Non-diabetic relatives of Type 2 diabetic families: dietary intake contributes to the increased risk of diabetes

Effectiveness of a culturally tailored diabetes education curriculum with real-time continuous glucose monitoring in a Latinx population with type 2 diabetes: the CUT-DM with CGM for Latinx randomised controlled trial study protocol

INTRODUCTION

The prevalence of type 2 diabetes (T2D) is increasing in the Latinx community. Despite telehealth and technology becoming more available, these resources are not reaching the Latinx population. Diabetes education is a cornerstone of treatment; however, access to culturally tailored content is a barrier to the Latinx population. Real-time continuous glucose monitoring (RT-CGM) is a patient-empowering tool that can improve glycaemic control, but it is not readily available for Latinx patients with T2D. We aim to evaluate a culturally tailored diabetes self-management education and support (DSMES) curriculum, using a team-based approach to improve glycaemic control, promote healthy behaviours and enhance patient access with the use of telehealth in Latinx individuals. The primary aim of the study is to evaluate the additive effectiveness of RT-CGM on glycaemia and behavioural changes among Latinx patients undergoing a culturally tailored DSMES. A sub aim of the study is to evaluate family members' change in behaviours.

METHODS

We propose a randomised controlled trial of blinded versus RT-CGM with 100 Latinx participants with T2D who will receive DSMES via telemedicine over 12 weeks (n=50 per group). The study will be conducted at a single large federally qualified health centre system. The control group will receive culturally tailored DSMES and blinded CGM. The intervention group will receive DSMES and RT-CGM. The DSMES is conducted by community health educators weekly over 12 weeks in Spanish or English, based on participant's language preference. Patients in the RT-CGM group will have cyclical use with a goal of 50 days wear time. The primary outcomes are changes in haemoglobin A1c and CGM-derived metrics at 3 and 6 months. The secondary outcomes include participants' self-management knowledge and behaviour and household members' change in lifestyle.

ETHICS AND DISSEMINATION

The study proposal was approved by the University of Washington ethics/institutional review board (IRB) Committee as minimal risk (IRB ID: STUDY00014396) and the Sea Mar IRB committee.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov identifier: NCT05394844.

A Comparison of Nutritional Status, Knowledge and Type 2 Diabetes Risk Among Malaysian Young Adults With and Without Family History of Diabetes

BACKGROUND

Genetic factors increase the risk of type 2 diabetes mellitus (T2DM). Thus, family history status may be a useful public health tool for disease prevention. This study compared the nutritional status, knowledge level, and T2DM risk among young adults with and without a family history of diabetes in Malaysia.

METHODS

A total of 288 university students aged 18 to 29 years participated in this comparative cross-sectional study. We assessed dietary intake, level of physical activity, knowledge of diabetes and T2DM risk.

RESULTS

Respondents with a family history of diabetes had significantly higher weight (P = 0.003), body mass index (P < 0.001), waist circumference (P < 0.001), diabetes knowledge level (P < 0.005) and T2DM risk (P < 0.001). Ethnicity, fibre intake, T2DM risk score and knowledge about diabetes were significant contributors toward family history of diabetes (P = 0.025, 0.034, < 0.001 and 0.004, respectively).

CONCLUSION

Young adults with a family history of diabetes had suboptimal nutritional status. Despite being more knowledgeable about diabetes, they did not practice a healthy lifestyle. Family history status can be used to screen young adults at the risk of developing T2DM for primary disease prevention.

Metabolic characteristics of individuals at a high risk of type 2 diabetes - a comparative cross-sectional study

BACKGROUND

Type 2 diabetes (T2D) is associated with substantial morbidity and mortality. Individuals with a family history of T2D are at an increased risk of developing the disease. The aim of this study was to assess metabolic differences between first-degree relatives (FDR) of T2D patients and persons with no known family history of T2D (non-FDR).

METHODS

In 200 FDR and 73 non-FDR, we compared anthropometrics, glucose tolerance status, different measurements of insulin secretion, insulin resistance, as well as blood lipids and other blood analyses.

RESULTS

In the FDR group, 30 individuals had impaired glucose tolerance or T2D. Among the non-FDR, two individuals had impaired glucose tolerance. In unadjusted data, the FDR were older, had stronger heredity for coronary heart disease, lower body mass index and weight, higher OGTT plasma glucose concentrations, and impaired insulin secretion (all p < 0.05). Using propensity score, we matched the groups, resulting in significantly stronger heredity of coronary heart disease, higher OGTT plasma glucose at 60 and 90 min, larger glucose area under curve during the OGTT and higher serum creatinine among the FDR. Using least squares means, OGTT glucose at 60 and 120 min, as well as the area under curve, and OGTT insulin levels at 60 min were significantly higher. Body mass index was negatively correlated with insulin sensitivity (MI) and positively correlated with HOMA-β, a measurement of insulin secretion.

CONCLUSIONS

We show that FDR are more likely to have impaired glucose tolerance and display higher OGTT plasma glucose and insulin, indicating an unfavorable metabolic profile. We conclude that OGTT is a simple and yet informative metabolic assessment in the FDR group. In both groups, we saw a negative correlation between body mass index and MI, confirming the role of body mass index in insulin resistance.

Metabolic predictors of impaired glucose tolerance and type 2 diabetes in a predisposed population--A prospective cohort study

BACKGROUND

We characterized in detail (oral and intravenous glucose tolerance tests (OGTT and IVGTT), euglycemic hyperinsulinemic clamp, adipose tissue biopsy), healthy first-degree relatives (FDR) of individuals with type 2 diabetes (T2D), to examine predictive factors for future development of impaired glucose tolerance (IGT) or T2D.

METHODS

Non-diabetic FDR (n = 138, mean age 40.5 ± 6.5 years, 57 % women) underwent an extended OGTT every 3 years to assess any deterioration in glucose tolerance status. Differences between groups were assessed by logistic fit for continuous variables and by contingency analysis for categorical variables. Multiple logistic regression analysis was applied to adjust for confounding variables.

RESULTS

At follow-up (mean 5.6 ± 2.4 years) 19 subjects had IGT and 4 had T2D. At baseline these 23 subjects had more family members with T2D, higher fasting plasma glucose, higher OGTT plasma glucose at 120 min, higher HbA1c, lower M-value and higher total cholesterol compared to subjects with normal glucose tolerance (NGT). There were significantly larger changes in weight, BMI, fasting plasma glucose, OGTT plasma glucose at 120 min and HbA1c in individuals developing IGT or T2D during the follow-up period than the subjects remaining NGT. Crude predictors of deteriorating glucose tolerance were age, family history of diabetes and of hypertension, OGTT plasma glucose levels at 60 min, 90 min, and 120 min, as well as serum bilirubin, ALP and creatinine (p-values <0.05). A multiple nominal logistic regression model revealed that male sex, low M-value and high physical exercise (p-values <0.05) predicted development of IGT/T2DM.

CONCLUSION

In sum, genetically predisposed individuals for T2D with deteriorating glucose tolerance exhibit insulin resistance as well as beta-cell and signs of adipose tissue dysfunction, emphasizing the multifactorial pathophysiology in the development of IGT and T2D.

Family and Community Influences on Diabetes-Related Dietary Change in a Low-Income Urban Neighborhood

Purpose

The purpose of this study is to explore the influence of the social environment, including family and community relationships, on diabetes-related dietary change behaviors in a low-income, predominantly African American community with limited access to healthy foods.

Methods

Study methods included interviews and focus groups with adults with diabetes and family members of individuals with diabetes in a low-income African American community. In this analysis, interview participants included 11 participants with diabetes, one with prediabetes, and 8 family members or close friends with diabetes. Information from 4 participants with diabetes and 6 with family members with diabetes was included from 6 focus groups. Transcripts were analyzed via thematic iterative coding influenced by social cognitive theory to understand the influence of family and community relationships on dietary change.

Results

Participants’ social environments strongly influenced diet-related behavioral change. Family members without diabetes provided reinforcements for dietary change for those with diabetes by preparing healthy food and monitoring intake, as well as by adopting dietary changes made by those with diabetes. Family and community members served as sources of observational learning about the potential impacts of diabetes and enhanced behavioral capability for dietary change among people with diabetes by providing dietary advice and strategies for making healthy choices.

Conclusions

This study demonstrates the ways in which family and community members can influence dietary change in people with diabetes. Interventions targeting diabetes management should incorporate families and communities as sources of information, learning, and support.

Effects on nutrient intake of a family-based intervention to promote increased consumption of low-fat starchy foods through education, cooking skills and personalised goal setting: the Family Food and Health Project

Reducing the prevalence of fat-rich, energy-dense diets is a public health priority. The present parallel-designed randomised study compared three interventions aimed to increase intakes of low-fat starchy foods and to reduce fat intakes among 589 individuals from 169 families in the Family Food and Health Project (FFHP). Intervention A was education only, intervention B provided 'cook and eat' sessions only, whereas intervention C included personalised goal setting, 'cook and eat' and education. Diet was assessed at baseline (T0) and at 3 months (T1), 6 months (T2) and 18 months (T3) post-intervention. Retention rates were 75 % at T1, 63 % at T2 and 40 % at T3. ANCOVA (baseline intake as covariate) was assessed between intervention differences at T1, T2 and T3. At T1, individuals in intervention C consumed less fat (P = 0·02) and more total carbohydrate (P = 0·001), starch (P = 0·04) vitamin C (P = 0·002) and NSP (P = 0·01) than those in intervention A. Whereas similar dietary intakes were reported across interventions at T2, participants in intervention C had less energy-dense diets that contained more NSP and vitamin C at T3 than intervention A (P < 0·0001, P = 0·002 and P = 0·01, respectively). Across all intervention groups, the more socially deprived participants in the FFHP (n 119) consumed less fat (P = 0·01) and more total carbohydrate (P = 0·02) at T2 than the least socially deprived (n 240). These data demonstrate the importance of personalised goal setting to translate knowledge and practical cooking skills into healthier food choices, suggesting that low-fat starchy food-focused interventions may be effective in reducing fat intake.

Feasibility and efficiency of indirect lifestyle interventions in offspring of type 2 diabetic patients

INTRODUCTION

Individuals genetically predisposed to type 2 diabetes represent an important target for preventive strategies. Genetic screening, based on information about individual genetic variants, will be possible technically, but translational research in this field is still insufficient. Family history thus represents a useful tool for detecting genetically high-risk populations in this post-genomic era.

OBJECTIVES

The purpose of this pilot study was to investigate the feasibility and efficiency of indirect lifestyle interventions in offspring of type 2 diabetic patients.

METHODS

Offspring were recruited from 74 diabetic (Group 1) and 39 non-diabetic (Group 2, control group) patients. A lifestyle intervention was conducted by mail, a total of 3 times, every 3 months. Lifestyle related to diet and physical activity was assessed using a self-administered questionnaire.

RESULTS

Ten offspring of type 2 diabetic and 6 of non-diabetic patients participated in this study. Total energy intake decreased after 3 interventions in both of the groups (Group 1: 305 ± 228.8 kcal/day, p = 0.004; Group 2: 82 ± 65.6 kcal/day, p = 0.04); however, the effect of intervention was significantly greater in Group 1 compared to Group 2 (p = 0.021). Physical activity and other physical outcomes were stable in normal levels during the study period in both of the groups.

CONCLUSIONS

The intervention program helped to reduce total energy intake in offspring of type 2 diabetic patients more than in the control group, but the acceptance rate of the intervention program was disappointingly low. Further consideration is required to access and motivate offspring to develop precautionary lifestyle principles.

Reducing health risk in family members of patients with type 2 diabetes: views of first degree relatives

Background

Patients with type 2 diabetes can have an important role in discussing health risk within families. This study aimed to establish the acceptability to first degree relatives towards their relative with type 2 diabetes intervening as health promoters in their own families, using the Health Belief Model as a theoretical framework for evaluation.

Methods

Cross-sectional questionnaire design. Survey questionnaire for first degree relative (sibling or child) mailed to a random sample of patients with type 2 diabetes registered with an urban hospital diabetes clinic (n = 607 eligible patients). Patients were asked to pass on questionnaires to one to two first degree relatives.

Results

Questionnaires were returned from 257 families (42% response rate) with two responses provided by 107 families (a total of 364 questionnaires). The majority (94%) of first degree relatives of patients with type 2 diabetes would like to be informed about reducing their risk. Half (48%) of respondents reported being spoken to by a relative with type 2 diabetes about their risk of diabetes. Those spoken to were more likely to see themselves at risk of diabetes, to worry about developing diabetes and to view diabetes as a serious condition.

Conclusions

A role for patients with type 2 diabetes in discussing health risk in their family appears to be acceptable to many relatives. Discussion of risk and interventions to reduce health risk with their relatives should be encouraged in patients with type 2 diabetes.

Knowledge about type 2 diabetes risk and prevention of African-American and Hispanic adults and adolescents with family history of type 2 diabetes

PURPOSE

The purpose of this study was to assess type 2 diabetes knowledge, perceptions, risk factor awareness, and prevention practices among African American and Hispanic families with a history of diabetes.

METHODS

Ninth and tenth grade Houston area students who had a parent who spoke English or Spanish and had a family history of type 2 diabetes were recruited. Student interviews took place during lunch. Parents were interviewed via telephone. Open-ended questions in the interview guide assessed knowledge of diabetes and risk factors, diabetes prevention practices, and perceived risk. Students reported dietary behaviors. Responses were recorded.

RESULTS

Interviews were conducted with 39 parents (95% female, 49% African-American, 51% Hispanic) and 21 ninth and tenth grade adolescents (71% female, 43% African-American, 57% Hispanic). The majority were overweight. Approximately one-half of both groups reported some knowledge of diabetes. The majority (74%) of parents correctly identified family history as a risk factor, but few adolescents responded correctly. Being overweight was identified as a risk factor by 26% of the parents and 10% of the adolescents. Losing weight was not acknowledged as a way to reduce diabetes risk. Sweetened beverage consumption consisted of 2 cans/day and 43% reported to have skipped breakfast.

CONCLUSIONS

Overall, there was a lack of knowledge about risk and prevention of type 2 diabetes among African American and Hispanic families at risk. From a public health perspective, there is a critical need for innovative prevention programs targeting families at risk for diabetes.

Will people with type 2 diabetes speak to family members about health risk?

OBJECTIVE

This study aimed to assess the potential for communication of familial risk by patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A questionnaire was completed by a random sample of patients with type 2 diabetes registered with a hospital diabetes clinic.

RESULTS

Two-thirds of patients (65%) had spoken to at least one sibling or child about diabetes risk. They were more likely to believe their family was at risk, to worry about their family developing diabetes, and to be aware of the seriousness of diabetes. The results revealed greater awareness of family risk of type 2 diabetes compared with those from previous studies.

CONCLUSIONS

Many patients with type 2 diabetes had already taken the initiative, without formal prompting, to talk to family members about their risk of diabetes. Discussion of risk and interventions to reduce risk should be encouraged within families.

Preventive advice given by patients with type 2 diabetes to their offspring

BACKGROUND

Patients' advice-giving behaviour could be a useful preventive strategy for type 2 diabetes.

AIM

To investigate the conditions under which patients offer advice to their offspring and to assess the factors that facilitate advice giving.

DESIGN OF STUDY

Cross-sectional observational study.

SETTING

A general hospital with a diabetes clinic in a metropolitan suburb in Japan.

METHOD

Parents with type 2 diabetes (n = 221) who had offspring aged 20-49 years inclusive without diabetes completed a self-administered questionnaire containing items relating to advice-giving behaviour, demographic characteristics, risk perception, and their disease status.

RESULTS

A total of 184 (83.3%) patients responded that parental advice-giving behaviour is needed for their offspring, while 138 (62.4%) actually advised their offspring. Multiple logistic regression analysis showed that patients who were female (odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.03 to 3.65, P = 0.041), living with their offspring (OR =1.92, 95% CI = 1.04 to 3.57, P = 0.038), had complications (OR = 2.74, 95% CI = 1.25 to 6.00, P = 0.029), or perceived that their offspring had a high risk of developing diabetes (OR =1.45, 95% CI = 1.09 to 1.93, P = 0.011) were most likely to advise their offspring.

CONCLUSION

Patients with type 2 diabetes recognised the need to give advice about preventive behaviour to their offspring but were not necessarily engaging in advice-giving behaviour. Advice-giving behaviour was affected by the parents' own disease status, their perception of their offspring's risk of developing diabetes, and the relationship between the patients and their offspring.

Family history of diabetes, awareness of risk factors, and health behaviors among African Americans

OBJECTIVES

We examined the role of family history of diabetes in awareness of diabetes risk factors and engaging in health behaviors.

METHODS

We conducted a cross-sectional analysis of 1122 African American adults without diabetes who were participants in Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together).

RESULTS

After adjustment for age, gender, income, education, body mass index, and perceived health status, African Americans with a family history of diabetes were more aware than those without such a history of several diabetes risk factors: having a family member with the disease (relative risk [RR]=1.09; 95% confidence interval [CI]=1.03, 1.15), being overweight (RR=1.12; 95% CI=1.05, 1.18), not exercising (RR=1.17; 95% CI=1.07, 1.27), and consuming energy-dense foods (RR=1.10; 95% CI=1.00, 1.17). Also, they were more likely to consume 5 or more servings of fruits and vegetables per day (RR=1.31; 95% CI=1.02, 1.66) and to have been screened for diabetes (RR=1.21; 95% CI=1.12, 1.29).

CONCLUSIONS

African Americans with a family history of diabetes were more aware of diabetes risk factors and more likely to engage in certain health behaviors than were African Americans without a family history of the disease.

The effect of exercise, training, and inactivity on insulin sensitivity in diabetics and their relatives: what is new?

Insulin resistance is a hallmark characteristic of type 2 diabetes. However, in healthy first-degree relatives of type 2 diabetics, insulin resistance is often present years before glucose intolerance or diabetes becomes clinically manifest. The mechanisms of insulin resistance involve conditions leading to an increased supply of fatty acids (e.g., high energy intake, obesity) and conditions in which the degradation/oxidation of muscular fatty acids is impaired. Several large-scale studies have documented the fact that increased physical activity can reduce or at least postpone the development of type 2 diabetes, and low physical fitness is a clear independent risk factor for the development of type 2 diabetes. The mechanisms responsible for the improvement in insulin sensitivity after exercise training have been studied extensively, but are not fully understood. This review focuses on insulin resistance in skeletal muscle and, in particular, its relation to changes in aerobic fitness in type 2 diabetics and their first-degree relatives.

Lifestyle modification improves risk factors in type 2 diabetes relatives

AIMS

To investigate the short-term (16 weeks) effect of lifestyle intervention on insulin sensitivity, anthropometric and metabolic variables in non-diabetic first-degree relatives of type 2 diabetic patients (FDR).

METHODS

Seventy-seven (49 male, 28 female) FDR were allocated to one of three groups, diet (D-group; n = 25), diet and exercise (DE-group; n = 30) or control group (C-group; n = 22). Lifestyle counselling was based on current nutrition recommendations, including increased intake of fatty fish and low glycaemic index foods. Group counselling was given on two occasions with follow-up through telephone interviews every 10 days. Assessments included insulin sensitivity index (Si), anthropometry, lipid parameters, circulating leptin and adiponectin levels.

RESULTS

The D-group reduced total cholesterol (-0.31 mmol/l, P = 0.024), LDL cholesterol (-0.22 mmol/l, P = 0.021) and apolipoprotein B (-9.5 mg/dl, P = 0.009) levels, whereas the DE-group decreased body weight (-2.1%, P = 0.030) and waist circumference (-3.0 cm, P < 0.001) versus controls. A 13% reduction in fasting insulin was observed in the DE-group, but no significant improvement in Si in D-group or DE-group was observed. A subgroup, adherent to diet and who increased exercise, significantly improved Si and lipid profile.

CONCLUSIONS

The improved metabolic risk profile in FDR suggests that lifestyle changes can be effective in individuals at high risk to develop type 2 diabetes and cardiovascular disease.

Attitudes and barriers to dietary advice aimed at reducing risk of type 2 diabetes in first-degree relatives of patients with type 2 diabetes

OBJECTIVE

To evaluate the attitudes to and adoption of dietary advice in nondiabetic first-degree relatives of patients with type 2 diabetes and to examine barriers to adherence.

DESIGN

One-year controlled intervention study, where treatment group (n=73) received lifestyle education. Attitudes towards dietary advice, change in dietary habits and importance of potential barriers to adherence were evaluated by questionnaires. Nondiabetic relatives (25-55 years; males and females) of individuals with type 2 diabetes were recruited. Education was based on current nutrition recommendations and aimed at improving dietary fat quality, increasing intake of fruit and vegetables, with additional advice to reduce dietary glycaemic index (GI).

MAIN OUTCOME MEASURES

Attitudes and importance of barriers were classified by the intervened subjects into four categories ranging from 'No problem' to 'Yes, definitely a problem'. Dietary adherence was monitored by food frequency questionnaire at baseline and after 1 year.

RESULTS

Participants were generally in favour of advice aimed at improving dietary fat quality. Attitudes towards advice to reduce GI varied widely. Food selection changed in accordance with predefined dietary goals. 'Forgetfulness', 'low availability in lunch restaurant' and 'lack of ideas for cooking' were barriers to adherence.

CONCLUSIONS

Dietary advice aimed at reducing risk of type 2 diabetes was generally positively received and adopted in subjects with heredity for the disease. The most prevalent barriers reported are potentially modifiable.