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Almuallem S, Ali AK, Vourtzoumis P, Demyttenaere S, Court O, Andalib A. Validation of the Individualized Metabolic Surgery score in predicting long-term remission of diabetes after duodenal switch-type procedures. Diabetes Obes Metab 2024; 26:3200-3206. [PMID: 38725101 DOI: 10.1111/dom.15647] [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: 03/20/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 07/10/2024]
Abstract
AIM To validate the Individualized Metabolic Surgery (IMS) score and assess long-term remission of type 2 diabetes (T2D) after duodenal switch (DS)-type procedures in patients with obesity. In addition, to help guide metabolic procedure selection for those patients categorized as having severe T2D. MATERIALS AND METHODS This is a retrospective single cohort study of all patients with T2D and severe obesity, who underwent DS-type procedures at a single institution from December 2010 to December 2018. Study endpoints included validating the IMS score in our cohort and evaluating the impact of DS-type procedures on long-term (≥ 5 years) remission of T2D, especially in patients with severe disease. A receiver operator characteristic curve was used to assess the accuracy of the IMS score using the area under the curve (AUC). RESULTS The study cohort included 30 patients with complete baseline and long-term glycaemic data after their index DS-type surgery. Twelve patients (40%) were classified with severe T2D, and the distribution of IMS-based severity groups was similar between our cohort and the original IMS study (P = .42). IMS scores predicted long-term T2D remission with AUC = 0.77. Patients with IMS-based severe diabetes achieved significantly higher long-term remission after DS-type procedures compared with gastric bypass and/or sleeve gastrectomy from the original IMS study (42% vs. 12%; P < .05). CONCLUSIONS The IMS score properly classifies the severity of T2D in our study cohort and adequately predicts its long-term remission after DS-type procedures. While T2D remission decreases with more severe IMS scores, long-term remission remains high after DS-type procedures among patients with severe disease.
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Affiliation(s)
- Sultan Almuallem
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Abdulaziz Karam Ali
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Phil Vourtzoumis
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Sebastian Demyttenaere
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Olivier Court
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Amin Andalib
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
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2
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Wu WJ. Diabetes remission and nonalcoholic fatty pancreas disease. World J Diabetes 2024; 15:1390-1393. [PMID: 39099818 PMCID: PMC11292330 DOI: 10.4239/wjd.v15.i7.1390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/13/2024] [Accepted: 04/09/2024] [Indexed: 07/08/2024] Open
Abstract
This editorial focuses on the relationship between nonalcoholic fatty pancreas disease (NAFPD) and the development and remission of type 2 diabetes (T2D). NAFPD is characterized by intrapancreatic fatty deposition associated with obesity and not associated with alcohol abuse, viral infections, and other factors. Ectopic fat deposition in the pancreas is associated with the development of T2D, and the underlying mechanism is lipotoxic β-cell dysfunction. However, the results on the relationship between intrapancreatic fat deposition (IPFD) and β-cell function are conflicting. Regardless of the therapeutic approach, weight loss improves IPFD, glycemia, and β-cell function. Pancreatic imaging is valuable for clinically monitoring and evaluating the management of T2D.
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Affiliation(s)
- Wen-Jun Wu
- Department of Endocrinology, Jinshan Branch of Shanghai Sixth People’s Hospital, Shanghai 201500, China
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Tsompanaki E, Aveyard P, Park RJ, Koutoukidis DA. The impact of low-energy total diet replacement with behavioural support for remission of type 2 diabetes on disordered eating (ARIADNE): Protocol for a non-inferiority randomised controlled trial. Contemp Clin Trials 2024; 142:107542. [PMID: 38685400 DOI: 10.1016/j.cct.2024.107542] [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: 10/09/2023] [Revised: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The National Health Service (NHS) in England is currently piloting a weight loss programme for remission of newly diagnosed type 2 diabetes (T2D), where participants replace all food with low-energy nutritionally complete formula products for 12 weeks (total diet replacement, TDR) and receive behavioural support. In a clinical trial, this programme led to remission in nearly half the participants. However, this weight loss programme might also worsen disordered eating and prompt eating disorders in susceptible people. We aim to investigate if the TDR programme is non-inferior to standard care in terms of disordered eating in susceptible individuals. METHODS Fifty six people with newly diagnosed T2D, BMI ≥ 27 kg/m2, and medium to high scores of disordered eating based on the Eating Disorders Examination questionnaire (EDE-Q) will be randomised 1:1 to TDR receiving remote weekly/bi-weekly dietetic support or standard care. Participants will be re-assessed remotely at 1, 3, 4, 6, and 12 months. The primary outcome will be the between-group difference in the score of the EDE-Q. If the sample size can be expanded to 150, we will reduce the non-inferiority boundary. Weight, glycated haemoglobin (HbA1c), impairment from disordered eating, and distress will be secondary outcomes. Using the recorded consultations, we will evaluate the process in observed changes in eating behaviour and disordered eating. CONCLUSIONS If TDR for T2D remission is deemed non-inferior to standard care, more people may enrol and benefit from T2D remission. If TDR exacerbates disordered eating, screening may reduce unintended harm. TRIAL REGISTRATION NCT05744232 (ClinicalTrials.gov, prospectively registered).
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Affiliation(s)
- E Tsompanaki
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R J Park
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - D A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Bennett KA, Sutherland C, Savage AL. A systematic review and meta-analysis of environmental contaminant exposure impacts on weight loss and glucose regulation during calorie-restricted diets in preclinical studies: Persistent organic pollutants may impede glycemic control. Biochem Pharmacol 2024; 225:116300. [PMID: 38782075 DOI: 10.1016/j.bcp.2024.116300] [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: 02/22/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Epidemiological evidence links chemical exposure with type 2 diabetes (T2DM) risk and prevalence. Chemical exposure may therefore also limit success of weight loss or restoration of glycemic control during calorie restricted diets. Few human studies examine this hypothesis. This systematic review and clustered meta-analysis examines preclinical evidence that exposure to anthropogenic environmental contaminants impedes weight loss and resumption of glycemic control during calorie restriction. Of five eligible papers from 212 unique citations, four used C57BL/6 mice and one used Sprague Dawley rats. In four the animals received high fat diets to induce obesity and impaired glycemic control. All examined persistent organic pollutants (POPs). Polychlorinated biphenyl (PCB) 77 exposure did not affect final mass (standardised mean difference (SMD) = -0.35 [-1.09, 0.39]; n = 5 (experiments); n = 3 (papers)), or response to insulin in insulin tolerance tests (SMD = -1.54 [-3.25, 0.16] n = 3 (experiments); n = 2 (papers)), but impaired glucose control in glucose tolerance tests (SMD = -1.30 [-1.96, -0.63]; n = 6 (experiments); n = 3 (papers)). The impaired glycemic control following perfluoro-octane sulphonic acid (PFOS) exposure and enhanced mass loss following dichlorodiphenyltrichloroethane (DDT) exposure have not been replicated. Animal studies thus suggest some chemical groups, especially PCB and PFOS, could impair glucose control management during calorie restriction, similar to conclusions from limited existing clinical studies. We discuss the research that is urgently required to inform weight management services that are now the mainstay prevention initiative for T2DM.
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Affiliation(s)
- K A Bennett
- Division of Health Sciences, School of Applied Sciences, Kydd Building, Abertay University, Dundee, DD1 1HG.
| | | | - A L Savage
- Division of Health Sciences, School of Applied Sciences, Kydd Building, Abertay University, Dundee, DD1 1HG
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5
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Hendrieckx C, Russell-Green S, Skinner T, Ng AH, Lee C, Barlow S, Davey A, Rogers C, Holmes-Truscott E, Speight J. Diabetes Research Matters: A Three-Round Priority-Setting Survey Consultation with Adults Living with Diabetes and Family Members in Australia. THE PATIENT 2024; 17:441-455. [PMID: 38582797 PMCID: PMC11189946 DOI: 10.1007/s40271-024-00688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE We aimed to identify the health and quality-of-life research priorities of Australians with diabetes or family members. METHODS Through an iterative, three-step, online survey process we (1) qualitatively generated research topics (long list) in response to one question "What research is needed to support people with diabetes to live a better life?"; (2) determined the most important research questions (short list); and (3) ranked research questions in order of importance (priorities). We aimed to recruit N = 800 participants, with approximate equal representation of diabetes type and family members. RESULTS Participants (N = 661) were adults (aged 18+ years) in Australia with a self-reporting diagnosis of diabetes (type 1, n = 302; type 2, n = 204; prior/current gestational, n = 58; less common types, n = 22, or a family member, n = 75). Retention rates for Surveys 2 and 3 were 47% (n = 295) and 50% (n = 316), respectively. From 1549 open-text responses, 25 topics and 125 research questions were identified thematically. Research priorities differed by cohort, resulting in specific lists developed and ranked by each cohort. The top-ranked research question for the type 1 diabetes cohort was "How can diabetes technology be improved …?" and for the type 2 diabetes cohort: "How can insulin resistance be reversed …?". One question was common to the final lists of all cohorts: "What are the causes or triggers of diabetes?" Within cohorts, the top priorities were perceived as being of similar importance. CONCLUSIONS The research priorities differ substantially by diabetes type and for family members. These findings should inform funding bodies and researchers, to align future research and its communication with community needs.
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Affiliation(s)
- Christel Hendrieckx
- School of Psychology, Deakin University, 1-11 Gheringhap Street, Geelong, VIC, 3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Sienna Russell-Green
- School of Psychology, Deakin University, 1-11 Gheringhap Street, Geelong, VIC, 3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Timothy Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, VIC, Australia
| | - Ashley H Ng
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
| | - Chris Lee
- National Aboriginal Community Controlled Health Organisation, Canberra, ACT, Australia
| | - Siobhan Barlow
- Diabetes Research Matters Steering Group, Melbourne, Australia
| | - Alan Davey
- Diabetes Research Matters Steering Group, Melbourne, Australia
| | - Caitlin Rogers
- Diabetes Research Matters Steering Group, Melbourne, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, 1-11 Gheringhap Street, Geelong, VIC, 3220, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.
| | - Jane Speight
- School of Psychology, Deakin University, 1-11 Gheringhap Street, Geelong, VIC, 3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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Aksoy AN, Abayomi J, Relph N, Butler T. Physiological and psychological determinants of long-term diet-induced type 2 diabetes (T2DM) remission: A narrative review. Obes Rev 2024; 25:e13733. [PMID: 38511597 DOI: 10.1111/obr.13733] [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: 03/09/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
Type 2 diabetes mellitus (T2DM) is a highly prevalent metabolic disease, causing a heavy burden on healthcare systems worldwide, with related complications and anti-diabetes drug prescriptions. Recently, it was demonstrated that T2DM can be put into remission via significant weight loss using low-carbohydrate diets (LCDs) and very low-energy diets (VLEDs) in individuals with overweight and obesity. Clinical trials demonstrated remission rates of 25-77%, and metabolic improvements such as improved blood lipid profile and blood pressure were observed. In contrast, clinical trials showed that remission rate declines with time, concurrent with weight gain, or diminished weight loss. This review aims to discuss existing literature regarding underlying determinants of long-term remission of T2DM including metabolic adaptations to weight loss (e.g., role of gastrointestinal hormones), type of dietary intervention (i.e., LCDs or VLEDs), maintaining beta (β)-cell function, early glycemic control, and psychosocial factors. This narrative review is significant because determining the factors that are associated with challenges in maintaining long-term remission may help in designing sustainable interventions for type 2 diabetes remission.
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Affiliation(s)
- Ayse Nur Aksoy
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Julie Abayomi
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Nicola Relph
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Thomas Butler
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Cardio-Respiratory Research Centre, Edge Hill University, Ormskirk, UK
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Janssen JAMJL. Overnutrition, Hyperinsulinemia and Ectopic Fat: It Is Time for A Paradigm Shift in the Management of Type 2 Diabetes. Int J Mol Sci 2024; 25:5488. [PMID: 38791525 PMCID: PMC11121669 DOI: 10.3390/ijms25105488] [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: 04/15/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
The worldwide incidence of prediabetes/type 2 has continued to rise the last 40 years. In the same period, the mean daily energy intake has increased, and the quality of food has significantly changed. The chronic exposure of pancreatic β-cells to calorie excess (excessive energy intake) and food additives may increase pancreatic insulin secretion, decrease insulin pulses and/or reduce hepatic insulin clearance, thereby causing chronic hyperinsulinemia and peripheral insulin resistance. Chronic calorie excess and hyperinsulinemia may promote lipogenesis, inhibit lipolysis and increase lipid storage in adipocytes. In addition, calorie excess and hyperinsulinemia can induce insulin resistance and contribute to progressive and excessive ectopic fat accumulation in the liver and pancreas by the conversion of excess calories into fat. The personal fat threshold hypothesis proposes that in susceptible individuals, excessive ectopic fat accumulation may eventually lead to hepatic insulin receptor resistance, the loss of pancreatic insulin secretion, hyperglycemia and the development of frank type 2 diabetes. Thus, type 2 diabetes seems (partly) to be caused by hyperinsulinemia-induced excess ectopic fat accumulation in the liver and pancreas. Increasing evidence further shows that interventions (hypocaloric diet and/or bariatric surgery), which remove ectopic fat in the liver and pancreas by introducing a negative energy balance, can normalize insulin secretion and glucose tolerance and induce the sustained biochemical remission of type 2 diabetes. This pathophysiological insight may have major implications and may cause a paradigm shift in the management of type 2 diabetes: avoiding/reducing ectopic fat accumulation in the liver and pancreas may both be essential to prevent and cure type 2 diabetes.
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Affiliation(s)
- Joseph A M J L Janssen
- Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
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8
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Tripathi P, Kadam N, Tiwari D, Vyawahare A, Sharma B, Kathrikolly T, Kuppusamy M, Vijayakumar V. Oral glucose tolerance test clearance in type 2 diabetes patients who underwent remission following intense lifestyle modification: A quasi-experimental study. PLoS One 2024; 19:e0302777. [PMID: 38701059 PMCID: PMC11068193 DOI: 10.1371/journal.pone.0302777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
Achieving diabetes remission (HbA1c<48mmol/mol without the use of anti-diabetic medication for 3 months) might not assure restoration of a normal glycemic profile [fasting blood sugar level <5.6 mmol/L and Post-Prandial (PP) blood glucose <7.8mmol/L]. The study investigates the factors associated with OGTT clearance in patients under type 2 diabetes remission. Four hundred participants who achieved remission during a one-year online structured lifestyle modification program, which included a plant-based diet, physical activity, psychological support, and medical management (between January 2021 and June 2022), and appeared for the OGTT were included in the study. OGTT clearance was defined by fasting blood glucose < 5.6 mmol/L and 2-hour post-prandial blood glucose <7.8 mmol/L post-consumption of 75g glucose solution. Of the 400 participants, 207 (52%) cleared OGTT and 175 (44%) had impaired glucose tolerance (IGT). A shorter diabetes duration (<5 years) was significantly associated with OGTT clearance (p<0.05). Pre-intervention use of glucose-lowering drugs showed no association with OGTT clearance (p<0.1). Post-intervention, the OGTT-cleared group showed significantly higher weight loss (p<0.05) and a decrease in HbA1c compared to the IGT group (p<0.05). Improvement in Insulin resistance and β-cell function was also higher in the OGTT-cleared group compared to the IGT group (p<0.05). In conclusion, clearing the OGTT is a possibility for those achieving remission through lifestyle interventions. Higher weight loss, a shorter duration of diabetes, and improvement in insulin resistance were significantly associated with OGTT clearance in participants in remission. Future randomized controlled trials with longer follow-ups may help substantiate our findings.
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Affiliation(s)
- Pramod Tripathi
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
| | - Nidhi Kadam
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
| | - Diptika Tiwari
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
| | - Anagha Vyawahare
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
| | - Baby Sharma
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
| | - Thejas Kathrikolly
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
| | - Maheshkumar Kuppusamy
- Department of Physiology, Government Yoga and Naturopathy Medical College and Hospital, Arumbakkam, Chennai, Tamil Nadu, India
| | - Venugopal Vijayakumar
- Department of Yoga, Government Yoga and Naturopathy Medical College and Hospital, Chennai, Tamil Nadu, India
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Fundoiano-Hershcovitz Y, Ritholz MD, Horwitz DL, Behar E, Manejwala O, Goldstein P. The Impact of Digital Self-Monitoring of Weight on Improving Diabetes Clinical Outcomes: Quasi-Randomized Study. J Med Internet Res 2024; 26:e54940. [PMID: 38564266 PMCID: PMC11022133 DOI: 10.2196/54940] [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: 11/28/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The management of type 2 diabetes (T2D) and obesity, particularly in the context of self-monitoring, remains a critical challenge in health care. As nearly 80% to 90% of patients with T2D have overweight or obesity, there is a compelling need for interventions that can effectively manage both conditions simultaneously. One of the goals in managing chronic conditions is to increase awareness and generate behavioral change to improve outcomes in diabetes and related comorbidities, such as overweight or obesity. There is a lack of real-life evidence to test the impact of self-monitoring of weight on glycemic outcomes and its underlying mechanisms. OBJECTIVE This study aims to assess the efficacy of digital self-monitoring of weight on blood glucose (BG) levels during diabetes management, investigating whether the weight changes may drive glucose fluctuations. METHODS In this retrospective, real-world quasi-randomized study, 50% of the individuals who regularly used the weight monitoring (WM) feature were propensity score matched with 50% of the users who did not use the weight monitoring feature (NWM) based on demographic and clinical characteristics. All the patients were diagnosed with T2D and tracked their BG levels. We analyzed monthly aggregated data 6 months before and after starting their weight monitoring. A piecewise mixed model was used for analyzing the time trajectories of BG and weight as well as exploring the disaggregation effect of between- and within-patient lagged effects of weight on BG. RESULTS The WM group exhibited a significant reduction in BG levels post intervention (P<.001), whereas the nonmonitoring group showed no significant changes (P=.59), and both groups showed no differences in BG pattern before the intervention (P=.59). Furthermore, the WM group achieved a meaningful decrease in BMI (P<.001). Finally, both within-patient (P<.001) and between-patient (P=.008) weight variability was positively associated with BG levels. However, 1-month lagged back BMI was not associated with BG levels (P=.36). CONCLUSIONS This study highlights the substantial benefits of self-monitoring of weight in managing BG levels in patients with diabetes, facilitated by a digital health platform, and advocates for the integration of digital self-monitoring tools in chronic disease management. We also provide initial evidence of testing the underlying mechanisms associated with BG management, underscoring the potential role of patient empowerment.
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Affiliation(s)
| | - Marilyn D Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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10
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Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Kelly T, Irvine K, Peters C, Zhyzhneuskaya S, Hollingsworth KG, Adamson AJ, Sniehotta FF, Mathers JC, McIlvenna Y, Welsh P, McConnachie A, McIntosh A, Sattar N, Taylor R. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. Lancet Diabetes Endocrinol 2024; 12:233-246. [PMID: 38423026 DOI: 10.1016/s2213-8587(23)00385-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND In DiRECT, a randomised controlled effectiveness trial, weight management intervention after 2 years resulted in mean weight loss of 7·6 kg, with 36% of participants in remission of type 2 diabetes. Of 36 in the intervention group who maintained over 10 kg weight loss at 2 years, 29 (81%) were in remission. Continued low-intensity dietary support was then offered up to 5 years from baseline to intervention participants, aiming to maintain weight loss and gain clinical benefits. This extension study was designed to provide observed outcomes at 5 years. METHODS The DiRECT trial took place in primary care practices in the UK. Participants were individuals aged 20-65 years who had less than 6 years' duration of type 2 diabetes, a BMI greater than 27 kg/m2, and were not on insulin. The intervention consisted of withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825-853 kcal per day formula diet for 12-20 weeks), stepped food reintroduction (2-8 weeks), and then structured support for weight-loss maintenance. After sharing the 2-year results with all participants, UK National Health Service data were collected annually until year 5 from remaining intervention participants who received low-intensity dietary support, intervention withdrawals, and the original randomly allocated groups. The primary outcome was remission of type 2 diabetes; having established in the DiRECT trial that sustained weight loss was the dominant driver of remission, this was assumed for the Extension study. The trial is registered with the ISRCTN registry, number 03267836. FINDINGS Between July 25, 2014, and Aug 5, 2016, 149 participants were randomly assigned to the intervention group and 149 were assigned to the control group in the original DiRECT study. After 2 years, all intervention participants still in the trial (101 [68%] of 149) were approached to receive low-intensity support for a further 3 years. 95 (94%) of 101 were able to continue and consented and were allocated to the DiRECT extension group. 54 participants were allocated to the non-extension group, where intervention was withdrawn. At 5 years, DiRECT extension participants (n=85) lost an average of 6·1 kg, with 11 (13%) of 85 in remission. Compared with the non-extension group, DiRECT extension participants had more visits with HbA1c <48 mmol/mol (<6·5%; 36% vs 17%, p=0·0004), without glucose-lowering medication (62% vs 30%, p<0·0001), and in remission (34% vs 12%, p<0·0001). Original control participants (n=149) had mean weight loss 4·6 kg (n=82), and 5 (5%) of 93 were in remission. Compared with control participants, original intervention participants had more visits with weight more than 5% below baseline (61% vs 29%, p<0·0001), HbA1c below 48 mmol/mol (29% vs 15%, p=0·0002), without antidiabetic medication (51% vs 16%, p<0·0001), and in remission (27% vs 4%, p<0·0001). Of those in remission at year 2, 26% remained in remission at 5 years. Serious adverse events in the original intervention group (4·8 events per 100 patient-years) were under half those in the control group (10·2 per 100 patient-years, p=0·0080). INTERPRETATION The extended DiRECT intervention was associated with greater aggregated and absolute weight loss, and suggested improved health status over 5 years. FUNDING Diabetes UK.
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Affiliation(s)
- Michael Ej Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Wilma S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alison C Barnes
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Counterweight, London, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Tara Kelly
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Keaton Irvine
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carl Peters
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sviatlana Zhyzhneuskaya
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J Adamson
- Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- Centre for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - John C Mathers
- Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Yvonne McIlvenna
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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11
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Skurk T, Bosy-Westphal A, Grünerbel A, Kabisch S, Keuthage W, Kronsbein P, Müssig K, Nussbaumer H, Pfeiffer AFH, Simon MC, Tombek A, Weber KS, Rubin D. Dietary Recommendations for Persons with Type 2 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2024; 132:182-215. [PMID: 38286422 DOI: 10.1055/a-2166-6772] [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: 01/31/2024]
Affiliation(s)
- Thomas Skurk
- ZIEL Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Anja Bosy-Westphal
- Institute of Human Nutrition, Faculty of Agriculture and Nutritional Sciences, Christian-Albrechts University of Kiel, Kiel, Germany
| | | | - Stefan Kabisch
- German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | - Winfried Keuthage
- Specialist Practice for Diabetes and Nutritional Medicine, Münster, Germany
| | - Peter Kronsbein
- Faculty of Nutrition and Food Sciences, Niederrhein University of Applied Sciences, Mönchengladbach Campus, Mönchengladbach, Germany
| | - Karsten Müssig
- Department of Internal Medicine, Gastroenterology and Diabetology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany
| | | | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marie-Christine Simon
- Institute of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Astrid Tombek
- Diabetes Centre Bad Mergentheim, Bad Mergentheim, Germany
| | - Katharina S Weber
- Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Diana Rubin
- Vivantes Hospital Spandau, Berlin, Germany
- Vivantes Humboldt Hospital, Berlin, Germany
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12
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Zhou XY, Guo KH, Huang SF, Liu RK, Zeng CP. Ketogenic diet combined with intermittent fasting: an option for type 2 diabetes remission? Nutr Rev 2024:nuae014. [PMID: 38472140 DOI: 10.1093/nutrit/nuae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
With increasing attention to diabetes remission, various special dietary patterns have been found to be effective in achieving diabetes remission. The effect of a single dietary pattern on lowering blood glucose is clear, but studies on the synergistic effects of different dietary patterns are limited. This article describes the types of intermittent fasting and ketogenic diets, potential mechanisms, contraindications of combination diets, recommendations for combination diets, and their health outcomes. This paper aims to illustrate the evidence for intermittent fasting combined with a ketogenic diet on outcomes of diabetes remission and effect on blood glucose control. Knowledge of these findings can help doctors and patients determine dietary patterns for achieving diabetes remission and understanding their application.
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Affiliation(s)
- Xiao-Ying Zhou
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Kai-Heng Guo
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Shao-Feng Huang
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Rui-Ke Liu
- Department of Endocrinology and Metabolism, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Chun-Ping Zeng
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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13
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Gregg EW, Chen H, Bancks MP, Manalac R, Maruthur N, Munshi M, Wing R. Impact of remission from type 2 diabetes on long-term health outcomes: findings from the Look AHEAD study. Diabetologia 2024; 67:459-469. [PMID: 38233592 PMCID: PMC10844408 DOI: 10.1007/s00125-023-06048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/28/2023] [Indexed: 01/19/2024]
Abstract
AIMS/HYPOTHESIS We examined the association of attainment of diabetes remission in the context of a 12 year intensive lifestyle intervention with subsequent incidence of chronic kidney disease (CKD) and CVD. METHODS The Look AHEAD study was a multi-centre RCT comparing the effect of a 12 year intensive lifestyle intervention with that of diabetes support and education on CVD and other long-term health conditions. We compared the incidence of CVD and CKD among 4402 and 4132 participants, respectively, based on achievement and duration of diabetes remission. Participants were 58% female, and had a mean age of 59 years, a duration of diabetes of 6 year and BMI of 35.8 kg/m2. We applied an epidemiological definition of remission: taking no diabetes medications and having HbA1c <48 mmol/mol (6.5%) at a single point in time. We defined high-risk or very high-risk CKD based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, and CVD incidence as any occurrence of non-fatal acute myocardial infarction, stroke, admission for angina or CVD death. RESULTS Participants with evidence of any remission during follow-up had a 33% lower rate of CKD (HR 0.67; 95% CI 0.52, 0.87) and a 40% lower rate of the composite CVD measure (HR 0.60; 95% CI 0.47, 0.79) in multivariate analyses adjusting for HbA1c, BP, lipid levels, CVD history, diabetes duration and intervention arm, compared with participants without remission. The magnitude of risk reduction was greatest for participants with evidence of longer-term remission. CONCLUSIONS/INTERPRETATION Participants with type 2 diabetes with evidence of remission had a substantially lower incidence of CKD and CVD, respectively, compared with participants who did not achieve remission. This association may be affected by post-baseline improvements in weight, fitness, HbA1c and LDL-cholesterol. TRIAL REGISTRATION ClinicalTrials.gov NCT00017953 DATA AVAILABILITY: https://repository.niddk.nih.gov/studies/look-ahead/.
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Affiliation(s)
- Edward W Gregg
- School of Population Health, Royal College of Surgeons of Ireland, Dublin, Ireland.
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Haiying Chen
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael P Bancks
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Raoul Manalac
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Nisa Maruthur
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Medha Munshi
- Joslin Diabetes Center, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rena Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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14
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Ghusn W, Hage K, Vierkant RA, Collazo-Clavell ML, Abu Dayyeh BK, Kellogg TA, Acosta A, Ghanem OM. Type-2 diabetes mellitus remission prediction models after Roux-En-Y gastric bypass and sleeve gastrectomy based on disease severity scores. Diabetes Res Clin Pract 2024; 208:111091. [PMID: 38224874 DOI: 10.1016/j.diabres.2024.111091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
AIM Metabolic and bariatric surgery (MBS) is considered one of the most effective interventions for weight loss and associated type-2 diabetes mellitus (T2DM) remission. Multiple scores including the Individualized Metabolic Surgery (IMS), DiaRem, advanced DiaRem, and Robert et al. scores, have been developed predict T2DM remission after MBS. We aim to validate each of these scores in our cohort of patients undergoing MBS with long-term follow-up and assess their efficacy based on procedure type and preoperative BMI. METHODS We conducted a multicenter cohort study including patients with T2DM undergoing either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Areas under the receiver operating characteristics (ROC) curve (AUC) were calculated to assess the discriminatory ability of the four models to detect T2DM remission. RESULTS A total of 503 patients (67 % females, mean age 53.5 [11] years, BMI 46.2 [8.8] kg/m2) with T2DM were included. The majority (78 %) underwent RYGB, while the rest (28 %) had SG. All four scores predicted T2DM remission in our cohort with an ROC AUC of 0.79 for IMS, 0.78 for both DiaRem and advanced-DiaRem, and 0.75 for Robert et al. score. Specific subgroups for each of these scores demonstrated higher T2DM remission rates after RYGB compared to SG. CONCLUSION We demonstrate the ability of the IMS, DiaRem, advanced-DiaRem and Robert et al. scores to predict T2DM remission in patients undergoing MBS. T2DM remission rates was demonstrated to decrease with more severe IMS, DiaRem and advanced-DiaRem scores and lower Robert et al. scores.
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Affiliation(s)
- Wissam Ghusn
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Maria L Collazo-Clavell
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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15
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Kim J, Kim B, Kim MK, Baek KH, Song KH, Han K, Kwon HS. Weight change in patients with new-onset type 2 diabetes mellitus and its association with remission: Comprehensive real-world data. Diabetes Obes Metab 2024; 26:567-575. [PMID: 37940352 DOI: 10.1111/dom.15345] [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: 05/08/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
AIMS We aimed to investigate weight change in patients with new-onset type 2 diabetes mellitus and the association of weight loss on diabetes remission in Korean adults. MATERIALS AND METHODS We used the health examination database of the Korean National Health Insurance Service. Patients diagnosed with type 2 diabetes mellitus from 2009 to 2012 were enrolled and followed to 2017. The baseline body weight was measured at the health examination closest to the time the patient was enrolled, and the change was calculated by examining the weight measured at the subsequent examination within 2 years. Remission was defined as fasting blood glucose less than 126 mg/dl at two or more consecutive health examinations after stopping medication. RESULTS In total, 114, 874 patients with new-onset type 2 diabetes mellitus were analysed. Of these, 23 156 (20.2%) lost more than 5% of their body weight, and 2429 (2.1%) achieved remission. The adjusted odds ratio for remission in the weight loss group was 2.56 (95% confidence interval 2.35-2.79) compared with the group with stable body weight. Sensitivity analysis according to the degree of weight change showed that the greater weight loss, the higher the likelihood of remission. In the subgroup analysis, the effects of weight loss on remission were significantly greater in subgroups of age <65 years, male sex and body mass index >25. CONCLUSION Weight loss within the first 2 years of treating type 2 diabetes mellitus was associated with diabetes remission. Physicians should pay more attention to weight management in new-onset type 2 diabetes mellitus, particularly for young and obese individuals.
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Affiliation(s)
- Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bongseong Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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Mohd Saad N, Mohamad M, Mat Ruzlin AN. Web-Based Intervention to Act for Weight Loss in Adults With Type 2 Diabetes With Obesity (Chance2Act): Protocol for a Nonrandomized Controlled Trial. JMIR Res Protoc 2024; 13:e48313. [PMID: 38294848 PMCID: PMC10867745 DOI: 10.2196/48313] [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: 05/02/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND In adults with type 2 diabetes (T2D), weight loss can improve hemoglobin A1c, blood pressure, and triglycerides, and reduce the frequency of medications needed. Unfortunately, a large proportion of these individuals are not ready to initiate weight efforts, making existing obesity management strategies less effective. Many digital health interventions aim at weight loss, but there is still limited evidence on their effectiveness in changing weight loss behavior, especially in adults with T2D. OBJECTIVE This study aims to develop and validate "Chance2Act," a new web-based intervention, designed specifically to facilitate behavioral change in adults with T2D with obesity who are not ready to act toward weight loss. Then, the effectiveness of the newly developed intervention will be determined from a nonrandomized controlled trial. METHODS A web-based intervention will be developed based on the Transtheoretical Model targeting adults with T2D with obesity who are not ready to change for weight loss. Phase 1 will involve the development and validation of the web-based health intervention module. In phase 2, a nonrandomized controlled trial will be conducted in 2 government health clinics selected by the investigator. This is an unblinded study with a parallel assignment (ie, intervention vs control [usual care] with an allocation ratio of 1:1). A total of 124 study participants will be recruited, of which 62 participants will receive the Chance2Act intervention in addition to the usual care. The primary outcome is the changes in an individual's readiness from a stage of not being ready to change (precontemplation, contemplation, or preparation stage) to being ready for weight loss (action stage). The secondary outcomes include changes in self-efficacy, decisional balance, family support for weight loss, BMI, waist circumference, and body fat composition. RESULTS The phase 1 study will reveal the intervention's validity through the Content Validity Index and Face Validity Index, considering it valid if both indices exceed 0.83. The effectiveness of the intervention will be determined in phase 2, where the differences within and between groups will be analyzed in terms of the improvement of stages of change and all secondary outcomes as defined in the methodology. Data analysis for phase 2 will commence in 2024, with the anticipated publication of results in March 2024. CONCLUSIONS If proven effective, the result of the study may give valuable insights into the effective behavioral modification strategies for a web-based intervention targeting adults with T2D with obesity but not yet ready to change for weight loss. This intervention may be replicated or adopted in different settings, focusing on behavioral modification support that patients need. This study offers a deeper understanding of the application of behavior change techniques for a more holistic approach to obesity care in T2D. TRIAL REGISTRATION ClinicalTrials.gov NCT05736536; https://clinicaltrials.gov/study/NCT05736536. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48313.
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Affiliation(s)
- Noraini Mohd Saad
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Mariam Mohamad
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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17
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Garner NJ, Smith JR, Sampson MJ, Greaves CJ. Quantity and specificity of action-plans as predictors of weight loss: analysis of data from the Norfolk Diabetes Prevention Study (NDPS). Psychol Health 2024; 39:42-67. [PMID: 35333685 DOI: 10.1080/08870446.2022.2055026] [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: 06/09/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Investigate associations between quantity, content and specificity of action-plans and weight loss in a diabetes prevention study. DESIGN Prospective cohort study nested within a randomised controlled trial. Participants completed action-planning worksheets during intervention sessions. MAIN OUTCOME MEASURES Action-plans were coded in terms of: number of plans set, their content, and specificity. Multivariate regression analyses assessed associations with weight loss at four-months. RESULTS 890 planning-worksheets from 106 participants were analysed. Participants wrote a mean of 2.12 (SD = 1.20) action-plans per worksheet, using a mean of 2.20 (SD = 0.68) specificity components per action-plan. Quantity of action-plans per worksheet decreased over time (r = -0.137, p < 0.001) and increased quantity was associated with reduced specificity [r = -.215, p < 0.001]. Walking (34.9% of action-plans) and reducing high fat/sugar snacks (26.1%) were the most commonly planned lifestyle actions. In multivariate modelling, increased quantity of action-plans was associated with greater weight loss (R2 = 0.135, Unstandardised Beta = 0.144, p = 0.002). Specificity was not significantly associated with weight-loss (p = 0.096). CONCLUSION Producing more action-plans was associated with greater weight loss. Further research should directly compare more versus less specific action-plans and explore ways to sustain engagement in action-planning. Our findings imply that participants should freely set numerous action-plans, rather than being encouraged to focus on specificity. Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2055026 .
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Affiliation(s)
- Nikki J Garner
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Jane R Smith
- University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Mike J Sampson
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Colin J Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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18
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Hage K, Ikemiya K, Ghusn W, Lu L, Kennel KA, McKenzie TJ, Kellogg TA, Abu Dayyeh BK, Higa KD, Spaniolas K, Ma P, Ghanem OM. Type 2 diabetes remission after Roux-en-Y gastric bypass: a multicentered experience with long-term follow-up. Surg Obes Relat Dis 2023; 19:1339-1345. [PMID: 37914608 DOI: 10.1016/j.soard.2023.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/10/2023] [Accepted: 09/10/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is associated with short- and mid-term type 2 diabetes (T2D) remission. Long-term outcomes and predictive parameters associated with remission following RYGB have not been well elucidated. OBJECTIVE Determining the overall long-term T2D remission rates following RYGB and identifying predictive variables associated with remission. SETTING Multicentered study including patients who underwent RYGB at 3 tertiary referral centers for bariatric surgery. METHODS We performed a retrospective cohort study between 2008-2017 to allow a minimum of 5 years of follow-up. We evaluated long-term T2D remission rates and annual T2D clinical and metabolic parameters up to 14 years after surgery. Predictors of remission were assessed using multivariate logistic regression. Patients were divided into 4 groups based on quartiles of total body weight loss percentage (%TBWL) to compare remission rates between groups. RESULTS A total of 815 patients were included (68.9% female, age 52.1 ± 11.5 yr; body mass index 45.1 ± 7.7 kg/m2) with a follow-up of 7.3 ± 3.8 years. Remission was demonstrated in 51% of patients. Predictors of remission included pre-operative duration of diabetes, baseline HbA1C, insulin use prior to surgery, number of antidiabetic medications and %TBWL (all P < .01). Remission rates were proportionally associated with %TBWL quartile (Q1, 40.9%; Q2, 52.7%; Q3, 53.1%; Q4, 56.1%) (P = .02). CONCLUSIONS Longer duration and higher severity of T2D were negatively associated with remission while higher %TBWL had a positive association. A significant proportion of patients in all quartiles experienced long-term remission after RYGB with a greater likelihood of remission correlated with greater weight loss.
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Affiliation(s)
- Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kayla Ikemiya
- Fresno Heart and Surgical Hospital UCSF Fresno, Fresno, California
| | - Wissam Ghusn
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lauren Lu
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kurt A Kennel
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kelvin D Higa
- Fresno Heart and Surgical Hospital UCSF Fresno, Fresno, California
| | - Konstantinos Spaniolas
- Division of Endocrine and Metabolic Surgery, Department of Surgery, Health Sciences Center, Stony Brook Medicine, Stony Brook, New York
| | - Pearl Ma
- Fresno Heart and Surgical Hospital UCSF Fresno, Fresno, California
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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19
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Yildirim V, Sheraton VM, Brands R, Crielaard L, Quax R, van Riel NA, Stronks K, Nicolaou M, Sloot PM. A data-driven computational model for obesity-driven diabetes onset and remission through weight loss. iScience 2023; 26:108324. [PMID: 38026205 PMCID: PMC10665812 DOI: 10.1016/j.isci.2023.108324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/22/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Obesity is a major risk factor for the development of type 2 diabetes (T2D), where a sustained weight loss may result in T2D remission in individuals with obesity. To design effective and feasible intervention strategies to prevent or reverse T2D, it is imperative to study the progression of T2D and remission together. Unfortunately, this is not possible through experimental and observational studies. To address this issue, we introduce a data-driven computational model and use human data to investigate the progression of T2D with obesity and remission through weight loss on the same timeline. We identify thresholds for the emergence of T2D and necessary conditions for remission. We explain why remission is only possible within a window of opportunity and the way that window depends on the progression history of T2D, individual's metabolic state, and calorie restrictions. These findings can help to optimize therapeutic intervention strategies for T2D prevention or treatment.
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Affiliation(s)
- Vehpi Yildirim
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Vivek M. Sheraton
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, 1100 DD Amsterdam, the Netherlands
| | - Ruud Brands
- AMRIF B.V., Agro Business Park, 6708 PW Wageningen, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, 3584 CL Utrecht, the Netherlands
| | - Loes Crielaard
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
| | - Natal A.W. van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, the Netherlands
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, 1100 DD Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Peter M.A. Sloot
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
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20
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Hart KJ, Kubilius A, Clark M. Psycho-social factors associated with type two diabetes remission through lifestyle intervention: A scoping review. PLoS One 2023; 18:e0294344. [PMID: 37972024 PMCID: PMC10653481 DOI: 10.1371/journal.pone.0294344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES There is growing evidence that type 2 diabetes (T2D) can be put into remission through lifestyle intervention. Current focus on remission in terms of physiological considerations and biomedical scales, means there is limited understanding of the role psycho-social factors play in moderating the efficacy of lifestyle interventions for T2D remission. In the current review we aimed to synthesise the emerging literature on psycho-social factors associated with T2D remission, specifically from lifestyle interventions. METHODS Five databases (EMBASE, MEDLINE, CINAHL ultimate, PsychINFO and PsycArticles) were searched to identify studies from 2009 onwards that reported remission outcomes from lifestyle interventions in participants ≥ 18years old, with a clinical diagnosis of T2D. Studies included were of an interventional or observational design and restricted to English language. Screening and data extraction was performed independently by two reviewers using prespecified criteria. RESULTS In total 6106 studies were screened, 36 studies meeting the inclusion criteria were included. Studies were globally diverse, with 30 (83%) being published ≥ 2017. Psycho-social scales were under-utilised with 22 (67%) of studies failing to include any psycho-social measures. Single arm, prospective studies were most frequently utilised, however study quality was perceived to be heterogeneous. Further disparity in the quality, content and delineation of the psycho-social interventions was also identified. Education and self-monitoring interventions were the most frequently incorporated. Self-monitoring was also identified as an important facilitator to remission, in addition to social support. CONCLUSIONS Our findings indicate that psycho-social factors in T2D remission are under-explored. We have identified a number of methodological issues (comparability, conflicting remission criteria and poorly defined psycho-social interventions) suggesting knowledge gaps which could inform the methodology of future research design. There is significant opportunity for future research to incorporate the social model of disease, conceptualise remission more holistically, and build a more comprehensive evidence base to guide clinical practice.
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Affiliation(s)
- Kathy J. Hart
- Department of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Andrew Kubilius
- Department of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Martin Clark
- Department of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire, United Kingdom
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21
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Fallows ESV. Lifestyle medicine: a cultural shift in medicine that can drive integration of care. Future Healthc J 2023; 10:226-231. [PMID: 38162213 PMCID: PMC10753218 DOI: 10.7861/fhj.2023-0094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Our traditional medical mindset and healthcare culture are being severely challenged. In the face of novel infectious diseases, such as Coronavirus 2019 (COVID-19), along with rising levels of chronic diseases, such as obesity, type 2 diabetes mellitus, psychiatric illness, cardiovascular disease and cancer, many argue that current healthcare practices are failing to meet our needs. Energy and vision for a new way of practicing medicine are colliding, from both top-down, driven by policy, and bottom-up, driven by clinicians and patients. Policy makers have laid out the need for integration of healthcare delivery to address the complex chronic disease burden; creating integrated care partnerships, health and wellbeing boards and primary care networks to bring together 'at the place level' primary and secondary care, mental and public health services, social care and the voluntary sector. In practice, this is starting to build lasting working relationships between previously siloed services, to address the complex environmental, social, cultural, lifestyle and biopsychosocial drivers of ill health rather than simply providing access to hospitals, doctors and medication. Similarly, out of frustration with our traditional pharmaceutically driven medical model, grass-roots clinicians have built a new vision for their role in this better integrated health system, with the discipline of lifestyle medicine.
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22
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Weir GC, Bonner-Weir S. Induction of remission in diabetes by lowering blood glucose. Front Endocrinol (Lausanne) 2023; 14:1213954. [PMID: 37409234 PMCID: PMC10318898 DOI: 10.3389/fendo.2023.1213954] [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: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
As diabetes continues to grow as major health problem, there has been great progress in understanding the important role of pancreatic beta-cells in its pathogenesis. Diabetes develops when the normal interplay between insulin secretion and the insulin sensitivity of target tissues is disrupted. With type 2 diabetes (T2D), glucose levels start to rise when beta-cells are unable to meet the demands of insulin resistance. For type 1 diabetes (T1D) glucose levels rise as beta-cells are killed off by autoimmunity. In both cases the increased glucose levels have a toxic effect on beta-cells. This process, called glucose toxicity, has a major inhibitory effect on insulin secretion. This beta-cell dysfunction can be reversed by therapies that reduce glucose levels. Thus, it is becoming increasingly apparent that an opportunity exists to produce a complete or partial remission for T2D, both of which will provide health benefit.
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Affiliation(s)
- Gordon C. Weir
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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23
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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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24
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Yang X, Zhou J, Shao H, Huang B, Kang X, Wu R, Bian F, Hu M, Liu D. Effect of an Intermittent Calorie-restricted Diet on Type 2 Diabetes Remission: A Randomized Controlled Trial. J Clin Endocrinol Metab 2023; 108:1415-1424. [PMID: 36515429 DOI: 10.1210/clinem/dgac661] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Indexed: 12/15/2022]
Abstract
CONTEXT The 2021 consensus report on the definition and interpretation of remission of type 2 diabetes (T2D) has been released. Although intermittent fasting diets (IF) are becoming very popular, no studies have investigated their benefit in diabetes remission. OBJECTIVE The present study examined the effectiveness of IF in diabetes remission and potential remission durability. METHODS Participants between ages 38 and 72 years with a duration of T2D of 1 to 11 years, a body mass index (BMI) of 19.1 to 30.4, 66.7% male, and antidiabetic agent use and/or insulin injection were randomly allocated at a ratio of 1:1 to the Chinese Medical Nutrition Therapy (CMNT) or control group. The primary outcome was diabetes remission, defined as a stable glycated hemoglobin A1c (HbA1c) level of less than 48 mmol/mol (< 6.5%) for at least 3 months after discontinuing all antidiabetic medications. The secondary outcomes included HbA1c level, fasting blood glucose level, blood pressure, weight, quality of life, and medication costs. We conducted a 12-month follow-up to assess the continuation of remission. RESULTS On completing the 3-month intervention plus 3-month follow-up, 47.2% (17/36) of participants achieved diabetes remission in the CMNT group, whereas only 2.8% (1/36) of individuals achieved remission in the control group (odds ratio 31.32; 95% CI, 2.39-121.07; P < 0.0001). The mean body weight of participants in the CMNT group was reduced by 5.93 kg (SD 2.47) compared to 0.27 kg (1.43) in the control group. After the 12-month follow-up, 44.4% (16/36) of the participants achieved sustained remission, with an HbA1c level of 6.33% (SD 0.87). The medication costs of the CMNT group were 77.22% lower than those of the control group (60.4/month vs 265.1/month). CONCLUSION This study demonstrated the clinical efficacy of CMNT in achieving diabetes remission for at least 1 year.
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Affiliation(s)
- Xiao Yang
- Horticulture College, Hunan Agricultural University, Changsha 410128, China
- Clinical Research Center, State Key Laboratory of Subhealth Intervention Technology, Changsha 410128, China
- Nutrition and Food Catering, Changsha Commerce and Tourism College, Changsha 410116, China
| | - Jiali Zhou
- Horticulture College, Hunan Agricultural University, Changsha 410128, China
- Department of Shizi Mountain Primary Care, Changsha 410007, China
| | - Huige Shao
- Endocrinology Department, Changsha Central Hospital, Changsha 410004, China
| | - Bi Huang
- Endocrinology Department, Changsha Central Hospital, Changsha 410004, China
| | - Xincong Kang
- Horticulture College, Hunan Agricultural University, Changsha 410128, China
- National Research Center of Engineering Technology For Utilization Ingredients From Botanicals, Changsha 410128, China
- Chinese Medicine Nutrition Center, Hunan Provincial Engineering Research Center of Medical Nutrition Intervention Technology for Metabolic Diseases, Changsha 410128, China
| | - Ruiyu Wu
- Horticulture College, Hunan Agricultural University, Changsha 410128, China
- Jinheyuan Outpatient Department, State Key Laboratory of Subhealth Intervention Technology Achievement Application Center, Changsha 410205, China
| | - Fangzhou Bian
- Biological Sciences, University of California Irvine, Irvine, CA 92697, USA
| | - Minghai Hu
- Department of Neurobiology and Human Anatomy, School of Basic Medical Science, Central South University, Changsha 410013, China
| | - Dongbo Liu
- Horticulture College, Hunan Agricultural University, Changsha 410128, China
- Clinical Research Center, State Key Laboratory of Subhealth Intervention Technology, Changsha 410128, China
- College of Food Science and Technology, Hunan Agricultural University, Changsha 410128, China
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25
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Lean MEJ, Taylor R, Sattar N. Determination of autoantibodies in type 2 diabetes: one simple way to improve classification. Reply by Lean et al to Ludvigsson J [letter]. Diabetologia 2023; 66:958-959. [PMID: 36690837 PMCID: PMC9870768 DOI: 10.1007/s00125-022-05863-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry & Nursing, Royal Infirmary, University of Glasgow, Glasgow, UK.
| | - Roy Taylor
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Naveed Sattar
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
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26
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Ludvigsson J. Determination of autoantibodies in type 2 diabetes: one simple way to improve classification. Diabetologia 2023; 66:955-957. [PMID: 36629876 DOI: 10.1007/s00125-022-05858-4] [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: 10/12/2022] [Accepted: 11/28/2022] [Indexed: 01/12/2023]
Abstract
This letter aims to increase interest in better classification of type 2 diabetes. This can be done in a simple and cheap way via determination of autoantibodies. Autoantibody analysis can be used to detect the 7-12% of people with diabetes that is phenotypic of type 2 diabetes but is, in fact, latent autoimmune diabetes in adults (LADA), which may be regarded as a variant of type 1 diabetes. This may help to explain why some individuals with type 2 diabetes do not go into remission after reducing their weight, while others do, and why remission sometimes ends earlier than expected. Improved classification of diabetes may play an important role in determining adequate therapy.
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Affiliation(s)
- Johnny Ludvigsson
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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27
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Luli M, Yeo G, Farrell E, Ogden J, Parretti H, Frew E, Bevan S, Brown A, Logue J, Menon V, Isack N, Lean M, McEwan C, Gately P, Williams S, Astbury N, Bryant M, Clare K, Dimitriadis GK, Finlayson G, Heslehurst N, Johnson B, Le Brocq S, Roberts A, McGinley P, Mueller J, O'Kane M, Batterham RL, Miras AD. The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference. EClinicalMedicine 2023; 58:101962. [PMID: 37090435 PMCID: PMC10119881 DOI: 10.1016/j.eclinm.2023.101962] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.
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Affiliation(s)
- Migena Luli
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Giles Yeo
- Department of Clinical Biochemistry, Institute of Metabolic Science, Cambridge University, Cambridge, United Kingdom
| | - Emma Farrell
- School of Education, University College Dublin, Dublin, Ireland
| | - Jane Ogden
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Helen Parretti
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, United Kingdom
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Stephen Bevan
- HR Research Development, Institute for Employment, Brighton, United Kingdom
| | - Adrian Brown
- Department of Experimental and Translational Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jennifer Logue
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Vinod Menon
- Department of Upper Gastrointestinal Team, University Hospitals and Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Nadya Isack
- Obesity Empowerment Network, London, United Kingdom
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | | | - Paul Gately
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | | | - Nerys Astbury
- Nuffield Department of Primary Care Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, York, United Kingdom
| | - Kenneth Clare
- European Coalition for People Living with Obesity, United Kingdom
| | - Georgios K. Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Graham Finlayson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Brett Johnson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Audrey Roberts
- European Coalition for People Living with Obesity, United Kingdom
| | - Patrick McGinley
- Department of Finance, Maidstone & Tunbridge Wells NHS Trust, Kent, United Kingdom
| | - Julia Mueller
- Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rachel L. Batterham
- School of Life and Medical Sciences, University College London, London, United Kingdom
| | - Alexander Dimitri Miras
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- School of Medicine, Ulster University, United Kingdom
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28
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Kautzky-Willer A, Leutner M, Harreiter J. Sex differences in type 2 diabetes. Diabetologia 2023; 66:986-1002. [PMID: 36897358 PMCID: PMC10163139 DOI: 10.1007/s00125-023-05891-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/30/2023] [Indexed: 03/11/2023]
Abstract
The prevalence of type 2 diabetes mellitus is increasing in both sexes, but men are usually diagnosed at a younger age and lower body fat mass than women. Worldwide, an estimated 17.7 million more men than women have diabetes mellitus. Women appear to bear a greater risk factor burden at the time of their type 2 diabetes diagnosis, especially obesity. Moreover, psychosocial stress might play a more prominent role in diabetes risk in women. Across their lifespan, women experience greater hormone fluctuations and body changes due to reproductive factors than men. Pregnancies can unmask pre-existing metabolic abnormalities, resulting in the diagnosis of gestational diabetes, which appears to be the most prominent risk factor for progression to type 2 diabetes in women. Additionally, menopause increases women's cardiometabolic risk profile. Due to the progressive rise in obesity, there is a global increase in women with pregestational type 2 diabetes, often with inadequate preconceptual care. There are differences between men and women regarding type 2 diabetes and other cardiovascular risk factors with respect to comorbidities, the manifestation of complications and the initiation of and adherence to therapy. Women with type 2 diabetes show greater relative risk of CVD and mortality than men. Moreover, young women with type 2 diabetes are currently less likely than men to receive the treatment and CVD risk reduction recommended by guidelines. Current medical recommendations do not provide information on sex-specific or gender-sensitive prevention strategies and management. Thus, more research on sex differences, including the underlying mechanisms, is necessary to increase the evidence in the future. Nonetheless, intensified efforts to screen for glucose metabolism disorders and other cardiovascular risk factors, as well as the early establishment of prophylactic measures and aggressive risk management strategies, are still required for both men and women at increased risk of type 2 diabetes. In this narrative review we aim to summarise sex-specific clinical features and differences between women and men with type 2 diabetes into risk factors, screening, diagnosis, complications and treatment.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria.
- Gender Institute, Lapura Women's Health Resort, Gars am Kamp, Austria.
| | - Michael Leutner
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
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29
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Hanipah ZN, Rubino F, Schauer PR. Remission with an Intervention: Is Metabolic Surgery the Ultimate Solution? Endocrinol Metab Clin North Am 2023; 52:65-88. [PMID: 36754498 DOI: 10.1016/j.ecl.2022.09.002] [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: 02/08/2023]
Abstract
Long-term remission of type 2 diabetes following lifestyle intervention or pharmacotherapy, even in patients with mild disease, is rare. Long-term remission following metabolic surgery however, is common and occurs in 23% to 98% depending on disease severity and type of surgery. Remission after surgery is associated with excellent glycemic control without reliance on pharmacotherapy, improvements in quality of life, and major reductions in microvascular and macrovascular complications. For patients with type 2 diabetes, early intervention with metabolic surgery, when beta cell function still remains intact, provides the greatest probability of long-term remission as high as 90% or more.
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Affiliation(s)
- Zubaidah Nor Hanipah
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Francesco Rubino
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London; Bariatric and Metabolic Surgery King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Philip R Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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30
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Iglesies-Grau J, Dionne V, Bherer L, Bouabdallaoui N, Aubut L, Besnier F, Bertholet J, Berthiaume A, Bisaillon M, Gayda M, Gagnon C, Hamrioui N, Latour É, L'Allier PL, Marie-Hélène MC, Nigam A, Pelletier V, Tessier G, Juneau M. Metabolic Improvements and Remission of Prediabetes and Type 2 Diabetes: Results From a Multidomain Lifestyle Intervention Clinic. Can J Diabetes 2023; 47:185-189. [PMID: 36402709 DOI: 10.1016/j.jcjd.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/12/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Although lifestyle interventions are first-line treatment for individuals living with prediabetes and type 2 diabetes (T2D), they are rarely implemented effectively in routine clinical care. METHODS We present a retrospective analysis of a 12-month, single-centre, structured multidomain lifestyle intervention clinic offered to individuals living with prediabetes and type 2 diabetes. The intervention consisted of expert-guided educational and nutritional counselling combined with a personalized physical exercise prescription, with the main goal of improving metabolic health and reaching remission. Anthropometric parameters, glucose, basal insulin, glycated hemoglobin (A1C), and lipid levels were measured at baseline and at 3, 6, and 12 months after the lifestyle intervention initiation. Remission of prediabetes and T2D were defined as a return of A1C at 6 months to <6.5% (or <5.7% for prediabetes) and persisting for at least 3 months in the absence of glucose-lowering pharmacotherapy. RESULTS After a multidomain, expert-guided lifestyle intervention, 117 individuals living with prediabetes and T2D had significantly improved metabolic profiles: Mean weight change at 12 months was -4.9 kg (95% confidence interval [CI], -4.0 to -5.7; p<0.001), and mean change in A1C at 12 months was -0.6% (95% CI, -0.4 to -0.7; p<0.001). A substantial proportion of individuals reached the criteria for remission (20% among participants with prediabetes and 12% among those with T2D). CONCLUSIONS The results of this study suggest that prioritizing lifestyle changes in a multifaceted, progressive, 12-month intervention in this population improves anthropometric and insulin resistance measures, and has the potential to normalize metabolic values, even to the point of reaching the criteria of remission.
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Affiliation(s)
- Josep Iglesies-Grau
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada.
| | - Valérie Dionne
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Louis Bherer
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Nadia Bouabdallaoui
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Lise Aubut
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Florent Besnier
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Johanne Bertholet
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Annie Berthiaume
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Marc Bisaillon
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Mathieu Gayda
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Christine Gagnon
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Nacima Hamrioui
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Élise Latour
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Philippe L L'Allier
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | | | - Anil Nigam
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Véronique Pelletier
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Geneviève Tessier
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Martin Juneau
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
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31
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Boyle JG, Lean MEJ. Type 2 diabetes remission: achieving calorie restriction and weight loss by any which way? J Clin Endocrinol Metab 2023; 108:e352-e353. [PMID: 36611260 DOI: 10.1210/clinem/dgac755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Affiliation(s)
- James G Boyle
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, Scotland
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, Scotland
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32
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Duhuze Karera MG, Wentzel A, Ishimwe MCS, Gatete JDD, Jagannathan R, Horlyck-Romanovsky MF, Sumner AE. A Scoping Review of Trials Designed to Achieve Remission of Type 2 Diabetes with Lifestyle Intervention Alone: Implications for Sub-Saharan Africa. Diabetes Metab Syndr Obes 2023; 16:677-692. [PMID: 36923683 PMCID: PMC10010137 DOI: 10.2147/dmso.s403054] [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: 01/04/2023] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
According to the International Diabetes Federation, sub-Saharan Africa is experiencing the highest anticipate increase in the prevalence of type 2 diabetes (T2D) in the world and has the highest percent of people living with T2D who are undiagnosed. Therefore, diagnosis and treatment need prioritization. However, pharmacological hypoglycemics are often unavailable and bariatric surgery is not an option. Therefore, the ability to induce T2D remission through lifestyle intervention alone (LSI-alone) needs assessment. This scoping review evaluated trials designed to induce T2D remission by LSI-alone. PubMed, Embase, Cochrane, and CINAHL databases were searched for trials designed to induce T2D remission through LSI-alone. Of the 928 identified, 63 duplicates were removed. With abstract review, 727 irrelevant articles were excluded. After full-text review, 112 inappropriate articles were removed. The remaining 26 articles described 16 trials. These trials were published between 1984 and 2021 and were conducted in 10 countries, none of which were in Africa. Remission rates varied across trials. Predictors of remission were 10% weight loss and higher BMI, lower A1C and shorter T2D duration at enrollment. However, LSI-alone regimens for newly diagnosed and established T2D were very different. In newly diagnosed T2D, LSI-alone were relatively low-cost and focused on exercise and dietary counseling with or without calorie restriction (~1500 kcal/d). Presumably due to differences in cost, LSI-alone trials in newly diagnosed T2D had higher enrollments and longer duration. For established T2D trials, the focus was on arduous phased dietary interventions; phase 1: low-calorie meal replacement (<1000 kcal/day); phase 2: food re-introduction; phase 3: weight maintenance. In short, LSI-alone can induce remission in both newly diagnosed and established T2D. To demonstrate efficacy in Africa, initial trials could focus on newly diagnosed T2D. Insight gained could provide proof of concept and a foundation in Africa on which successful studies of LSI-alone in established T2D could be built.
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Affiliation(s)
- M Grace Duhuze Karera
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
- Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda
| | - Annemarie Wentzel
- Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa
- South African Medical Research Council, Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - M C Sage Ishimwe
- Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda
| | - Jean de Dieu Gatete
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ram Jagannathan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Margrethe F Horlyck-Romanovsky
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, New York, NY, USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
- National Institute of Minority Health and Health Disparities, NIH, Bethesda, MD, USA
- Correspondence: Anne E Sumner, Building 10, CRC-Rm 6940, Bethesda, MD, 20892-1612, USA, Tel +1 301-402-4240, Email
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Caring for people with diabetes: A fresh look at an old disease. Nursing 2022; 52:26-32. [PMID: 36259901 DOI: 10.1097/01.nurse.0000884536.18596.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT This article describes current evidence-based approaches to the care and education of adults living with diabetes. It also highlights revisions in the 2022 Standards of Care and evidence-based strategies nurses can use to be more effective.
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Xin Z, Huang J, Cao Q, Wang J, He R, Hou T, Ding Y, Lu J, Xu M, Wang T, Zhao Z, Wang W, Ning G, Bi Y, Xu Y, Li M. Nonalcoholic fatty liver disease in relation to the remission and progression along the glycemic continuum. J Diabetes 2022; 14:606-619. [PMID: 36163589 PMCID: PMC9512772 DOI: 10.1111/1753-0407.13314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/01/2022] [Accepted: 08/27/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The study aimed to explore the associations of nonalcoholic fatty liver disease (NAFLD) with the remission and progression along the glycemic continuum. METHODS This prospective cohort study was performed among the general population in 2010-2015. NAFLD was defined as ultrasound-detected hepatic steatosis with absence of excessive alcohol consumption and other hepatic diseases. Remission of type 2 diabetes referred to glycated hemoglobin <6.5% without hypoglycemic agents for ≥3 months. Prediabetes remission referred to normalization of blood glucose. Multivariable logistic analysis was applied to identify the risk of glycemic metabolic transition. RESULTS During a median follow-up of 4.3 years, participants with NAFLD had a significantly higher risk of progressing from normal glucose tolerance to diabetes (3.36 [1.60-7.07]) and lower likelihood of diabetes remission (0.48 [0.30-0.78]). Associations in participants with overweight or obesity and higher probability of hepatic fibrosis remained consistent. Results related to the effect of NAFLD on the specific glucose parameters were generally in line with the changes of glycemic status. NAFLD improvement decreased the risk of prediabetes progressing to diabetes (0.50 [0.32-0.80]) and increased the probability of prediabetes remission (2.67 [1.49-4.79]). NAFLD tended to show the most significant association with glycemic progression and decreased the likelihood in remission of prediabetes and diabetes. CONCLUSIONS Presence of NAFLD increased risk of glycemic progression and decreased likelihood of remission. NAFLD improvement mitigated glycemic deterioration, whereas NAFLD progression impeded the chance of remission. The results emphasized joint management of NAFLD and diabetes and further focused on liver-specific subgroups of diabetes to tailor early intervention.
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Affiliation(s)
- Zhuojun Xin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiaojiao Huang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qiuyu Cao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jialu Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ruixin He
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tianzhichao Hou
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yi Ding
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic DiseasesRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- 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 GenomicsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
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Real-World Data of a Group-Based Formula Low Energy Diet Programme in Achieving Type 2 Diabetes Remission and Weight Loss in an Ethnically Diverse Population in the UK: A Service Evaluation. Nutrients 2022; 14:nu14153146. [PMID: 35956322 PMCID: PMC9370492 DOI: 10.3390/nu14153146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
(1) Background: Formula low energy diets (LED) are effective at inducing weight loss and type 2 diabetes (T2DM) remission. However, the effect of LED programmes in ethnic minority groups in the UK is unknown. (2) Methods: A service-evaluation was undertaken of a group-based LED, total diet replacement (TDR) programme in London, UK. The programme included: a 12-week TDR phase, 9-week food reintroduction and a 31-week weight maintenance phase and was delivered by a diabetes multi-disciplinary team. (3) Results: Between November 2018 and March 2020, 216 individuals were referred, 37 commenced the programme, with 29 completing (78%). The majority were of Black British (20%) ethnicity with a mean (SD) age of 50.4 (10.5) years, a body mass index of 34.4 (4.4) kg/m2 and a T2DM duration of 4.2 (3.6) years. At 12 months, 65.7% achieved T2DM remission, with a mean bodyweight loss of 11.6 (8.9) kg. Completers lost 15.8 (5.3) kg, with 31.4% of participants achieving ≥15 kg weight loss. Quality of life measures showed significant improvements. (4) Conclusions: This service evaluation shows for the first time in the UK that a group-based formula LED programme can be effective in achieving T2DM remission and weight loss in an ethnical diverse population.
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Ko JH, Kim TN. Type 2 Diabetes Remission with Significant Weight Loss: Definition and Evidence-Based Interventions. J Obes Metab Syndr 2022; 31:123-133. [PMID: 35618657 PMCID: PMC9284579 DOI: 10.7570/jomes22001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/14/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
Type 2 diabetes (T2D) has long been regarded as an incurable and chronic disease according to conventional management methods. Clinical and pathophysiological studies on the natural course of T2D have shown that blood glucose control worsens with an increase in the number of required anti-hyperglycemic agents, as β-cell function progressively declines over time. However, recent studies have shown remission of T2D after metabolic surgery, intensive lifestyle modification, or medications, raising the possibility that β-cell function may be preserved or the decline in β-cell function may even be reversible. The World Health Organization as well as the American Diabetes Association and the European Association for the Study of Diabetes recognize remission as an appropriate management aim. In the light of the state of evidence for T2D reversal, physicians need to be educated on treatment options to achieve T2D remission so that they can actively play a part in counseling patients who may wish to explore these approaches to their disease. This review will introduce each of these approaches, summarizing their beneficial effects, supporting evidence, degree of sustainability, and challenges to be addressed in the future.
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Affiliation(s)
- Jung Hae Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Tae Nyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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Tahrani AA, Morton J. Benefits of weight loss of 10% or more in patients with overweight or obesity: A review. Obesity (Silver Spring) 2022; 30:802-840. [PMID: 35333446 DOI: 10.1002/oby.23371] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Modest weight loss (5%-10%) is clinically meaningful in patients with overweight or obesity. However, greater weight loss may be required to achieve improvements in or remission of certain weight-related complications. Therefore, this study reviewed the effect of large weight loss (≥10%). Most studies reporting large weight loss and relevant outcomes used bariatric surgery or lifestyle modifications. RESULTS Benefits of large weight loss were observed in patients with various overweight- or obesity-related complications, including improvements in comorbidities such as type 2 diabetes and hypertension. Improvements in glucose metabolism and cardiovascular risk factors were observed in patients who achieved large weight loss through lifestyle interventions or pharmacotherapy (phentermine/topiramate 15/92 mg once daily or subcutaneous semaglutide 2.4 mg once weekly). Other benefits associated with large weight loss included reduced cancer risk and improvements in knee osteoarthritis, sleep apnea, fertility-related end points, and health-related quality of life. While costly, bariatric surgery is currently the most cost-effective intervention, although most weight-management programs are deemed cost-effective. CONCLUSIONS Overall, large weight loss has a major beneficial impact on overweight- and obesity-related complications. Large weight loss should be the main treatment target when modest weight loss has had insufficient effects on obesity-related complications and for patients with severe obesity.
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Affiliation(s)
| | - John Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Skurk T, Bosy-Westphal A, Grünerbel A, Kabisch S, Keuthage W, Kronsbein P, Müssig K, Pfeiffer AFH, Simon MC, Tombek A, Weber KS, Rubin D. Dietary recommendations for persons with type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes 2022; 130:S151-S184. [PMID: 35359013 DOI: 10.1055/a-1624-5095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Thomas Skurk
- ZIEL Institute for Food & Health, Technical University of Munich, Freising, Germany.,Else Kröner-Fresenius-Center for Nutritional Medicine, Technical University of Munich, Freising, Germany
| | - Anja Bosy-Westphal
- Institute for Human Nutrition, Faculty of Agricultural and Nutritional Sciences, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Stefan Kabisch
- German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany.,Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Diabetes Research (DZD), Munich, Germany
| | - Winfried Keuthage
- Focus Practice for Diabetes and Nutritional Medicine, Münster, Germany
| | - Peter Kronsbein
- Department of Ecotrophology, Niederrhein University of Applied Sciences, Mönchengladbach Campus, Germany
| | - Karsten Müssig
- Department of Internal Medicine, Gastroenterology and Diabetology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany
| | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marie-Christine Simon
- Institute of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | | | - Katharina S Weber
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Diana Rubin
- Vivantes Hospital Spandau, Berlin, Germany.,Vivantes Humboldt Hospital, Berlin, Germany
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Kim J, Kwon HS. Not Control but Conquest: Strategies for the Remission of Type 2 Diabetes Mellitus. Diabetes Metab J 2022; 46:165-180. [PMID: 35385632 PMCID: PMC8987695 DOI: 10.4093/dmj.2021.0377] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/02/2022] [Indexed: 12/14/2022] Open
Abstract
A durable normoglycemic state was observed in several studies that treated type 2 diabetes mellitus (T2DM) patients through metabolic surgery, intensive therapeutic intervention, or significant lifestyle modification, and it was confirmed that the functional β-cell mass was also restored to a normal level. Therefore, expert consensus introduced the concept of remission as a common term to express this phenomenon in 2009. Throughout this article, we introduce the recently updated consensus statement on the remission of T2DM in 2021 and share our perspective on the remission of diabetes. There is a need for more research on remission in Korea as well as in Western countries. Remission appears to be prompted by proactive treatment for hyperglycemia and significant weight loss prior to irreversible β-cell changes. T2DM is not a diagnosis for vulnerable individuals to helplessly accept. We attempt to explain how remission of T2DM can be achieved through a personalized approach. It may be necessary to change the concept of T2DM towards that of an urgent condition that requires rapid intervention rather than a chronic, progressive disease. We must grasp this paradigm shift in our understanding of T2DM for the benefit of our patients as endocrine experts.
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Affiliation(s)
- Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author: Hyuk-Sang Kwon https://orcid.org/0000-0003-4026-4572 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63(yuksam)-ro, Yeongdeungpo-gu, Seoul 07345, Korea E-mail:
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Wei J, Chen J, Wei X, Xiang X, Cheng Q, Xu J, Xu S, Chen G, Liu C. Long-term remission of type 2 diabetes after very-low-calorie restriction and related predictors. Front Endocrinol (Lausanne) 2022; 13:968239. [PMID: 36171906 PMCID: PMC9510590 DOI: 10.3389/fendo.2022.968239] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Very low-calorie restriction (VLCR) can induce remission of type 2 diabetes mellitus (T2DM), but its long-term remission and related predictors have not been clarified. The aim of present study is to investigate the effect of VLCR in inducing long-term T2DM remission, and the underlying predictors. METHODS A total of 61 participants with T2DM who received 9 days of VLCR from Dec 2012 to Oct 2020 were followed up in Nov 2021, and divided into responders and non-responders groups. Responders were defined as HbA1c < 6.5% over at least 3 months in the absence of pharmacotherapy. Clinical characteristics were compared between responders and non-responders. Potential predictors were examined by logistic regression analyses based on clinical data before and after VLCR. RESULTS Forty-four participants were successfully followed up, including 19 males and 25 females. Long-term remission was observed in 17 participants (38.64%) after VLCR, with a median 7.83 years. Compared with non-responders, responders had a shorter disease duration, a lower fasting blood glucose (FBG) level, a higher fasting insulin level, and better HOMA-β after VLCR. Besides, acute insulin response (AIR), insulin area under curve in intravenous and oral glucose tolerance test (IVGTT-IAUC and OGTT-IAUC) in responders were higher than those in non-responders after VLCR. Multivariable logistic analysis showed that higher post-VLCR IVGTT-IAUC predicted a longer T2DM remission. CONCLUSIONS After VLCR, more than one third of the participants presented remission over up to 8 years. The improvement of β-cell function, especially the restoration of first-phase insulin-secreting capacity, could prolongate the remission.
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Affiliation(s)
- Jie Wei
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Jie Chen
- Department of Nutrition, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Xiao Wei
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Xiaoduo Xiang
- Department of Nutrition, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Qing Cheng
- Department of Nutrition, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Jiechao Xu
- Department of Nutrition, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Guofang Chen, ; Chao Liu,
| | - Chao Liu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Guofang Chen, ; Chao Liu,
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Glenn AJ, Liu S. Commentary: Is there a role for diabetes-specific nutrition formulas as meal replacements in type 2 diabetes? Front Endocrinol (Lausanne) 2022; 13:1094954. [PMID: 36743918 PMCID: PMC9890048 DOI: 10.3389/fendo.2022.1094954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Andrea J. Glenn
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON, Canada
| | - Simin Liu
- Centre for Global Cardiometabolic Health and Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
- Division of Endocrinology Department of Medicine, The Warren Alpert School of Medicine and Rhode Island Hospital, Providence, RI, United States
- Department of Medicine, and Division of Cardiothoracic Surgery, Department of Surgery, The Warren Alpert School of Medicine and Rhode Island Hospital, Providence, RI, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- *Correspondence: Simin Liu,
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Noronha JC, Thom G, Lean MEJ. Total Diet Replacement Within an Integrated Intensive Lifestyle Intervention for Remission of Type 2 Diabetes: Lessons From DiRECT. Front Endocrinol (Lausanne) 2022; 13:888557. [PMID: 35721753 PMCID: PMC9202990 DOI: 10.3389/fendo.2022.888557] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 12/05/2022] Open
Abstract
The prognosis for people with type 2 diabetes (T2D) remains concerning, yet its seriousness is often underestimated. T2D is a manifestation, in susceptible individuals, of the disease-process of obesity, and at diagnosis, 10-year survival rates for T2D are around 50%. Here, we will examine: (a) the role of weight loss in T2D, (b) use of total diet replacements (TDRs) to induce weight loss, (c) the Diabetes Remission Clinical Trial (DiRECT) protocol and key results, (d) other dietary interventions related to T2D remission, (e) remission in real life, and (f) future directions. Remission of short-duration T2D will usually require 10-15% body weight loss, and results from the DiRECT trial demonstrated that this can be achieved within routine care in nearly half of all people undertaking a supported, TDR-led behavioural weight management programme. In light of these findings, which have since been replicated in the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) trial conducted in the Middle East and North Africa, it is now time to prioritize weight loss programmes for T2D remission from diagnosis, and with increasing acceptance and availability of digital healthcare, there is an opportunity to scale up delivery of remission programmes in a cost effective manner.
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Affiliation(s)
- Jarvis C. Noronha
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON, Canada
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - George Thom
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Michael E. J. Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
- *Correspondence: Michael E. J. Lean,
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Churuangsuk C, Hall J, Reynolds A, Griffin SJ, Combet E, Lean MEJ. Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia 2022; 65:14-36. [PMID: 34796367 PMCID: PMC8660762 DOI: 10.1007/s00125-021-05577-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/28/2021] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Weight reduction is fundamental for type 2 diabetes management and remission, but uncertainty exists over which diet type is best to achieve and maintain weight loss. We evaluated dietary approaches for weight loss, and remission, in people with type 2 diabetes to inform practice and clinical guidelines. METHODS First, we conducted a systematic review of published meta-analyses of RCTs of weight-loss diets. We searched MEDLINE (Ovid), PubMed, Web of Science and Cochrane Database of Systematic Reviews, up to 7 May 2021. We synthesised weight loss findings stratified by diet types and assessed meta-analyses quality with A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2. We assessed certainty of pooled results of each meta-analysis using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (PROSPERO CRD42020169258). Second, we conducted a systematic review of any intervention studies reporting type 2 diabetes remission with weight-loss diets, in MEDLINE (via PubMed), Embase and Cochrane Central Register of Controlled Trials, up to 10 May 2021. Findings were synthesised by diet type and study quality (Cochrane Risk of Bias tool 2.0 and Risk Of Bias In Non-randomised Studies - of Interventions [ROBINS-I]), with GRADE applied (PROSPERO CRD42020208878). RESULTS We identified 19 meta-analyses of weight-loss diets, involving 2-23 primary trials (n = 100-1587), published 2013-2021. Twelve were 'critically low' or 'low' AMSTAR 2 quality, with seven 'high' quality. Greatest weight loss was reported with very low energy diets, 1.7-2.1 MJ/day (400-500 kcal) for 8-12 weeks (high-quality meta-analysis, GRADE low), achieving 6.6 kg (95% CI -9.5, -3.7) greater weight loss than low-energy diets (4.2-6.3 MJ/day [1000-1500 kcal]). Formula meal replacements (high quality, GRADE moderate) achieved 2.4 kg (95% CI -3.3, -1.4) greater weight loss over 12-52 weeks. Low-carbohydrate diets were no better for weight loss than higher-carbohydrate/low-fat diets (high quality, GRADE high). High-protein, Mediterranean, high-monounsaturated-fatty-acid, vegetarian and low-glycaemic-index diets all achieved minimal (0.3-2 kg) or no difference from control diets (low to critically low quality, GRADE very low/moderate). For type 2 diabetes remission, of 373 records, 16 met inclusion criteria. Remissions at 1 year were reported for a median 54% of participants in RCTs including initial low-energy total diet replacement (low-risk-of-bias study, GRADE high), and 11% and 15% for meal replacements and Mediterranean diets, respectively (some concerns for risk of bias in studies, GRADE moderate/low). For ketogenic/very low-carbohydrate and very low-energy food-based diets, the evidence for remission (20% and 22%, respectively) has serious and critical risk of bias, and GRADE certainty is very low. CONCLUSIONS/INTERPRETATION Published meta-analyses of hypocaloric diets for weight management in people with type 2 diabetes do not support any particular macronutrient profile or style over others. Very low energy diets and formula meal replacement appear the most effective approaches, generally providing less energy than self-administered food-based diets. Programmes including a hypocaloric formula 'total diet replacement' induction phase were most effective for type 2 diabetes remission. Most of the evidence is restricted to 1 year or less. Well-conducted research is needed to assess longer-term impacts on weight, glycaemic control, clinical outcomes and diabetes complications.
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Affiliation(s)
- Chaitong Churuangsuk
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Julien Hall
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Reynolds
- Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
- Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, Otago, New Zealand
| | - Simon J Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Emilie Combet
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
- Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, Otago, New Zealand.
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Yau B, Hocking S, Andrikopoulos S, Kebede MA. Targeting the insulin granule for modulation of insulin exocytosis. Biochem Pharmacol 2021; 194:114821. [PMID: 34748819 DOI: 10.1016/j.bcp.2021.114821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 02/08/2023]
Abstract
The pancreatic β-cells control insulin secretion in the body to regulate glucose homeostasis, and β-cell stress and dysfunction is characteristic of Type 2 Diabetes. Pharmacological targeting of the β-cell to increase insulin secretion is typically utilised, however, extended use of common drugs such as sulfonylureas are known to result in secondary failure. Moreover, there is evidence they may induce β-cell failure in the long term. Within β-cells, insulin secretory granules (ISG) serve as compartments to store, process and traffic insulin for exocytosis. There is now growing evidence that ISG exist in multiple populations, distinct in their protein composition, motility, age, and capacity for secretion. In this review, we discuss the implications of a heterogenous ISG population in β-cells and highlight the need for more understanding into how unique ISG populations may be targeted in anti-diabetic therapies.
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Affiliation(s)
- Belinda Yau
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.
| | - Samantha Hocking
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia; Central Clinical School, Faculty of Medicine and Health and Department of Endocrinology Royal Prince Alfred Hospital, NSW, Australia
| | | | - Melkam A Kebede
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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Kalra S, Bantwal G, Kapoor N, Sahay R, Bhattacharya S, Anne B, Gopal RA, Kota S, Kumar A, Joshi A, Sanyal D, Tiwaskar M, Das AK. Quantifying Remission Probability in Type 2 Diabetes Mellitus. Clin Pract 2021; 11:850-859. [PMID: 34842637 PMCID: PMC8628725 DOI: 10.3390/clinpract11040100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is increasingly being recognized by various global guidelines. Multiple models have been developed and validated for quantifying the extent of remission achieved. Based on favorable clinical evidence, T2DM remission can be considered as the therapeutic goal in diabetes management and, in select cases, as an alternative to expensive treatment options, which can be burdensome as T2DM progresses. This narrative review discusses the available strategies, such as lifestyle interventions, physical activity, bariatric surgery, medical nutrition therapy, and non-insulin glucose-lowering medications, for achieving T2DM remission. Although the concept of T2DM remission has emerged as a real-world option, effective implementation in routine clinical practice may not be feasible until long-term studies prove the efficacy of different approaches in this regard.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St Johns Medical College & Hospital, Bengaluru 560034, India;
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, India;
- Non Communicable Disease Unit, The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad 500095, India;
| | | | - Beatrice Anne
- Department of Endocrinology, Nizams Institute of Medical Sciences, Hyderabad 500082, India;
| | - Raju A Gopal
- Department of Endocrinology, Endodiab Clinic, Kozhikode 673016, India;
| | - Sunil Kota
- Department of Endocrinology, Diabetes and Endocare Clinic, Berhampur 760004, India;
| | - Ashok Kumar
- Department of Endocrinology, CEDAR Diabetes Thyroid & Hormone Clinic Panipat, Panipat 132103, India;
| | - Ameya Joshi
- Department of Endocrinology & Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai 401107, India;
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata 700032, India;
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai 400068, India;
| | - Ashok Kumar Das
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry 605014, India;
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Skurk T, Bosy-Westphal A, Grünerbel A, Kabisch S, Keuthage W, Kronsbein P, Müssig K, Pfeiffer AFH, Simon MC, Tombek A, Weber KS, Rubin D. Empfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1543-1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas Skurk
- ZIEL- Institute for Food & Health, Technische Universität München, Freising
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technische Universität München, Freising
| | - Anja Bosy-Westphal
- Institut für Humanernährung, Agrar- und Ernährungswissenschaftliche Fakultät, Christian-Albrechts-Universität zu Kiel, Kiel
| | | | - Stefan Kabisch
- Abt. Endokrinologie, Diabetes und Ernährungsmedizin, Charité Universitätsmedizin Berlin, Berlin
- Deutsche Zentrum für Diabetesforschung (DZD), München
| | | | - Peter Kronsbein
- Fachbereich Oecotrophologie, Hochschule Niederrhein, Campus Mönchengladbach
| | - Karsten Müssig
- Klinik für Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte
| | - Andreas F. H. Pfeiffer
- Abt. Endokrinologie, Diabetes und Ernährungsmedizin, Charité Universitätsmedizin Berlin, Berlin
| | - Marie-Christine Simon
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn
| | | | - Katharina S. Weber
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Diana Rubin
- Vivantes Klinikum Spandau, Berlin
- Vivantes Humboldt Klinikum, Berlin
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Juray S, Axen KV, Trasino SE. Remission of Type 2 Diabetes with Very Low-Calorie Diets-A Narrative Review. Nutrients 2021; 13:2086. [PMID: 34207117 PMCID: PMC8234895 DOI: 10.3390/nu13062086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022] Open
Abstract
Very low-calorie diets (VLCD) are hypocaloric dietary regimens of approximately 400-800 kcal/day that result in 20-30% reductions in body weight, sometimes in just 12-16 weeks. A body of evidence demonstrates that adherence to VLCD in adults with type 2 diabetes (T2D) can result in marked improvements to glycemic control and even full T2D remission, challenging the convention that T2D is a lifelong disease. Although these data are promising, the majority of VLCD studies have focused on weight loss and not T2D remission as a primary endpoint. Moreover, there is a wide range of VLCD protocols and definitions of T2D remission used across these hypocaloric studies. Together the large degree of heterogeneity in VLCD studies, and how T2D remission is defined, leave many gaps in knowledge to efficacy and durability of VLCD approaches for T2D remission. This narrative review examines findings from a body of data from VLCD studies that specifically sought to investigate T2D remission, and discusses the efficacy of VLCD compared to other hypocaloric approaches, and who is likely to benefit from VLCD approaches for T2D remission.
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Affiliation(s)
- Susan Juray
- Nutrition Program, School of Urban Public Health, Hunter College, City University of New York, New York, NY 10035, USA;
- Clinical Nutrition Department, Mount Sinai Hospital, New York, NY 10025, USA
| | - Kathleen V. Axen
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, New York, NY 11201, USA;
| | - Steven E. Trasino
- Nutrition Program, School of Urban Public Health, Hunter College, City University of New York, New York, NY 10035, USA;
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