4 in the Division of Acquired Immunodeficiency Syndrome [DAIDS] adverse event grading table) or died in the metformin arm compared with 18/182 (9.9%) in the placebo arm; these events were either unrelated to or unlikely to be related to the study drugs. CONCLUSIONS/INTERPRETATION Blood glucose decreased over time in both the metformin and placebo arms during the trial but did not differ significantly between the arms at 12 months of follow up. Metformin therapy was found to be safe for use in individuals with HIV and prediabetes. A larger trial with longer follow up is needed to establish if metformin can be safely used for the prevention of diabetes in people who have HIV. TRIAL REGISTRATION The trial is registered on the International Standard Randomised Controlled Trial Number (ISRCTN) registry ( www.isrctn.com/ ), registration number: ISCRTN76157257. FUNDING This research was funded by the National Institute for Health Research using UK aid from the UK Government to support global health research.
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Affiliation(s)
- Anupam Garrib
- UCL Institute for Global Health, University College London, London, UK.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Sokoine Kivuyo
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Katie Bates
- UCL Institute for Global Health, University College London, London, UK
- Institute of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Edna Majaliwa
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Rehema Simbauranga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Godbless Charles
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Huanyan Luo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool University NHS Hospital Foundation Trust, Liverpool, UK
- Department of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Moffat J Nyirenda
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- NCD Theme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Shabbar Jaffar
- UCL Institute for Global Health, University College London, London, UK
| | - Sayoki Mfinanga
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
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Wang W, Wei R, Huang Z, Luo J, Pan Q, Guo L. Effects of treatment with Glucagon-like peptide-1 receptor agonist on prediabetes with overweight/obesity: A systematic review and meta-analysis. Diabetes Metab Res Rev 2023; 39:e3680. [PMID: 37356073 DOI: 10.1002/dmrr.3680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/02/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effects of Glucagon-like peptide-1 receptor agonist (GLP-1RA) on prediabetes with overweight/obesity. METHODS A search of PubMed, Embase, Cochrane Library, and Web of Science databases was performed to identify randomised controlled trials (up to 4 July 2022) which evaluated the effect of GLP-1RA on prediabetes with overweight/obesity. RESULTS Eight hundred and nine articles were retrieved (80 from PubMed, 481 from Embase, 137 from Cochrane library, and 111 from Web of Science) and a total of 5 articles were included in this meta-analysis. More individuals in GLP-1RAs group regressed from prediabetes to normoglycemia than individuals in the placebo group (OR = 4.56, 95% CI:3.58, 5.80, P = 0.004); fewer individuals in GLP-1RAs group were diagnosed with diabetes than those in the placebo group (OR = 0.31, 95% CI:0.12,0.81, P = 0.017). Results from five studies showed that GLP-1RAs significantly reduced fasting glucose (mean difference = -0.41 mmol/L, 95% CI: -0.58, -0.25, P < 0.00001), with an acceptable heterogeneity (I2 = 42%). CONCLUSIONS The present meta-analysis suggested that GLP-1RA significantly improves glucose metabolism, reduces systolic blood pressure and body weight in prediabetes with overweight/obesity. It could also prevent the development of diabetes and reverse abnormal glucose metabolism.
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Affiliation(s)
- Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ran Wei
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Zhengxiang Huang
- School of Biomedical Sciences, University of Queensland, St Lucia, Brisbane, Australia
| | - Jingyi Luo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking University Fifth School of Clinical Medicine, Beijing, China
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Mohan V. National diabetes prevention programmes in LMICs are now a necessity. Lancet Glob Health 2023; 11:e1480-e1481. [PMID: 37734780 DOI: 10.1016/s2214-109x(23)00381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, India; Dr Mohan's Diabetes Specialities Centre, Chennai 600 086, India.
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U-Din M, de Mello VD, Tuomainen M, Raiko J, Niemi T, Fromme T, Klåvus A, Gautier N, Haimilahti K, Lehtonen M, Kristiansen K, Newman JW, Pietiläinen KH, Pihlajamäki J, Amri EZ, Klingenspor M, Nuutila P, Pirinen E, Hanhineva K, Virtanen KA. Cold-stimulated brown adipose tissue activation is related to changes in serum metabolites relevant to NAD + metabolism in humans. Cell Rep 2023; 42:113131. [PMID: 37708023 DOI: 10.1016/j.celrep.2023.113131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/06/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
Cold-induced brown adipose tissue (BAT) activation is considered to improve metabolic health. In murine BAT, cold increases the fundamental molecule for mitochondrial function, nicotinamide adenine dinucleotide (NAD+), but limited knowledge of NAD+ metabolism during cold in human BAT metabolism exists. We show that cold increases the serum metabolites of the NAD+ salvage pathway (nicotinamide and 1-methylnicotinamide) in humans. Additionally, individuals with cold-stimulated BAT activation have decreased levels of metabolites from the de novo NAD+ biosynthesis pathway (tryptophan, kynurenine). Serum nicotinamide correlates positively with cold-stimulated BAT activation, whereas tryptophan and kynurenine correlate negatively. Furthermore, the expression of genes involved in NAD+ biosynthesis in BAT is related to markers of metabolic health. Our data indicate that cold increases serum tryptophan conversion to nicotinamide to be further utilized by BAT. We conclude that NAD+ metabolism is activated upon cold in humans and is probably regulated in a coordinated fashion by several tissues.
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Affiliation(s)
- Mueez U-Din
- Turku PET Centre, Turku University Hospital, Turku, Finland; Turku PET Centre, University of Turku, Turku, Finland
| | - Vanessa D de Mello
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marjo Tuomainen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Juho Raiko
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Tarja Niemi
- Department of Surgery, Turku University Hospital, Turku, Finland
| | - Tobias Fromme
- Chair for Molecular Nutritional Medicine, Technical University of Munich, Freising, Germany; EKFZ - Else Kröner Fresenius Center for Nutritional Medicine, Technical University of Munich, Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Anton Klåvus
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Kimmo Haimilahti
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland; Research Program for Stem Cells and Metabolism, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland
| | - Marko Lehtonen
- Department of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - John W Newman
- Obesity and Metabolism Research Unit, USDA-ARS Western Human Nutrition Research Center, Davis, CA, USA; West Coast Metabolomics Center, Davis Genome Center, University of California, Davis, Davis, CA 95616, USA; Department of Nutrition, University of California, Davis, Davis, CA 95616, USA
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Obesity Center, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Pihlajamäki
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | - Martin Klingenspor
- Chair for Molecular Nutritional Medicine, Technical University of Munich, Freising, Germany; EKFZ - Else Kröner Fresenius Center for Nutritional Medicine, Technical University of Munich, Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Pirjo Nuutila
- Turku PET Centre, Turku University Hospital, Turku, Finland; Turku PET Centre, University of Turku, Turku, Finland; Department of Endocrinology, Turku University Hospital, Turku, Finland
| | - Eija Pirinen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland; Research Unit for Internal Medicine, Faculty of Medicine, University of Oulu, 90220 Oulu, Finland
| | - Kati Hanhineva
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Life Technologies, Food Chemistry and Food Development Unit, University of Turku, Turku, Finland; Department of Biology and Biological Engineering, Division of Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden
| | - Kirsi A Virtanen
- Turku PET Centre, Turku University Hospital, Turku, Finland; Turku PET Centre, University of Turku, Turku, Finland; Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland; Department of Endocrinology, Turku University Hospital, Turku, Finland.
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Sobczyk MK, Zheng J, Davey Smith G, Gaunt TR. Systematic comparison of Mendelian randomisation studies and randomised controlled trials using electronic databases. BMJ Open 2023; 13:e072087. [PMID: 37751957 PMCID: PMC10533809 DOI: 10.1136/bmjopen-2023-072087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE To scope the potential for (semi)-automated triangulation of Mendelian randomisation (MR) and randomised controlled trials (RCTs) evidence since the two methods have distinct assumptions that make comparisons between their results invaluable. METHODS We mined ClinicalTrials.Gov, PubMed and EpigraphDB databases and carried out a series of 26 manual literature comparisons among 54 MR and 77 RCT publications. RESULTS We found that only 13% of completed RCTs identified in ClinicalTrials.Gov submitted their results to the database. Similarly low coverage was revealed for Semantic Medline (SemMedDB) semantic triples derived from MR and RCT publications -36% and 12%, respectively. Among intervention types that can be mimicked by MR, only trials of pharmaceutical interventions could be automatically matched to MR results due to insufficient annotation with Medical Subject Headings ontology. A manual survey of the literature highlighted the potential for triangulation across a number of exposure/outcome pairs if these challenges can be addressed. CONCLUSIONS We conclude that careful triangulation of MR with RCT evidence should involve consideration of similarity of phenotypes across study designs, intervention intensity and duration, study population demography and health status, comparator group, intervention goal and quality of evidence.
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Affiliation(s)
- Maria K Sobczyk
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jie Zheng
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
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Zhang X, Moran C, Wang R, Zhou Y. Effect of Aerobic Exercise in Chinese Adult Individuals at Risk for Type 2 Diabetes Mellitus (T2DM) with Low Salivary Amylase Gene (AMY1) Copy Number Variation. Diabetes Metab Syndr Obes 2023; 16:2875-2883. [PMID: 37753482 PMCID: PMC10518248 DOI: 10.2147/dmso.s409007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/18/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose Type 2 Diabetes mellitus (T2DM) has become a life-threatening health problem around the world. Studies have confirmed that aerobic exercise can prevent the risk of T2DM. Furthermore, recent research showed that salivary amylase gene (AMY1) copy number variation (CNV) could be one of the genetic factors that increased the risk of T2DM. To provide more evidence on how AMY1 CNV and exercise is correlated with the risk of T2DM, we designed this study to show the differences in postprandial carbohydrate metabolism between people with different AMY1 copy numbers, and how aerobic exercise can influence this process. Participants and Methods Sixteen participants without cardiovascular disease were chosen, 8 with AMY1 CNV≥6 (High CNV group, HCNV), and 8 with AMY1 CNV ≤ 2 (Low CNV group, LCNV). All participants were Chinese, Han nationality, 18 to 40 years old, with fasting blood glucose lower than 6.1 mmol/L and normal blood pressure levels. They were asked to visit the laboratory in fasting state and drink a cup of solution with 75 grams of edible carbohydrate (glucose or starch). After carbohydrate intake, blood samples were taken at certain times at rest or after aerobic exercise. Blood glucose levels were tested with a portable blood glucose monitor, and insulin levels were tested with the enzyme-linked immunosorbent assay (ELISA). Results The LCNV group had significantly higher resting insulin levels and homeostatic model assessment of insulin resistance (HOMA-IR) than the HCNV group. Compared to the HCNV group, postprandial blood glucose levels and insulin levels were insensitive to starch intake in the LCNV group. However, this difference disappeared after aerobic exercise was added as an intervention. Conclusion Lower AMY1 CNV could be associated with higher risk of T2DM and complex carbohydrate metabolism disorder, while aerobic exercise can reduce the risk by increasing the carbohydrate utilization rate.
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Affiliation(s)
- Xinming Zhang
- School of Sport Science, Nantong University, Nantong City, Jiangsu Province, People’s Republic of China
| | - Colin Moran
- School of Health Sciences and Sport, University of Stirling, Stirling, Scotland, The United Kingdom
| | - Ruiyuan Wang
- School of Sport Science, Beijing Sport University, Beijing City, People’s Republic of China
| | - Yue Zhou
- School of Sport Science, Beijing Sport University, Beijing City, People’s Republic of China
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Febles RM, Miranda DM, Perera CDLCC, Martín LD, Rodríguez-Rodríguez AE, González Martín AR, Sánchez Báez DJ, Porrini E. Therapeutic Exercise on Metabolic and Renal Outcomes in Patients with Chronic Kidney Disease: A Narrative Review. Nephron Clin Pract 2023; 148:85-94. [PMID: 37611542 DOI: 10.1159/000531921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/28/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) affects 11-13% of the world population. The main risk factors for CKD include diabetes, hypertension, and obesity. Metabolic syndrome (MS) is associated with the onset of CKD in the nondiabetic population. Obesity and MS are also risk factors for a worse progression of established CKD. Therapeutic exercise is an effective option to treat and manage obesity, MS, and diabetes in the general population. However, the evidence on the effect of exercise on patients with CKD, obesity, and MS is scarce. SUMMARY We evaluated available evidence on the effect of therapeutic exercise in patients with CKD, excluding dialysis, particularly in improving the metabolic risk factors and main renal outcomes: renal function loss and albuminuria/proteinuria. This review includes prospective studies and clinical trials. A total of 44 studies were analysed in 1,700 subjects with renal disease (2-5), including patients with renal transplantation. Most studies did not prove a major effect of exercise on albuminuria/proteinuria, glomerular filtration rate (GFR), obesity, or MS. These results are intriguing and deserve attention. The exploratory nature of most studies, including a low number of cases and short follow-up, might explain the lack of efficacy of exercise in our analysis. Specific aspects like the type of exercise, frequency, intensity, duration, accommodation during follow-up, individualization, safety, and adherence are crucial to the success of therapeutic exercise. The beneficial role of exercise in patients with CKD remains to be determined. KEY MESSAGES Key messages of this review are as follows. (1) The effect of therapeutic exercise on renal and metabolic outcomes in patients with CKD remains to be determined. (2) According to the evidence selected, therapeutic exercise seems to be safe to treat patients with CKD. (3) Most studies are exploratory by nature, with results that need further investigation. (4) Therapeutic exercise is a complex procedure that must be specifically designed to treat patients with CKD.
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Affiliation(s)
- Raúl Morales Febles
- Faculty of Medicine, University of La Laguna, Tenerife, Spain,
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain,
| | - Domingo Marrero Miranda
- Instituto de Tecnologías Biomédicas (ITB), Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | - Coriolano de la Concepción Cruz Perera
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain
| | - Laura Díaz Martín
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | | | | | | | - Esteban Porrini
- Faculty of Medicine, University of La Laguna, Tenerife, Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain
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Zhou Y, Xu P, Qin S, Zhu Y, Gu K. The associations between dietary flavonoid intake and the prevalence of diabetes mellitus: Data from the National Health and Nutrition Examination Survey 2007-2010 and 2017-2018. Front Endocrinol (Lausanne) 2023; 14:1250410. [PMID: 37664856 PMCID: PMC10474301 DOI: 10.3389/fendo.2023.1250410] [Citation(s) in RCA: 1] [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: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Diabetes mellitus (DM) is a prominent health concern worldwide, leading to the high incidence of disability and mortality and bringing in heavy healthcare and social burden. Plant-based diets are reported associated with a reduction of DM risk. Plant-based diets are rich in flavonoids, which possess properties such as scavenging free radicals and exerting both anti-inflammatory and antioxidant effects. Purpose However, whether dietary flavonoids are associated with the prevalence of DM remains controversial. The potential reasons for contradictory epidemiological outcomes on the association between dietary flavonoids and DM prevalence have not been determined. Methods To address these limitations, we employed data from 22,481 participants in the National Health and Nutrition Examination Survey to explore the association between the intake of flavonoids and DM prevalence by weighted Logistic regression and weighted restricted cubic splines. Results We found that the prevalence of DM was inversely associated with the intake of total flavonoids in the second quartile [Odds Ratio (OR) 0.78 95% confidence interval (CI) (0.63, 0.97), p = 0.028], in the third quartile [0.76 (0.60, 0.97), p = 0.031], and in the fourth quartile [0.80 (0.65, 0.97), p = 0.027]. However, the p for trend was not significant [0.94 (0.88, 1.01), p = 0.096]. Moreover, the association between DM prevalence and the intake of total flavonoids was significantly influenced by race (p for interaction = 0.006). In Mexican Americans, there was a significant positive association between DM prevalence and total flavonoid intake within the third quartile [1.04 (1.02, 1.07), p = 0.003]. Total flavan-3-ol and subtotal catechin intake exhibited a non-linear U-shaped association with DM prevalence (p for non-linearity < 0.0001 and p for non-linearity < 0.0001, respectively). Compared to the first quartile of corresponding intakes, consumption within the third quartile of subtotal catechins [0.70 (0.55, 0.89), p = 0.005] and total flavan-3-ols [0.65 (0.50, 0.84), p = 0.002] was associated with a lower prevalence of DM. Conclusion Taken together, our study may provide preliminary research evidence for personalized improvement of dietary habits to reduce the prevalence of diabetes.
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Affiliation(s)
- Yanjun Zhou
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Peng Xu
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Shaolei Qin
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Yan Zhu
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Ke Gu
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Hsia DS, Nelson J, Vickery EM, Rasouli N, LeBlanc ES, Kim S, Brodsky I, Pratley R, Dawson-Hughes B, Pittas AG. Effect of vitamin D on regression to normal glucose regulation and individual glycemic measures: A secondary analysis among participants adherent to the trial protocol in the randomized clinical trial vitamin D and type 2 diabetes (D2d) study. Diabetes Res Clin Pract 2023; 202:110792. [PMID: 37343726 PMCID: PMC10491428 DOI: 10.1016/j.diabres.2023.110792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
AIMS To examine the effect of vitamin D on regression to normal glucose regulation (NGR) and individual glycemic measures in the D2d study. METHODS In per-protocol analyses, we examined time to new-onset diabetes; time to new-onset NGR defined as first occurrence of: 2-or-3 glycemic criteria in the normal range (NGR-1) or fasting plasma glucose (FPG) and 2-hour post-load-glucose (2hPG) in the normal range (NGR-2); proportion meeting NGR at the last study visit; and change in FPG, 2hPG, and HbA1c. RESULTS Among 2423 participants, hazard ratio [HR] for diabetes was 0.84 [95%CI, 0.71, 0.99]). HR (95%CI) was 1.16 (0.99, 1.36) for new-onset NGR-1 and 1.06 (0.87, 1.30) for NGR-2. At the last visit, NGR-1 occurred in 12.4% vs. 9.5% participants in the vitamin D vs. placebo group (rate ratio for vitamin D 1.31 [1.02, 1.70]); whereas, NGR-2 occurred in 8.7% vs. 6.0% (rate ratio for vitamin D 1.45 [1.05, 2.00]). During follow-up, FPG, HbA1c, and 2hPG increased in both groups. Mean difference in FPG favored vitamin D (-0.80 mg/dL; 95%CI, -1.26, -0.33). CONCLUSIONS In secondary analyses among participants adherent to the trial protocol, vitamin D lowered risk of developing diabetes and increased likelihood of NGR at the end of the study.
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Affiliation(s)
- Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Jason Nelson
- Tufts CTSI, BERD Center, Tufts Medical Center, Boston, MA, USA
| | - Ellen M Vickery
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA, USA
| | - Neda Rasouli
- University of Colorado, School of Medicine and VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Erin S LeBlanc
- Center for Health Research, Kaiser Permanente NW, Portland, OR, USA
| | - Sun Kim
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Irwin Brodsky
- Endocrinology and Diabetes Center, Maine Medical Center and Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Richard Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA, USA
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Zhang L, Zhang Y, Shen S, Wang X, Dong L, Li Q, Ren W, Li Y, Bai J, Gong Q, Kuang H, Qi L, Lu Q, Cheng W, Liu Y, Yan S, Wu D, Fang H, Hou F, Wang Y, Yang Z, Lian X, Du J, Sun N, Ji L, Li G. Safety and effectiveness of metformin plus lifestyle intervention compared with lifestyle intervention alone in preventing progression to diabetes in a Chinese population with impaired glucose regulation: a multicentre, open-label, randomised controlled trial. Lancet Diabetes Endocrinol 2023; 11:567-577. [PMID: 37414069 DOI: 10.1016/s2213-8587(23)00132-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Impaired glucose regulation (defined as either impaired glucose tolerance or impaired fasting glucose) is an important risk factor for the development of diabetes. We aimed to evaluate the safety and effectiveness of metformin plus lifestyle intervention compared with lifestyle intervention alone in preventing diabetes in Chinese participants with impaired glucose regulation. METHODS We did a multicentre, open-label, randomised controlled trial at 43 endocrinology departments in general hospitals across China. Eligible participants were individuals with impaired glucose regulation (ie, impaired glucose tolerance or impaired fasting glucose, or both), men or women aged 18-70 years with a BMI of 21-32 kg/m2. Eligible participants were randomly assigned (1:1) via a computer-generated randomisation to receive either standard lifestyle intervention alone or metformin (850 mg orally once per day for the first 2 weeks and titrated to 1700 mg orally per day [850 mg twice per day]) plus lifestyle intervention. Block randomisation was used with a block size of four, stratified by glucose status (impaired fasting glucose or impaired glucose tolerance), hypertension, and use of any anti-hypertensive medication. Lifestyle intervention advice was given by investigators at all participating sites. The primary endpoint was the incidence of newly diagnosed diabetes at the end of the 2-year follow-up. Analysis was done using the full analysis set and per-protocol set. This study is registered with ClinicalTrials.gov, number NCT03441750, and is completed. FINDINGS Between April, 2017, and June, 2019, 3881 individuals were assessed for eligibility, of which 1678 (43·2%) participants were randomly assigned to either the metformin plus lifestyle intervention group (n=831) or the lifestyle intervention alone group (n=847) and received the allocated intervention at least once. During a median follow-up of 2·03 years, the incidence rate of diabetes was 17·27 (95% CI 15·19-19·56) per 100 person-years in the metformin plus lifestyle intervention group and 19·83 (17·67-22·18) per 100 person-years in the lifestyle intervention alone group. The metformin plus lifestyle intervention group showed a 17% lower risk of developing diabetes than the lifestyle intervention alone group (HR 0·83 [95% CI 0·70-0·99]; log-rank p=0·043). A higher proportion of participants in the metformin plus lifestyle intervention group reported adverse events than in the lifestyle intervention alone group, primarily due to more gastrointestinal adverse events. The percentage of participants reporting a serious adverse event was similar in both groups. INTERPRETATION Metformin plus lifestyle intervention further reduced the risk of developing diabetes than lifestyle intervention alone in Chinese people with impaired glucose regulation, showing additional benefits of combined intervention in preventing progression to diabetes without new safety concerns. FUNDING Merck Serono China, an affiliate of Merck KGaA, Darmstadt, Germany. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Lihui Zhang
- Department of Endocrinology and Metabolism, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yunliang Zhang
- Department of Endocrinology and Metabolism, Baoding First Central Hospital, Baoding, Hebei, China
| | - Sheng'ai Shen
- Department of Endocrinology and Metabolism, Yanji Hospital, Yanji, Yanbian Korean Autonomous Prefecture, Jilin, China
| | - Xueying Wang
- Department of Endocrinology and Metabolism, Jinzhou Central Hospital, Jinzhou, Liaoning, China
| | - Luling Dong
- Department of Endocrinology and Metabolism, Zhangjiakou First Hospital, Zhangjiakou, Hebei, China
| | - Qiuyun Li
- Department of Endocrinology and Metabolism, Kailuan General Hospital, Tangshan, Hebei, China
| | - Weidong Ren
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Yufeng Li
- Department of Endocrinology and Metabolism, Beijing Pinggu Hospital, Beijing, China
| | - Jianling Bai
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiuhong Gong
- Department of Endocrinology, Fuwai Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Hongyu Kuang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lin Qi
- Department of Endocrinology and Metabolism, Beijing Yanhua Hospital, Beijing, China
| | - Qiang Lu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Wenli Cheng
- Department of Hypertension, Beijing Anzhen Hospital, Beijing, China
| | - Yanjie Liu
- Department of Endocrinology and Hematology, Affiliated Hospital of Jilin Medical University, Jilin city, Jilin, China
| | - Shuang Yan
- Department of Endocrinology and Metabolism, Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Donghong Wu
- Department of Endocrinology, Harbin The First Hospital, Harbin, Heilongjiang, China
| | - Hui Fang
- Department of Endocrinology, Tangshan Gongren Hospital, Tangshan, Hebei, China
| | - Fang Hou
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New Area, Tianjin, China
| | - Yingju Wang
- Department of Endocrinology, Beijing Miyun District Hospital, Beijing, China
| | - Zhixia Yang
- Department of Endocrinology, The People's Hospital of Langfang, Langfang, Hebei, China
| | - Xu Lian
- Department of Endocrinology and Metabolism, Hongqi Hospital, Mudanjiang Medical University, Mudanjiang, Heilongjiang, China
| | - Jianling Du
- Department of Endocrinology, The First affiliated hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ningling Sun
- Department of Hypertension, Peking University People's Hospital, Beijing, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Guangwei Li
- Department of Endocrinology, Fuwai Hospital and Chinese Academy of Medical Sciences, Beijing, China.
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Cranston KD, MacPherson MM, Sim JA, Jung ME. Small Steps Towards an Inclusive Diabetes Prevention Program: How Small Steps for Big Changes is Improving Program Equity and Inclusion. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023:2752535X231189932. [PMID: 37478867 DOI: 10.1177/2752535x231189932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Social determinants of health, the effects of colonialism, and systemic injustices result in some groups being at disproportionately higher risk for developing type 2 diabetes (T2D). Many T2D prevention programs have not been designed to provide equitable and inclusive care to everyone. This paper presents an example of the steps taken in an evidence-based community T2D prevention program, Small Steps for Big Changes (SSBC), to improve equitable access and inclusivity based on input from a stakeholder advisory group and the ConNECT Framework. To improve reach to those most at risk for T2D, SSBC has changed both eligibility criteria and program delivery. To ensure that all testing is done in an inclusive manner, changes have been made to measurements, and to training for those delivering the program. This paper also provides actionable recommendations for other researchers to incorporate into their own health programs to promote inclusivity and ensure that they reach those most at risk of T2D.
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Affiliation(s)
- Kaela D Cranston
- School of Health and Exercise Sciences, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Megan M MacPherson
- School of Health and Exercise Sciences, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Jenna Ap Sim
- School of Health and Exercise Sciences, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
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Sakboonyarat B, Poovieng J, Sangkool T, Lertsakulbunlue S, Jongcherdchootrakul K, Srisawat P, Mungthin M, Rangsin R. Relationship between pulse pressure and body mass index in active-duty Royal Thai Army personnel in Thailand. BMC Cardiovasc Disord 2023; 23:361. [PMID: 37464282 DOI: 10.1186/s12872-023-03390-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Elevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few studies. However, the findings were inconsistent. Therefore, the aim of the present study is to identify the association between elevated PP and BMI using a large sample of active-duty Royal Thai Army (RTA) personnel. METHODS A cross-sectional study was conducted through the use of the dataset obtained from the annual health examination database of RTA personnel in Thailand in 2022. BMI 25.0-29.9 kg/m2 was classified as obesity I, whereas BMI ≥ 30.0 kg/m2 was classified as obesity II. Elevated PP was defined as PP ≥ 50 mmHg. Multivariable linear regression and log-binomial regression models were utilized for determining the association between elevated PP and BMI. RESULTS A total of 62,113 active-duty RTA personnel were included in the study. The average BMI was 25.4 ± 3.8 kg/m2, while the average PP was 50.1 ± 11.2 mmHg. Compared to individuals with normal weight, the [Formula: see text] coefficients of PP and BMI were 1.38 (95% CI: 1.15-1.60) and 2.57 (95% CI: 2.25-2.88) in individuals with obesity I and obesity II, respectively. Effect modification by high blood pressure (BP) on the association between elevated PP and BMI was observed. Among participants with normal BP, in comparison with BMI of 18.5-22.9 kg/m2, the adjusted prevalence ratio (PR) for elevated PP was 1.23 (95% CI: 1.19-1.28) and 1.41 (95% CI: 1.35-1.48) in those with obesity I and obesity II, respectively. Meanwhile, among individuals with high BP, the adjusted PR for elevated PP was 1.05 (95% CI: 1.01-1.08) and 1.09 (95% CI: 1.06-1.13) in those with obesity I and obesity II, respectively. CONCLUSION PP was positively associated with BMI in active-duty RTA personnel. High BP was the modifier of the association between PP and BMI. A weaker association between elevated PP and BMI was observed among RTA personnel with high BP.
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Affiliation(s)
- Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Jaturon Poovieng
- Department of Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Tanatip Sangkool
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | | | - Kanlaya Jongcherdchootrakul
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Phutsapong Srisawat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Mathirut Mungthin
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.
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Jing T, Zhang S, Bai M, Chen Z, Gao S, Li S, Zhang J. Effect of Dietary Approaches on Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review with Network Meta-Analysis of Randomized Trials. Nutrients 2023; 15:3156. [PMID: 37513574 PMCID: PMC10384204 DOI: 10.3390/nu15143156] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Dietary patterns play a critical role in diabetes management, while the best dietary pattern for Type 2 diabetes (T2DM) patients is still unclear. The aim of this network meta-analysis was to compare the impacts of various dietary approaches on the glycemic control of T2DM patients. METHODS Relevant studies were retrieved from PubMed, Embase, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL), and other additional records (1949 to 31 July 2022). Eligible RCTs were those comparing different dietary approaches against each other or a control diet in individuals with T2DM for at least 6 months. We assessed the risk of bias of included studies with the Cochrane risk of bias tool and confidence of estimates with the Grading of Recommendations Assessment, Development, and Evaluation approach for network meta-analyses. In order to determine the pooled effect of each dietary approach relative to each other, we performed a network meta-analysis (NMA) for interventions for both HbA1c and fasting glucose, which enabled us to estimate the relative intervention effects by combing both direct and indirect trial evidence. RESULTS Forty-two RCTs comprising 4809 patients with T2DM were included in the NMA, comparing 10 dietary approaches (low-carbohydrate, moderate-carbohydrate, ketogenic, low-fat, high-protein, Mediterranean, Vegetarian/Vegan, low glycemic index, recommended, and control diets). In total, 83.3% of the studies were at a lower risk of bias or had some concerns. Findings of the NMA revealed that the ketogenic, low-carbohydrate, and low-fat diets were significantly effective in reducing HbA1c (viz., -0.73 (-1.19, -0.28), -0.69 (-1.32, -0.06), and -1.82 (-2.93, -0.71)), while moderate-carbohydrate, low glycemic index, Mediterranean, high-protein, and low-fat diets were significantly effective in reducing fasting glucose (viz., -1.30 (-1.92, -0.67), -1.26 (-2.26, -0.27), -0.95 (-1.51, -0.38), -0.89 (-1.60, -0.18) and -0.75 (-1.24, -0.27)) compared to a control diet. The clustered ranking plot for combined outcomes indicated the ketogenic, Mediterranean, moderate-carbohydrate, and low glycemic index diets had promising effects for controlling HbA1c and fasting glucose. The univariate meta-regressions showed that the mean reductions of HbA1c and fasting glucose were only significantly related to the mean weight change of the subjects. CONCLUSIONS For glycemic control in T2DM patients, the ketogenic diet, Mediterranean diet, moderate-carbohydrate diet, and low glycemic index diet were effective options. Although this study found the ketogenic diet superior, further high-quality and long-term studies are needed to strengthen its credibility.
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Affiliation(s)
- Tiantian Jing
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
| | - Shunxing Zhang
- Department of Global Public Health/Media, Culture, and Communication, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10016, USA
| | - Mayangzong Bai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
| | - Zhongwan Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
| | - Sihan Gao
- School of Public Health, University of Washington Seattle Campus, Seattle, WA 98105, USA
| | - Sisi Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
| | - Jing Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (T.J.)
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Wang Y, Li H, Yang D, Wang M, Han Y, Wang H. Effects of aerobic exercises in prediabetes patients: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1227489. [PMID: 37522127 PMCID: PMC10374027 DOI: 10.3389/fendo.2023.1227489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Aims To evaluate the effects of different durations of continuous aerobic exercise on prediabetic patients. Materials and methods The research encompassed randomized controlled trials that examined how various durations of aerobic exercise training affected outcomes related to Body Mass Index (BMI), Fasting blood glucose (FBG), 2-hour plasma glucose (2hPG), and glycated hemoglobin (HbA1c) in individuals diagnosed with prediabetes. PubMed, Embase, Web of Science, and the Cochrane Library were searched as of January 7, 2023. The Cochrane Risk of Bias, version 2 (ROB 2) tool was used to assess the risk of bias. Results A total of 10 RCTs with 815 prediabetic patients were included. The average age of the participants was 56.1 years, with a standard deviation of 5.1 years. Among the participants, 39.2% were male. The interventions consisted of aerobic dance, treadmill running, walking, and a combination of aerobic exercises. The training sessions occurred three or four times per week. In prediabetic patients, aerobic exercise demonstrated a significant reduction in BMI compared to the control group, with a weighted mean difference (WMD) of -1.44 kg/m2 (95% confidence interval [CI] -1.89, -0.98). There was a decrease in FBG levels, with WMD of -0.51 mmol/L (95% CI -0.70, -0.32). Additionally, aerobic training led to significant improvements in 2hPG levels, with a WMD of -0.76 mmol/L (95% CI -1.14, -0.38). Furthermore, prediabetic patients showed a decrease in HbA1c levels after engaging in aerobic training compared to the control group, with a WMD of -0.34% (95% CI -0.45, -0.23). Conclusion In summary, engaging in aerobic exercise can have a significant positive impact on glycemic levels in individuals with prediabetes. It can also lead to reductions in BMI, FBG, 2hPG, HbA1c, and other relevant indicators. The extent of these improvements may vary slightly depending on the duration of the aerobic exercise intervention. Systematic review registration PROSPERO https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023395515.
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Affiliation(s)
- Yifei Wang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Honglei Li
- School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, China
| | - Dongxue Yang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Mengzhao Wang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Yanbai Han
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Hongli Wang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
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Rooney MR, Fang M, Ogurtsova K, Ozkan B, Echouffo-Tcheugui JB, Boyko EJ, Magliano DJ, Selvin E. Global Prevalence of Prediabetes. Diabetes Care 2023; 46:1388-1394. [PMID: 37196350 PMCID: PMC10442190 DOI: 10.2337/dc22-2376] [Citation(s) in RCA: 73] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/10/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To estimate the global, regional, and national prevalence of prediabetes, defined by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). RESEARCH DESIGN AND METHODS We reviewed 7,014 publications for high-quality estimates of IGT (2-h glucose, 7.8-11.0 mmol/L [140-199 mg/dL]) and IFG (fasting glucose, 6.1-6.9 mmol/L [110-125 mg/dL]) prevalence for each country. We used logistic regression to generate prevalence estimates for IGT and IFG among adults aged 20-79 years in 2021 and projections for 2045. For countries without in-country data, we extrapolated estimates from countries with available data with similar geography, income, ethnicity, and language. Estimates were standardized to the age distribution for each country from the United Nations. RESULTS Approximately two-thirds of countries did not have high-quality IGT or IFG data. There were 50 high-quality studies for IGT from 43 countries and 43 high-quality studies for IFG from 40 countries. Eleven countries had data for both IGT and IFG. The global prevalence of IGT in 2021 was 9.1% (464 million) and is projected to increase to 10.0% (638 million) in 2045. The global prevalence of IFG in 2021 was 5.8% (298 million) and is projected to increase to 6.5% (414 million) in 2045. The 2021 prevalence of IGT and IFG was highest in high-income countries. In 2045, the largest relative growth in cases of IGT and IFG would be in low-income countries. CONCLUSIONS The global burden of prediabetes is substantial and growing. Enhancing prediabetes surveillance is necessary to effectively implement diabetes prevention policies and interventions.
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Affiliation(s)
- Mary R. Rooney
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael Fang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine Ogurtsova
- Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bige Ozkan
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Edward J. Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA
| | - Dianna J. Magliano
- Baker Heart and Diabetes Institute & School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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84
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Kong APS, Cos X. Management of people with prediabetes and the implementation of diabetes prevention programme. Prim Care Diabetes 2023:S1751-9918(23)00113-4. [PMID: 37394313 DOI: 10.1016/j.pcd.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Alice Pik-Shan Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xavier Cos
- The Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Spain; CAP Sant Martí de Provençals, Gerencia Territorial Barcelona ciutat, Institut Català de la Salut. Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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85
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Al-Sofiani ME, Asiri A, Alajmi S, Alkeridy W. Perspectives on Prediabetes and Aging. Endocrinol Metab Clin North Am 2023; 52:377-388. [PMID: 36948785 DOI: 10.1016/j.ecl.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Diabetes prevention programs (DPPs) have been shown to effectively delay, and sometimes prevent, the progression from prediabetes to diabetes; however, labeling someone with prediabetes comes with potential negative psychological, financial, and self-perception consequences. Many older adults with prediabetes nowadays have a relatively "low-risk" form of prediabetes that rarely progresses to diabetes and may regress to normoglycemia. In this article, we review the impact of aging on glucose metabolism and provide a holistic approach to cases of prediabetes in older adults that maximizes the benefit-risk balance of interventions aimed at addressing prediabetes.
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Affiliation(s)
- Mohammed E Al-Sofiani
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Central Region, 12372, Saudi Arabia; Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, 1830 East Monument Street, Baltimore, MD 21287, USA.
| | - Alanood Asiri
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Central Region, 12372, Saudi Arabia
| | - Sarah Alajmi
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Central Region, 12372, Saudi Arabia
| | - Walid Alkeridy
- Department of Medicine, King Saud University, College of Medicine, Riyadh, Central Region, 12372, Saudi Arabia
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Aas AM, Axelsen M, Churuangsuk C, Hermansen K, Kendall CWC, Kahleova H, Khan T, Lean MEJ, Mann JI, Pedersen E, Pfeiffer A, Rahelić D, Reynolds AN, Risérus U, Rivellese AA, Salas-Salvadó J, Schwab U, Sievenpiper JL, Thanopoulou A, Uusitupa EM. Evidence-based European recommendations for the dietary management of diabetes. Diabetologia 2023; 66:965-985. [PMID: 37069434 DOI: 10.1007/s00125-023-05894-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes.
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87
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Cao C, Hu H, Han Y, Yuan S, Zheng X, Zhang X, Zan Y, Wang Y, He Y. The nonlinear correlation between alanine aminotransferase to high-density lipoprotein cholesterol ratio and the risk of diabetes: a historical Japanese cohort study. BMC Endocr Disord 2023; 23:124. [PMID: 37248447 DOI: 10.1186/s12902-023-01382-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/25/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Low levels of high-density lipoprotein cholesterol (HDL-C) and high levels of alanine aminotransferase (ALT) are related to insulin resistance, metabolic syndrome, and diabetes mellitus (DM). However, evidence on the connection between the alanine aminotransferase to high-density lipoprotein cholesterol (ALT/HDL-C) ratio and diabetes mellitus (DM) risk was limited. The study aimed to investigate the relationship between baseline ALT/HDL-C ratio and DM among Japanese individuals. METHODS This second analysis was based on a cohort study using open-source data. Data from 15,342 individuals who participated in the medical examination program were recorded at Murakami Memorial Hospital in Japan between 2004 and 2015. Smooth curve fitting, subgroup analysis, Cox proportional-hazards regression, and a series of sensitivity analyses were conducted to examine the relationship between ALT/HDL-C ratio and incident diabetes. The ability of the ALT/HDL-C ratio to predict diabetes was evaluated using a receiver operating characteristic curve analysis. RESULTS After controlling for confounding covariates, the ALT/HDL-C ratio was found to be positively correlated to the DM risk in Japanese adults (HR: 1.01, 95%CI: 1.00-1.02, P = 0.049). This study also found a stable relationship between ALT/HDL-C ratio and diabetes after employing a series of sensitivity analyses. Additionally, there was a non-linear association between the ALT/HDL-C ratio and incident diabetes, and the ALT/HDL-C ratio inflection point was 30.12. When the ALT/HDL-C ratio was below 30.12, the present study discovered a significant positive association between the ALT/HDL-C ratio and incident diabetes (HR: 1.04, 95%CI: 1.02-1.06, P = 0.001). Furthermore, among liver enzymes, blood lipids, and anthropometric indicators, the ALT/HDL-C ratio best predicts DM (AUC = 0.75, 95%CI: 0.73-0.78). CONCLUSION Increased ALT/HDL-C ratio levels at baseline correlated to incident DM. The relationship between ALT/HDL-C ratio and incident DM was also non-linear. When the ALT/HDL-C ratio is below 30.12, there is a statistically significant positive correlation between the ALT/HDL-C ratio and incident DM.
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Affiliation(s)
- Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong Province, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China
| | - Shuting Yuan
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong Province, China
| | - Xiaodan Zheng
- Department of Neurology, Shenzhen Samii International Medical Center (The Fourth People's Hospital of Shenzhen), Shenzhen, 518000, Guangdong Province, China
| | - Xiaohua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong Province, China
| | - Yibing Zan
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong Province, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong Province, China.
- Department of Nephrology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China.
| | - Yongcheng He
- Department of Nephrology, Shenzhen Hengsheng Hospital, Shenzhen, 518000, Guangdong Province, China.
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
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Boonpor J, Parra-Soto S, Petermann-Rocha F, Lynskey N, Cabanas-Sánchez V, Sattar N, Gill JMR, Welsh P, Pell JP, Gray SR, Ho FK, Celis-Morales C. Dose-response relationship between device-measured physical activity and incident type 2 diabetes: findings from the UK Biobank prospective cohort study. BMC Med 2023; 21:191. [PMID: 37226202 DOI: 10.1186/s12916-023-02851-5] [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] [Received: 06/02/2022] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Most studies investigating the association between physical activity (PA) and the risk of type 2 diabetes are derived from self-reported questionnaires, with limited evidence using device-based measurements. Therefore, this study aimed to investigate the dose-response relationship between device-measured PA and incident type 2 diabetes. METHODS This prospective cohort study included 40,431 participants of the UK Biobank. Wrist-worn accelerometers were used to estimate total, light, moderate, vigorous and moderate-to-vigorous PA. The associations between PA and incident type 2 diabetes were analysed using Cox-proportional hazard models. The mediating role of body mass index (BMI) was tested under a causal counterfactual framework. RESULTS The median follow-up period was 6.3 years (IQR: 5.7-6.8), with 591 participants developing type 2 diabetes. Compared to those achieving < 150 min/week of moderate PA, people achieving 150-300, 300-600 and > 600 min/week were at 49% (95% CI 62-32%), 62% (95% CI 71-50%) and 71% (95% CI 80-59%) lower risk of type 2 diabetes, respectively. For vigorous PA, compared to those achieving < 25 min/week, individuals achieving 25-50, 50-75 and > 75 min/week were at 38% (95% CI 48-33%), 48% (95% CI 64-23%) and 64% (95% CI 78-42%) lower type 2 diabetes risk, respectively. Twelve per cent and 20% of the associations between vigorous and moderate PA and type 2 diabetes were mediated by lower BMI, respectively. CONCLUSIONS PA has clear dose-response relationship with a lower risk of type 2 diabetes. Our findings support the current aerobic PA recommendations but suggest that additional PA beyond the recommendations is associated with even greater risk reduction. TRIAL REGISTRATION The UK Biobank study was approved by the North West Multi-Centre Research Ethics Committee (Ref 11/NW/0382 on June 17, 2011).
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Affiliation(s)
- Jirapitcha Boonpor
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, Thailand
| | - Solange Parra-Soto
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Nutrition and Public Health, Universidad del Bío-Bío, Chillan, Chile
| | - Fanny Petermann-Rocha
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Nathan Lynskey
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Verónica Cabanas-Sánchez
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stuart R Gray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Human Performance Lab, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, Chile.
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Yang H, Zhang M, Nie J, Zhang M, Lu G, Chen R, He Q. Associations of obesity-related indices with prediabetes regression to normoglycemia among Chinese middle-aged and older adults: a prospective study. Front Nutr 2023; 10:1075225. [PMID: 37275653 PMCID: PMC10235473 DOI: 10.3389/fnut.2023.1075225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
Background Prediabetes is associated with increased cardiovascular risk and all-cause mortality, while its regression will decrease the risks. This study investigated the associations of six obesity-related indices (waist-to-height ratio (WHtR), body roundness index (BRI), conicity index (CI), body shape index (ABSI), Chinese visceral adiposity index (CVAI), and triglyceride glucose (TyG) index) with prediabetes regression based on the China Health and Retirement Longitudinal Study (CHARLS), enrolling middle-aged and older adults. Methods We included 2,601 participants with prediabetes from CHARLS, who were followed up from 2011-2012 to 2015-2016, with blood samples collected for measuring fasting plasma glucose and hemoglobin A1c. All the obesity-related indices at baseline and their dynamic changes were calculated and categorized into tertiles. Logistic regression analysis was applied to obtain the odds ratio (OR) and 95% confidence intervals (CIs). Attributable fractions (AFs) and 95% CIs of these indices and the dynamic changes were calculated with the AF package in R software, and the cutoff values of initial obesity-related indices were obtained by the receiver operating characteristic (ROC) analysis. Results During the 4-year follow-up period, 562 (21.61%) participants regressed from prediabetes to normoglycemia. They had lower initial BRI, WHtR, CI, ABSI, CVAI, and TyG than those who did not (P < 0.05). After multivariable adjustment, participants in the first tertile of initial BRI (OR, 1.45, 95%CIs, 1.09-1.93), WHtR (OR, 1.46, 95%CIs, 1.10-1.95), and CVAI (OR, 1.47, 95%CIs, 1.11-1.93) had increased odds of prediabetes regression compared with those in the highest tertile. Participants with decreased TyG (OR, 2.08; 95%CIs, 1.61-2.70) also had increased odds of prediabetes regression compared with those with increased TyG. The cutoff values of initial obesity-related indices were 4.374 for BRI, 0.568 for WHtR, 8.621 for TyG, 1.320 for CI, 0.083 for ABSI, and 106.152 for CVAI, respectively. The AFs were 21.10% for BRI < 4.374, 20.85% for WHtR < 0.568, 17.48% for CVAI < 107.794, and 17.55% for ΔTyG < 0, respectively. Conclusion Low initial BRI, WHtR, and CVAI, as well as TyG reduction, were significantly related to prediabetes regression to normoglycemia, and the AFs were around 20%. Less abdominal fat and insulin resistance reduction would benefit future health outcomes among people with prediabetes.
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Affiliation(s)
| | - Minjie Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Jiaqi Nie
- School of Public Health, Wuhan University, Wuhan, China
| | - Minzhe Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Gaolei Lu
- School of Public Health, Wuhan University, Wuhan, China
| | - Rui Chen
- School of Public Health, Wuhan University, Wuhan, China
| | - Qiqiang He
- School of Public Health, Wuhan University, Wuhan, China
- Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, China
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Morales Febles R, Marrero Miranda D, Jiménez Sosa A, González Rinne A, Cruz Perera C, Rodríguez-Rodríguez AE, Álvarez González A, Díaz Martín L, Negrín Mena N, Acosta Sørensen C, Pérez Tamajón L, Rodríguez Hernández A, González Rinne F, Dorta González A, Ledesma Pérez E, González Delgado A, Domínguez-Rodríguez A, García Baute MDC, Torres Ramírez A, Porrini E. Exercise and Prediabetes After Renal Transplantation (EXPRED-I): A Prospective Study. SPORTS MEDICINE - OPEN 2023; 9:32. [PMID: 37202497 DOI: 10.1186/s40798-023-00574-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/25/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Post-transplant diabetes mellitus (PTDM) beyond 12 months (late PTDM) is a severe complication after renal transplantation. Late PTDM develops mostly in subjects with prediabetes. Although exercise may have a potential role in preventing late PTDM, there are no previous data on the effect of exercise in patients with prediabetes. MATERIAL AND METHODS The design was a 12-month exploratory study to test the capacity of exercise in reverting prediabetes in order to prevent late-PTDM. The outcome was the reversibility of prediabetes, assessed every 3 months with oral glucose tolerance tests (OGTT). The protocol included an incremental plan of aerobic and/or strength training as well as an active plan for promoting adherence (telephone calls, digital technology, and visits). A priori, a sample size cannot be calculated which makes this an exploratory analysis. Based on previous studies, the spontaneous reversibility of prediabetes was 30% and the reversibility induced by exercise will account for another 30%, a total reversibility of 60% (p value < 0.05, assuming a potency of 85%). Ad interim analysis was performed during follow-up to test the certainty of this sample calculation. Patients beyond 12 months after renal transplantation with prediabetes were included. RESULTS The study was interrupted early due to efficacy after the evaluation of the follow-up of 27 patients. At the end of follow-up, 16 (60%) patients reverted to normal glucose levels at fasting (from 102.13 mg/dL ± 11 to 86.75 ± 6.9, p = 0.006) and at 120 min after the OGTTs (154.44 mg/dL ± 30 to 113.0 ± 13.1, p = 0.002) and 11 patients had persistent prediabetes (40%). Also, insulin sensitivity improved with the reversibility of prediabetes, compared to those with persistent prediabetes: 0.09 [0.08-0.11] versus 0.04 [0.01-0.07], p = 0.001 (Stumvoll index). Most needed at least one increment in the prescription of exercise and compliance. Finally, measures aimed at the improvement of compliance were successful in 22 (80%) patients. CONCLUSION Exercise training was effective to improve glucose metabolism in renal transplant patients with prediabetes. Exercise prescription must be conducted considering both the clinical characteristics of the patients and pre-defined strategy to promote adherence. The trial registration number of the study was NCT04489043.
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Affiliation(s)
- Raúl Morales Febles
- Faculty of Medicine, University of La Laguna, La Laguna, Tenerife, Spain
- Research Unit, University Hospital of Canary Islands, La Laguna, Spain
| | | | | | - Ana González Rinne
- Nephrology Department, University Hospital of Canary Islands, La Laguna, Spain
| | | | | | | | - Laura Díaz Martín
- Research Unit, University Hospital of Canary Islands, La Laguna, Spain
| | | | | | | | | | - Federico González Rinne
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, La Laguna, Tenerife, Spain
| | | | | | | | - Alberto Domínguez-Rodríguez
- Cardiology Department, University Hospital of Canary Islands, La Laguna, Spain
- CIBER of Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Faculty of Health Science, European University of Canary Islands, La Laguna, Tenerife, Spain
| | | | - Armando Torres Ramírez
- Faculty of Medicine, University of La Laguna, La Laguna, Tenerife, Spain
- Nephrology Department, University Hospital of Canary Islands, La Laguna, Spain
- Instituto de Tecnologías Biomédicas (ITB), Faculty of Medicine, University of La Laguna, La Laguna, Tenerife, Spain
| | - Esteban Porrini
- Faculty of Medicine, University of La Laguna, La Laguna, Tenerife, Spain.
- Research Unit, University Hospital of Canary Islands, La Laguna, Spain.
- Instituto de Tecnologías Biomédicas (ITB), Faculty of Medicine, University of La Laguna, La Laguna, Tenerife, Spain.
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Grieve NJ, Cranston KD, Jung ME. Examining the Effectiveness of an E-Learning Training Course for Coaches of a Type 2 Diabetes Prevention Program. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023:1-11. [PMID: 37362065 PMCID: PMC10191814 DOI: 10.1007/s41347-023-00316-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/07/2023] [Accepted: 04/10/2023] [Indexed: 06/28/2023]
Abstract
Small Steps for Big Changes (SSBC) is a community-based diabetes prevention program (DPP). SSBC utilizes a motivational interviewing (MI) informed counseling style to deliver a structured diet and exercise curriculum to empower healthy behavioral modifications and prevent type 2 diabetes (T2D). An electronic learning (e-learning) platform to train SSBC coaches was developed to improve flexibility, reach, and accessibility. While e-learning has shown to be an effective mode of teaching content to health professionals, less is known in the context of DPP coaches. This study aimed to assess the effectiveness of the SSBC e-learning course. Twenty coaches (eleven fitness staff personnel and nine university students) were recruited through existing fitness facilities to participate in the online SSBC coach training which included completing pre- and post-training questionnaires, seven online modules of content and a mock client session. Knowledge regarding MI (Mpre = 3.30 ± 1.95, Mpost = 5.90 ± 1.29; p < 0.01), SSBC content (Mpre = 5.15 ± 2.23, Mpost = 8.60 ± 0.94; p < 0.01), and T2D (Mpre = 6.95 ± 1.57, Mpost = 8.25 ± 0.72; p < 0.01), and self-efficacy to deliver the program (Mpre = 7.93 ± 1.51, Mpost = 9.01 ± 1.00; p < 0.01) all significantly increased from pre- to post e-learning training. Participants reported positively on the user satisfaction and feedback questionnaire with a mean score of 4.58/5 (SD = 0.36). These findings suggest e-learning platforms are a promising mode to improve DPP coaches' knowledge, counseling skills, and to bolster confidence in program delivery with high levels of satisfaction. E-learning to train DPP coaches allows for effective and feasible expansion of DPP's, ultimately permitting more reach to adults living with prediabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s41347-023-00316-3.
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Affiliation(s)
- Natalie J. Grieve
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, Canada
| | - Kaela D. Cranston
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, Canada
| | - Mary E. Jung
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, Canada
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92
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Pi L, Zheng Y, Shi X, Wang Z, Zhou Z. Using point-of-care HbA1c to facilitate the identification of diabetes and abnormal glucose regulation in primary healthcare settings. Front Public Health 2023; 11:1078361. [PMID: 37228727 PMCID: PMC10203162 DOI: 10.3389/fpubh.2023.1078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
Background Glycated hemoglobin A1c (HbA1c) is a critical index for the diagnosis and glycemic control evaluation of diabetes. However, a standardized method for HbA1c measurement is unaffordable and unavailable among the Chinese population in low-resource rural settings. Point-of-care (POC) HbA1c testing is convenient and inexpensive, but its performance remains to be elucidated. Objective To investigate the value of POC HbA1c for identifying diabetes and abnormal glucose regulation (AGR) in the resource-limited Chinese population. Methods Participants were recruited from 6 Township Health Centers in Hunan Province. Samples for POC HbA1c, venous HbA1c, fasting plasma glucose, and 2 h-plasma glucose were obtained after physical examination. The oral glucose tolerance test was performed as the gold standard for diagnosis. The diagnostic capacities of the POC HbA1c measurement in predicting undiagnosed diabetes and AGR were evaluated. Results Among 388 participants, 274 (70.6%) normoglycemic controls, 63 (16.2%) prediabetes patients, and 51 (13.1%) diabetes patients were identified with oral glucose tolerance test (OGTT). Meanwhile, among 97 participants who underwent two HbA1c detection methods simultaneously, a positive correlation was found between POC HbA1c and standardized HbA1c (r = 0.75, P < 0.001). No notable systematic difference was observed from the Bland-Altman Plots. The POC HbA1c cutoff values were 5.95 and 5.25%, which efficiently identified diabetes (AUC 0.92) and AGR (AUC 0.89), respectively. Conclusions The alternative POC HbA1c test efficiently discriminated AGR and diabetes from normoglycemia, especially among the Chinese population in primary healthcare settings.
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Affiliation(s)
- Linhua Pi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Zheng
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Center for Medical Research, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiajie Shi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhen Wang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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93
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Bodhini D, Morton RW, Santhakumar V, Nakabuye M, Pomares-Millan H, Clemmensen C, Fitzpatrick SL, Guasch-Ferre M, Pankow JS, Ried-Larsen M, Franks PW, Tobias DK, Merino J, Mohan V, Loos RJF. Role of sociodemographic, clinical, behavioral, and molecular factors in precision prevention of type 2 diabetes: a systematic review. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.03.23289433. [PMID: 37205385 PMCID: PMC10187453 DOI: 10.1101/2023.05.03.23289433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The variability in the effectiveness of type 2 diabetes (T2D) preventive interventions highlights the potential to identify the factors that determine treatment responses and those that would benefit the most from a given intervention. We conducted a systematic review to synthesize the evidence to support whether sociodemographic, clinical, behavioral, and molecular characteristics modify the efficacy of dietary or lifestyle interventions to prevent T2D. Among the 80 publications that met our criteria for inclusion, the evidence was low to very low to attribute variability in intervention effectiveness to individual characteristics such as age, sex, BMI, race/ethnicity, socioeconomic status, baseline behavioral factors, or genetic predisposition. We found evidence, albeit low certainty, to support conclusions that those with poorer health status, particularly those with prediabetes at baseline, tend to benefit more from T2D prevention strategies compared to healthier counterparts. Our synthesis highlights the need for purposefully designed clinical trials to inform whether individual factors influence the success of T2D prevention strategies.
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94
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Wang H, Shen Q, Zhang F, Fu Y, Zhu Y, Zhao L, Wang C, Zhao Q. Heat-treated foxtail millet protein delayed the development of pre-diabetes to diabetes in mice by altering gut microbiota and metabolomic profiles. Food Funct 2023; 14:4866-4880. [PMID: 37133422 DOI: 10.1039/d3fo00294b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Millet protein has gained much attention for its beneficial effects in mitigating metabolic diseases. However, most individuals pass through a prediabetic phase before developing full-blown diabetes, and whether millet protein has hypoglycemic effects on prediabetic mice remains unclear. In the present study, heat-treated foxtail millet protein (HMP) supplementation significantly decreased fasting blood glucose and serum insulin levels, alleviated insulin resistance, and improved impaired glucose tolerance in prediabetic mice. In addition, HMP altered the intestinal flora composition, as evidenced by the reduction in the abundance of Dubosiella and Marvinbryantia and the increase in the content of Lactobacillus, Bifidobacterium, and norank_f_Erysipelotrichaceae. Moreover, HMP supplementation dramatically regulated the levels of serum metabolites (i.e., LysoPCs, 11,14,17-eicosatrienoic acid, and sphingosine) and related metabolic pathways, such as sphingolipid metabolism and pantothenate and CoA biosynthesis. In conclusion, the improvement of gut microbiota and serum metabolic profiles was related to the hypoglycemic potential of HMP in prediabetes.
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Affiliation(s)
- Han Wang
- College of Food Science and Nutritional Engineering, China Agricultural University, National Center of Technology Innovation (Deep Processing of Highland Barley) in Food Industry, National Engineering Research Center for Fruit and Vegetable Processing, Beijing 100083, China.
| | - Qun Shen
- College of Food Science and Nutritional Engineering, China Agricultural University, National Center of Technology Innovation (Deep Processing of Highland Barley) in Food Industry, National Engineering Research Center for Fruit and Vegetable Processing, Beijing 100083, China.
| | - Fan Zhang
- Beijing Industrial Technology Research Institute Ltd, Beijing, China
| | - Yongxia Fu
- Shanxi Institute for Functional Food, Shanxi Agricultural University, Taiyuan, China
| | - Yiqing Zhu
- College of Food Science and Nutritional Engineering, China Agricultural University, National Center of Technology Innovation (Deep Processing of Highland Barley) in Food Industry, National Engineering Research Center for Fruit and Vegetable Processing, Beijing 100083, China.
| | - Liangxing Zhao
- College of Food Science and Nutritional Engineering, China Agricultural University, National Center of Technology Innovation (Deep Processing of Highland Barley) in Food Industry, National Engineering Research Center for Fruit and Vegetable Processing, Beijing 100083, China.
| | - Chao Wang
- College of Food Science and Nutritional Engineering, China Agricultural University, National Center of Technology Innovation (Deep Processing of Highland Barley) in Food Industry, National Engineering Research Center for Fruit and Vegetable Processing, Beijing 100083, China.
| | - Qingyu Zhao
- College of Food Science and Nutritional Engineering, China Agricultural University, National Center of Technology Innovation (Deep Processing of Highland Barley) in Food Industry, National Engineering Research Center for Fruit and Vegetable Processing, Beijing 100083, China.
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95
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Mack M, Savila F, Bagg W, Harwood M, Swinburn B, Goodyear-Smith F. Interventions to prevent or manage obesity in Māori and Pacific adults: a systematic review and narrative synthesis. ETHNICITY & HEALTH 2023; 28:562-585. [PMID: 35608909 DOI: 10.1080/13557858.2022.2078482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Obesity and its sequelae are an increasing problem, disproportionally affecting Māori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review is to identify evaluated interventions for prevention and management of obesity amongst Māori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake. DESIGN Systematic review of databases (Medline, PubMed, EMBASE, CINAHL, Scopus, CENTRAL), key non-indexed journals, and reference lists of included articles were searched from inception to June 2021. Eligibility criteria defined using a Population, Intervention, Control, Outcome format and study/publication characteristics. Quantitative and qualitative data were extracted and analysed using narrative syntheses. Study quality was assessed using modified GRADE approach. RESULTS From the 8190 articles identified, 21 were included, with 18 eligible for quantitative and five for qualitative analysis. The studies were heterogenous, with most graded as low quality. Some studies reported small but statistically significant improvements in weight and body mass index. Key enablers identified were social connection, making achievable sustainable lifestyle changes, culturally-centred interventions and incentives including money and enjoyment. Barriers to intervention uptake included difficulty in maintaining adherence to a programme due to intrinsic programme factors such as lack of social support and malfunctioning or lost equipment. CONCLUSIONS Normal weight trajectory is progressive increase over time. Modest weight loss or no weight gain after several years may have a positive outcome in lowering progression to diabetes, or improvement of glycaemic control in people with diabetes. We recommend urgent implementation of Māori and Pacific-led, culturally-tailored weight loss programmes that promote holistic, small and sustainable lifestyle changes delivered in socially appropriate contexts.
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Affiliation(s)
- Michaela Mack
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - F Savila
- Pacific Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - W Bagg
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - M Harwood
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - B Swinburn
- Department of Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand
| | - F Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
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Samson SL, Vellanki P, Blonde L, Christofides EA, Galindo RJ, Hirsch IB, Isaacs SD, Izuora KE, Low Wang CC, Twining CL, Umpierrez GE, Valencia WM. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocr Pract 2023; 29:305-340. [PMID: 37150579 DOI: 10.1016/j.eprac.2023.02.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE This consensus statement provides (1) visual guidance in concise graphic algorithms to assist with clinical decision-making of health care professionals in the management of persons with type 2 diabetes mellitus to improve patient care and (2) a summary of details to support the visual guidance found in each algorithm. METHODS The American Association of Clinical Endocrinology (AACE) selected a task force of medical experts who updated the 2020 AACE Comprehensive Type 2 Diabetes Management Algorithm based on the 2022 AACE Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan and consensus of task force authors. RESULTS This algorithm for management of persons with type 2 diabetes includes 11 distinct sections: (1) Principles for the Management of Type 2 Diabetes; (2) Complications-Centric Model for the Care of Persons with Overweight/Obesity; (3) Prediabetes Algorithm; (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Complications-Centric Algorithm for Glycemic Control; (7) Glucose-Centric Algorithm for Glycemic Control; (8) Algorithm for Adding/Intensifying Insulin; (9) Profiles of Antihyperglycemic Medications; (10) Profiles of Weight-Loss Medications (new); and (11) Vaccine Recommendations for Persons with Diabetes Mellitus (new), which summarizes recommendations from the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention. CONCLUSIONS Aligning with the 2022 AACE diabetes guideline update, this 2023 diabetes algorithm update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and diabetes mellitus and highlights the importance of appropriate management of atherosclerotic risk factors of dyslipidemia and hypertension. One notable new theme is an emphasis on a complication-centric approach, beyond glucose levels, to frame decisions regarding first-line pharmacologic choices for the treatment of persons with diabetes. The algorithm also includes access/cost of medications as factors related to health equity to consider in clinical decision-making.
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Affiliation(s)
- Susan L Samson
- Chair of Task Force; Chair of the Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Priyathama Vellanki
- Vice Chair of Task Force; Associate Professor of Medicine, Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Emory University; Section Chief, Endocrinology, Grady Memorial Hospital, Atlanta, Georgia
| | - Lawrence Blonde
- Director, Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Health, New Orleans, Louisiana
| | | | - Rodolfo J Galindo
- Associate Professor of Medicine, University of Miami Miller School of Medicine; Director, Comprehensive Diabetes Center, Lennar Medical Center, UMiami Health System; Director, Diabetes Management, Jackson Memorial Health System, Miami, Florida
| | - Irl B Hirsch
- Professor of Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Scott D Isaacs
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kenneth E Izuora
- Associate Professor, Department of Internal Medicine, Endocrinology, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Cecilia C Low Wang
- Professor of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Christine L Twining
- Endocrinology, Diabetes and Metabolism, Maine Medical Center, Maine Health, Scarborough, Maine
| | - Guillermo E Umpierrez
- Professor of Medicine, Emory University School of Medicine, Division of Endocrinology, Metabolism; Chief of Diabetes and Endocrinology, Grady Health Systems, Atlanta, Georgia
| | - Willy Marcos Valencia
- Endocrinology and Metabolism Institute, Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio
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97
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Shen X, He S, Wang J, Qian X, Wang H, Zhang B, Chen Y, Li H, An Y, Gong Q, Li G. Modifiable predictors of type 2 diabetes mellitus and roles of insulin resistance and β-cell function over a 6-year study and 30-year follow-up. J Endocrinol Invest 2023; 46:883-891. [PMID: 36219314 DOI: 10.1007/s40618-022-01932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/29/2022] [Indexed: 04/17/2023]
Abstract
PURPOSE This study aimed to examine the modifiable predictors of T2DM and the roles of insulin resistance (IR) and β-cell function over a 6-year study and 30-year follow-up. METHODS A total of 462 non-diabetic participants, 282 with impaired glucose tolerance (IGT), and 180 with normal glucose tolerance (NGT) were enrolled in this analysis. The Matsuda IR index and area under the curve of insulin-to-glucose ratio (AUCI/G-R) were used as IR and β-cell function indices in the analysis. RESULTS In all participants, multivariable analysis showed that BMI, glucose status, Matsuda IR index and systolic blood pressure (SBP) at baseline were independently associated with an increased risk of T2DM over 30 years, whereas lifestyle intervention and AUCI/G-R were inversely associated with this risk. The predictive effect of the Matsuda IR index and AUCI/G-R in participants with IGT was consistent with the results of all participants, whereas in those with NGT, only the Matsuda IR index, not the AUCI/G-R, predicted the development of T2DM (HR = 1.42, 95% CI 1.07-1.89 vs HR = 1.09, 95% CI 0.76-1.56). The predictive effect of the Matsuda IR index on T2DM existed even in participants with BMI < 25 (p = 0.049). CONCLUSION The modifiable predictors of T2DM in Chinese adults were high BMI, hypertension, mild hyperglycaemia, IR, and β-cell dysfunction. Both IR and β-cell function contributed to the development of T2DM in the long term; however, IR remains the initial and long-standing key risk factor for T2DM.
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Affiliation(s)
- X Shen
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - S He
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - J Wang
- Department of Cardiology, Da Qing First Hospital, No. 9 Zhongkang Street, Saltu District, Da Qing, 163411, Heilongjiang, China
| | - X Qian
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - H Wang
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - B Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Y Chen
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - H Li
- Department of Cardiology, Da Qing First Hospital, No. 9 Zhongkang Street, Saltu District, Da Qing, 163411, Heilongjiang, China
| | - Y An
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Q Gong
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China.
| | - G Li
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China.
- Department of Endocrinology, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.
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98
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Barthow C, Krebs J, McKinlay E. A multiple case study of pre-diabetes care undertaken by general practice in Aotearoa/New Zealand: de-incentivised and de-prioritised work. BMC PRIMARY CARE 2023; 24:109. [PMID: 37120507 PMCID: PMC10147904 DOI: 10.1186/s12875-023-02053-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/02/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND In Aotearoa/New Zealand (NZ) general practices diagnose and manage pre-diabetes. This work is important as it has the potential to delay or prevent the onset of Type 2 Diabetes (T2DM), reduce NZ's health inequities, and the burden that T2DM places on health care services. However, no study has previously examined how this work routinely occurs in NZ. METHODS Two case studies of practices serving ethnically and socio-economically diverse populations, followed by cross-case analysis. RESULTS The NZ health care context including funding mechanisms, reporting targets, and the disease centred focus of care, acted together to dis-incentivise and de-prioritise pre-diabetes care in general practices. The social determinants of health differentially influenced patients' ability to engage with and respond to pre-diabetes care, significantly impacting this work. Differing perspectives about the significance of pre-diabetes and gaps in systematic screening practices were identified. Interventions used were inconsistent and lacked comprehensive ongoing support. CONCLUSIONS Complex multi-layered factors impact on pre-diabetes care, and many of the barriers cannot be addressed at the general practice level. The practice serving the most disadvantaged population who concurrently have higher rates of pre-diabetes/T2DM were more adversely affected by the barriers identified.
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Affiliation(s)
- Christine Barthow
- Department of Medicine, University of Otago, PO Box 7343, Wellington, Wellington South, 6242, New Zealand.
| | - Jeremy Krebs
- Department of Medicine, University of Otago, PO Box 7343, Wellington, Wellington South, 6242, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington, Wellington South, 6242, New Zealand
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Liu J, Wang L, Cui X, Shen Q, Wu D, Yang M, Dong Y, Liu Y, Chen H, Yang Z, Liu Y, Zhu M, Ma H, Jin G, Qian Y. Polygenic Risk Score, Lifestyles, and Type 2 Diabetes Risk: A Prospective Chinese Cohort Study. Nutrients 2023; 15:2144. [PMID: 37432247 DOI: 10.3390/nu15092144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 07/12/2023] Open
Abstract
The aim of this study was to generate a polygenic risk score (PRS) for type 2 diabetes (T2D) and test whether it could be used in identifying high-risk individuals for lifestyle intervention in a Chinese cohort. We genotyped 80 genetic variants among 5024 participants without non-communicable diseases at baseline in the Wuxi Non-Communicable Diseases cohort (Wuxi NCDs cohort). During the follow-up period of 14 years, 440 cases of T2D were newly diagnosed. Using Cox regression, we found that the PRS of 46 SNPs identified by the East Asians was relevant to the future T2D. Participants with a high PRS (top quintile) had a two-fold higher risk of T2D than the bottom quintile (hazard ratio: 2.06, 95% confidence interval: 1.42-2.97). Lifestyle factors were considered, including cigarette smoking, alcohol consumption, physical exercise, diet, body mass index (BMI), and waist circumference (WC). Among high-PRS individuals, the 10-year incidence of T2D slumped from 6.77% to 3.28% for participants having ideal lifestyles (4-6 healthy lifestyle factors) compared with poor lifestyles (0-2 healthy lifestyle factors). When integrating the high PRS, the 10-year T2D risk of low-clinical-risk individuals exceeded that of high-clinical-risk individuals with a low PRS (3.34% vs. 2.91%). These findings suggest that the PRS of 46 SNPs could be used in identifying high-risk individuals and improve the risk stratification defined by traditional clinical risk factors for T2D. Healthy lifestyles can reduce the risk of a high PRS, which indicates the potential utility in early screening and precise prevention.
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Affiliation(s)
- Jia Liu
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Lu Wang
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Xuan Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Qian Shen
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Dun Wu
- College of Arts and Science, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Man Yang
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Yunqiu Dong
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Yongchao Liu
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Hai Chen
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Zhijie Yang
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Yaqi Liu
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Meng Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Hongxia Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Guangfu Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yun Qian
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
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Gao Q, Li R, Chen Z, Yin W, Liao G, Zhang H, Wang J, Chen Y. Weight self-perception and weight loss attempts in Chinese cardiovascular patients and non-cardiovascular patients: evidence from a population-based study. BMC Public Health 2023; 23:707. [PMID: 37072724 PMCID: PMC10114385 DOI: 10.1186/s12889-023-15380-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Weight loss is a significant improvement for individuals with overweight or obesity, especially for cardiovascular patients. The driving effects of weight self-perception and attempts to lose weight are vital in weight management, yet weight misperception is a direct culprit for the undesirability of weight control and obesity prevention. This study aimed to investigate weight self-perception and misperception and weight loss attempts in Chinese adults, especially among cardiovascular and non-cardiovascular patients. METHODS We collected data from China HeartRescue Global Evaluation Baseline Household Survey 2015. Questionnaires were used to assess self-reported weight and cardiovascular patients. We used kappa statistics to check the consistency between weight self-perception and BMI. Logistic regression models were fitted to identify risk factors associated with weight misperception. RESULTS A total of 2690 participants were enrolled in the household survey, while 157 respondents were cardiovascular patients. According to questionnaire results, 43.3% of cardiovascular patients thought they were overweight and obese, while the percentage is 35.3% among non-cardiovascular patients. Kappa statistics indicated higher consistency of self-reported weight and actual weight among cardiovascular patients. Multivariate analysis showed weight misperception was significantly associated with gender, education level, and actual BMI. Lastly, 34.5% of non-cardiovascular patients and 35.0% of cardiovascular patients were trying to lose weight or keep weight. The majority of these people adopted combined strategies of controlling diet and exercise to lose or maintain weight. CONCLUSIONS Weight misperception was highly prevalent among cardiovascular or non-cardiovascular patients. Obese respondents, women, and individuals with lower education levels were more vulnerable to make weight misperception. However, no difference in the purpose of weight loss attempts was indicated among cardiovascular and non-cardiovascular patients.
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Affiliation(s)
- Qingyuan Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Ruotong Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, People's Republic of China
| | - Zhiteng Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Wenyao Yin
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Guanghong Liao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Haifeng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China.
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China.
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China.
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China.
| | - Yangxin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China.
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China.
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