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Lunder M, Janić M, Šabovič M. Prevention of Vascular Complications in Diabetes Mellitus Patients: Focus on the Arterial Wall. Curr Vasc Pharmacol 2018; 17:6-15. [DOI: 10.2174/1570161116666180206113755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/16/2017] [Accepted: 11/07/2017] [Indexed: 12/14/2022]
Abstract
In Diabetes Mellitus (DM), hyperglycaemia and insulin resistance progressively lead to both
microvascular and macrovascular complications. Whereas the incidence of microvascular complications
is closely related to tight glycaemic control, this does not apply to macrovascular complications. Hyperglycaemia
influences many interweaving molecular pathways that initially lead to increased oxidative
stress, increased inflammation and endothelial dysfunction. The latter represents the initial in both types
of vascular complications; it represents the “obligatory damage” in microvascular complications development
and only “introductory damage” in macrovascular complications development. Other risk factors,
such as arterial hypertension and dyslipidaemia, also play an important role in the progression of
macrovascular complications. All these effects accumulate and lead to functional and structural arterial
wall damage. In the end, all factors combined lead to the promotion of atherosclerosis and consequently
major adverse cardiovascular events. If we accept the pivotal role of vascular wall impairment in the
pathogenesis and progression of microvascular and macrovascular complications, treatment focused
directly on the arterial wall should be one of the priorities in prevention of vascular complications in
patients with DM. In this review, an innovative approach aimed at improving arterial wall dysfunction is
described, which may show efficacy in clinical studies. In addition, the potential protective effects of
current treatment approaches targeting the arterial wall are summarised.
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Affiliation(s)
- Mojca Lunder
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloska cesta 7; SI-1000 Ljubljana, Slovenia
| | - Miodrag Janić
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloska cesta 7; SI-1000 Ljubljana, Slovenia
| | - Mišo Šabovič
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloska cesta 7; SI-1000 Ljubljana, Slovenia
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Gorgojo Martínez JJ. Relevance of weight in the management of patients with type 2 diabetes mellitus: towards an adipocentric approach to diabetes. Med Clin (Barc) 2017; 147 Suppl 1:8-16. [PMID: 28760227 DOI: 10.1016/s0025-7753(17)30619-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In recent decades, there has been a worldwide parallel increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM), which is not surprising, given that increased visceral fat is the main risk factor for the development of T2DM in genetically predisposed individuals. An intervention focused on intensive blood glucose control in T2DM with classic drugs increases the risk of weight gain and the rate of hypoglycaemia. In contrast, weight loss through lifestyle changes, drugs and/or surgery simultaneously improves most cardiovascular (CV) risk factors, including hyperglycemia. Intensive intervention on lifestyle induces an overall benefit in patients with T2DM, but long-term weight loss is modest and has not been shown to reduce CV morbidity and mortality. The emergence of new therapeutic classes for T2DM and obesity, which simultaneously improve HbA1c, weight and other CV risk factors without inducing hypoglycaemia, represents a major change in the management of patients with diabesity. A sodium-glucose cotransporter-2 inhibitor and a GLP-1 receptor agonist have recently been shown to decrease CV and total mortality in type 2 diabetic patients with CV disease. Furthermore, bariatric surgery rapidly induces remission or improvement of T2DM in a large percentage of patients and reduces diabetes-related mortality. The emergence of new therapies raises the possibility of changing the current glucose-centred therapeutic strategy for a weight-centred approach.
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Affiliation(s)
- Juan José Gorgojo Martínez
- Unidad de Endocrinologíe, y Nutrición, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
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Jeejeebhoy K, Dhaliwal R, Heyland DK, Leung R, Day AG, Brauer P, Royall D, Tremblay A, Mutch DM, Pliamm L, Rhéaume C, Klein D. Family physician-led, team-based, lifestyle intervention in patients with metabolic syndrome: results of a multicentre feasibility project. CMAJ Open 2017; 5:E229-E236. [PMID: 28401139 PMCID: PMC5378505 DOI: 10.9778/cmajo.20160101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a medical condition with major complications and health care costs. Previous research has shown that diet and exercise can improve and reverse this condition. The goal of this study was to test the feasibility and effectiveness of implementing the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program into diverse family medicine practices to improve MetS. METHODS In this longitudinal before-after study, 305 adult patients with MetS were recruited from 3 diverse family medicine team-based organizations to the CHANGE personalized diet and exercise program. Participants were followed for 12 months. Primary outcomes included feasibility and reversal of MetS. Secondary outcomes included improvement in MetS components, changes in diet quality, aerobic fitness and cardiovascular risk. RESULTS Participants attended 76% and 90% of the kinesiologist and dietitian visits, respectively. At 12 months, 19% of patients (95% confidence interval [CI] 14%-24%) showed reversal of MetS, VO2max increased by 16% (95% CI 13%-18%), and Healthy Eating Index and Mediterranean Diet Scores improved by 9.6% (95% CI 7.6%-11.6%) and 1.4% (1.1%-1.6%), respectively. In addition, the Prospective Cardiovascular Munster (PROCAM) 10-year risk of acute coronary event decreased by 1.4%, from a baseline of 8.6%. INTERPRETATION A team-based program led by the family physician that educates patients about the risks of MetS, and with a dietitian and kinesiologist, empowers them to undertake an individualized supervised program of diet modification and exercise, is feasible, improves aerobic capacity and diet quality, reverses MetS and improves MetS components at 12 months.
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Affiliation(s)
- Khursheed Jeejeebhoy
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Rupinder Dhaliwal
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Daren K Heyland
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Roger Leung
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Andrew G Day
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Paula Brauer
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Dawna Royall
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Angelo Tremblay
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - David M Mutch
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Lew Pliamm
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Caroline Rhéaume
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
| | - Doug Klein
- Metabolic Syndrome Canada is a not-for-profit charitable organization that funded the current study. Daren Heyland received grant funds from Metabolic Syndrome Canada for program development, study coordination and data analyses. Rupinder Dhaliwal, Andrew Day and Roger Leung were paid for their work on the study by Kingston General Hospital and Queen's University from this grant. Rupinder Dhaliwal became an employee of Metabolic Syndrome Canada after the completion of study enrolment. Lew Pliamm, Caroline Rhéuame and Doug Klein received grants as participating sites for patient enrolment and data collection from Metabolic Syndrome Canada. Paula Brauer, Dawna Royall, David Mutch and Angelo Tremblay received grants for program development from Metabolic Syndrome Canada. Khursheed Jeejeebhoy is on the board of directors for Metabolic Syndrome Canada and will be involved in discussions about fundraising for this nonprofit organization
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Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical Update: Cardiovascular Disease in Diabetes Mellitus: Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus - Mechanisms, Management, and Clinical Considerations. Circulation 2016; 133:2459-502. [PMID: 27297342 PMCID: PMC4910510 DOI: 10.1161/circulationaha.116.022194] [Citation(s) in RCA: 650] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease remains the principal cause of death and disability among patients with diabetes mellitus. Diabetes mellitus exacerbates mechanisms underlying atherosclerosis and heart failure. Unfortunately, these mechanisms are not adequately modulated by therapeutic strategies focusing solely on optimal glycemic control with currently available drugs or approaches. In the setting of multifactorial risk reduction with statins and other lipid-lowering agents, antihypertensive therapies, and antihyperglycemic treatment strategies, cardiovascular complication rates are falling, yet remain higher for patients with diabetes mellitus than for those without. This review considers the mechanisms, history, controversies, new pharmacological agents, and recent evidence for current guidelines for cardiovascular management in the patient with diabetes mellitus to support evidence-based care in the patient with diabetes mellitus and heart disease outside of the acute care setting.
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Affiliation(s)
- Cecilia C Low Wang
- From Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Aurora (C.C.L.); CPC Clinical Research, Aurora, CO (C.C.L., C.N.H., W.R.H.); Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H., W.R.H.); Joslin Diabetes Center, and Harvard Medical School, Boston, MA (A.B.G.)
| | - Connie N Hess
- From Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Aurora (C.C.L.); CPC Clinical Research, Aurora, CO (C.C.L., C.N.H., W.R.H.); Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H., W.R.H.); Joslin Diabetes Center, and Harvard Medical School, Boston, MA (A.B.G.)
| | - William R Hiatt
- From Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Aurora (C.C.L.); CPC Clinical Research, Aurora, CO (C.C.L., C.N.H., W.R.H.); Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H., W.R.H.); Joslin Diabetes Center, and Harvard Medical School, Boston, MA (A.B.G.)
| | - Allison B Goldfine
- From Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Aurora (C.C.L.); CPC Clinical Research, Aurora, CO (C.C.L., C.N.H., W.R.H.); Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H., W.R.H.); Joslin Diabetes Center, and Harvard Medical School, Boston, MA (A.B.G.).
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Gómez Huelgas R, Gómez Peralta F, Carrillo Fernández L, Galve E, Casanueva F, Puig Domingo M, Mediavilla Bravo J, Orozco Beltrán D, Muñoz JE, Menéndez Torre E, Artola Menendez S, Mazón Ramos P, Monereo Megías S, Caixas Pedrágos A, López Simarro F, Álvarez Guisasola F. Hacia un manejo integral del paciente con diabetes y obesidad. Posicionamiento de la SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC. Rev Clin Esp 2015; 215:505-14. [DOI: 10.1016/j.rce.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/06/2015] [Indexed: 01/21/2023]
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Abstract
INTRODUCTION Low carbohydrate diets are again in the spotlight and have been identified as particularly appropriate for people with type 2 diabetes. There is confusion amongst both health professionals and people with diabetes about the suitability of these diets. This review aims to provide an overview of the latest evidence and to explore the role of low carbohydrate diets for people with type 2 diabetes. METHODS An electronic search of English language articles was performed using MEDLINE (2010-May 2015), EMBASE (2010-May 2015), and the Cochrane Central Register of Controlled Trials (2010-May 2015). Only randomized controlled trials comparing interventions evaluating reduced carbohydrate intake with higher carbohydrate intake in people with diagnosed type 2 diabetes were included. Primary outcomes included weight, glycated hemoglobin, and lipid concentrations. RESULTS Low carbohydrate diets in people with type 2 diabetes were effective for short-term improvements in glycemic control, weight loss, and cardiovascular risk, but this was not sustained over the longer term. Overall, low carbohydrate diets failed to show superiority over higher carbohydrate intakes for any of the measures evaluated including weight loss, glycemic control, lipid concentrations, blood pressure, and compliance with treatment. CONCLUSION Recent studies suggest that low carbohydrate diets appear to be safe and effective over the short term, but show no statistical differences from control diets with higher carbohydrate content and cannot be recommended as the default treatment for people with type 2 diabetes.
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Affiliation(s)
- Pamela Dyson
- Churchill Hospital, University of Oxford, OCDEM, Oxford, UK.
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Gómez Huelgas R, Gómez Peralta F, Carrillo Fernández L, Galve E, Casanueva F, Puig Domingo M, Mediavilla Bravo J, Orozco Beltrán D, Ena Muñoz J, Menéndez Torre E, Artola Menendez S, Mazón Ramos P, Monereo Megías S, Caixas Pedrágos A, López Simarro F, Álvarez Guisasola F. Position statement of the SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lih A, Pereira L, Bishay RH, Zang J, Omari A, Atlantis E, Kormas N. A novel multidisciplinary intervention for long-term weight loss and glycaemic control in obese patients with diabetes. J Diabetes Res 2015; 2015:729567. [PMID: 25950007 PMCID: PMC4408626 DOI: 10.1155/2015/729567] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/25/2015] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Obesity and diabetes are difficult to treat in public clinics. We sought to determine the effectiveness of the Metabolic Rehabilitation Program (MRP) in achieving long-term weight loss and improving glycaemic control versus "best practice" diabetes clinic (DC) in obese patients using a retrospective cohort study. METHODS Patients with diabetes and BMI > 30 kg/m(2) who attended the MRP, which consisted of supervised exercise and intense allied health integration, or the DC were selected. Primary outcomes were improvements in weight and glycaemia with secondary outcomes of improvements in blood pressure and lipid profile at 12 and 30 months. RESULTS Baseline characteristics of both cohorts (40 MRP and 40 DC patients) were similar at baseline other than age (63 in MRP versus 68 years in DC, P = 0.002). At 12 months, MRP patients lost 7.65 ± 1.74 kg versus 1.76 ± 2.60 kg in the DC group (P < 0.0001) and 9.70 ± 2.13 kg versus 0.98 ± 2.65 kg at 30 months (P < 0.0001). Similarly, MRP patients had significant absolute reductions in %HbA1c at 30 months versus the DC group (-0.86 ± 0.31% versus 0.12% ± 0.33%, P < 0.038), with nonsignificant improvements in lipids and blood pressure in MRP patients. CONCLUSION Further research is needed to establish the MRP as an effective strategy for achieving sustained weight loss and improving glycaemic control in obese patients with type 2 diabetes.
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Affiliation(s)
- Anna Lih
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Rhodes, NSW 2139, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Lorraine Pereira
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Rhodes, NSW 2139, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Ramy H. Bishay
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Rhodes, NSW 2139, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
- *Ramy H. Bishay:
| | - Johnson Zang
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Rhodes, NSW 2139, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Abdullah Omari
- University of New South Wales Medical Program, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Vascular Medicine, St. Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia
| | - Evan Atlantis
- School of Nursing and Midwifery, University of Western Sydney, Campbelltown, NSW 2560, Australia
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nic Kormas
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Rhodes, NSW 2139, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
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