Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis

Lifestyle Intervention in Reducing Insulin Resistance and Preventing type 2 Diabetes in Asia Pacific Region: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

To update the evidence of lifestyle interventions for the prevention of type 2 diabetes mellites (T2DM) in adults, particularly in the Asia Pacific region. The key questions to ask are: 1) How effective are lifestyle interventions in preventing T2DM among at-risk adults in the Asia Pacific Region? 2)What are the key characteristics of the implementation of lifestyle interventions for diabetes prevention?

RECENT FINDINGS

Lifestyle interventions for the prevention of T2DM have been suggested to be effective. There is evidence of ethnic differences in some glycaemic and anthropometric outcomes. The meta-analysis suggested a significant result in reducing waist circumference (standardised mean difference - 019, 95%CI ( -0.31, -0.06)), and no significant effects in other outcomes. However, the implementation outcomes suggested lifestyle intervention might be a cost-effective and sustainable approach in T2DM particularly in countries in the Asia Pacific Region. The focus of lifestyle intervention in the Asia Pacific Region should not only lie in the effectiveness of the trial but a thorough evaluation of the implementation outcomes, as well as cultural adaptations, with the support of all stakeholders through all stages of the implementation.

The multimorbidity association of metabolic syndrome and depression on type 2 diabetes: a general population cohort study in Southwest China

Background

Metabolic syndrome(MetS) and depression are independently associated with type 2 diabetes (T2DM) risk. However, little is known about the combined effect of MetS and depression on the risk of T2DM. The present study aims to prospectively explore the impact of MetS and depression on T2DM susceptibility among the Chinese general population.

Methods

6489 general population without T2DM adults in Southwest China were recruited from 2010 to 2012. Depression and MetS were prospectively assessed using a 9-item Patient Health Questionnaire(PHQ-9) and Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) (CDS2020) during 2016-2020, respectively. Modified Poisson regression models were conducted to estimate relative risk(RR) and 95% confidence intervals (95%CI) for independent and combined associations of MetS and depression with an incidence of T2DM.

Results

During a median follow-up of 6.6 years, 678 cases of T2DM were documented. Individuals with MetS were 1.33 times more likely to develop T2DM than those without MetS. The corresponding RR(95%CI) for depression with no depression was 1.45(1.22-1.72). Notably, compared with no MetS or depression, the multivariate-adjusted RR for a combined effect of MetS and depression on the risk of T2DM was 2.11(1.39-3.22). Moreover, an increased risk of T2DM was more apparent in those ≥ 60 years, males, and overweight.

Conclusions

Individuals with multimorbidity of MetS and depression are at a higher risk of T2DM compared with those with no MetS or depression.

Association between sugar-sweetened beverages and duration of physical exercise with psychological symptoms among Tibetan university students at high altitude

Background

Sugar-sweetened beverages (SSBs) and duration of physical exercise are strongly associated with physical health. Unfortunately, there are few studies focused on the association with psychological symptoms, let alone Tibetan university students at high altitudes in China.

Methods

A stratified cluster sampling method was used to include 8,268 Tibetan university students aged 19-22 years in Qinghai and Tibet, both of which are high-altitude regions of China. Self-assessment questionnaires on SSBs, duration of physical exercise, and psychological symptoms were administered. The chi-square test and logistic regression analysis were used to analyze the associations among them.

Results

The detection rate of psychological symptoms among Tibetan university students in high-altitude areas of China was 16.7%, with in girls (18.2%) higher than that in boys (14.8%), and the difference was statistically significant (χ2 = 11.73, p < 0.01). The proportion of SSBs for university students ≤1 time/week, 2-5 times/week, and ≥ 6 times/week were 54.2, 24.3, and 21.5%, respectively. The proportion of duration of physical exercise for >60 min/d was only 5.4%. Logistic regression analysis showed that compared with the SSBs ≤1 time/week group of university students, SSBs 2-5 times/week (OR = 1.45, 95% CI: 1.24-1.70) and ≥ 6 times/week (OR = 3.06, 95% CI: 2.62-3.57) had an increased risk of psychological symptoms (p < 0.001). In the reference group, the risk of psychological symptoms was also significantly increased in the group of university students with duration of physical exercise >60 min/d (OR = 2.08, 95% CI: 1.48-2.93), and the risk of psychological symptoms was also significantly increased in the group with duration of physical exercise <30 min/d (OR = 2.08, 95% CI: 1.48-2.93). The risk of psychological symptoms was also significantly increased in the university students with the duration of physical exercise <30 min/d (OR = 2.08, 95% CI: 1.48 ~ 2.93) group.

Conclusion

SSBs and exercise time may be important influences on the psychological symptoms of Tibetan university students at high altitudes in China. This study has important implications for mental health planning in universities in highland areas and may also provide guidance for mental health interventions for Tibetan university students.

RS3480 Polymorphism of FNDC5/Irisin Is Associated with Type 2 Diabetes Mellitus in Maya-Mestizo Women

Objective: To investigate the possible association between rs3480 and rs16835198 of the fibronectin type III domain containing 5 (FNDC5)/Irisin and their haplotypes with the presence of type 2 diabetes mellitus (T2DM) in Maya-Mestizo women. Methods: We studied 547 postmenopausal women of Maya-Mestizo origin. The diagnosis of T2DM was based on the criteria of the American Diabetes Association. DNA was obtained from blood leukocytes. rs3480 and rs16835198 of FNDC5/Irisin were studied using real-time polymerase chain reaction allelic discrimination. Deviations from Hardy-Weinberg equilibrium and alleles differences, as well as genotype frequencies between groups, were assessed by χ2 tests. Using logistic regression analysis, the odds ratio and 95% confidence intervals were calculated to estimate the association between both polymorphisms of FNDC5/Irisin and the presence of T2DM. Pairwise linkage disequilibrium between polymorphisms was calculated by direct correlation r2, and haplotype analysis was conducted. Results: We found that the G-allele of rs3480, as well as under a dominant model, this polymorphism was significantly associated with T2DM (P = 0.028 and P = 0.003, respectively). Besides, one haplotype was associated with T2DM (P = 0.035). Conclusions: Our results suggest that the FNDC5/Irisin rs3480, and one haplotype formed by rs3480 and rs16835198 were associated with the risk of presenting T2DM in Maya-Mestizo women.

Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes

AIMS

With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes.

METHODS

We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors.

RESULTS

We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities.

CONCLUSIONS

A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.

Usability and Preliminary Efficacy of an Artificial Intelligence-Driven Platform Supporting Dietary Management in Diabetes: Mixed Methods Study

BACKGROUND

Nutrition plays an important role in diabetes self-management. Web-based diabetes care, driven by artificial intelligence (AI), enables more personalized care.

OBJECTIVE

This study aimed to examine the usability and preliminary efficacy of a web-based AI-driven nutrition platform to support people with diabetes and their carers in identifying healthy recipes, meal planning, and web-based shopping.

METHODS

Diabetes UK signposted people with diabetes and their carers to the platform's study-specific portal through its website, social media, and newsletters. A total of 73 adult participants with prediabetes or diabetes or their carers completed the baseline web-based survey. Of these 73 participants, 23 (32%) completed a web-based survey after 8 weeks of platform use. Web-based semistructured interviews were conducted with platform users (7/23, 30%) who agreed to be followed up and diabetes experts (n=3) who had nutrition and platform knowledge. The intervention consists of a web-based platform that incorporates AI to personalize recipes, meal planning, and shopping list experiences and was made available for 8 weeks. Baseline characteristics, satisfaction, system usability, and diabetes-related and general health indicators were assessed before and after using the platform for 8 weeks.

RESULTS

Reductions in weight (mean difference 4.5 kg/m2, 95% CI 1.0-12.0; P=.009; Cliff δ=0.33) and waist size (mean difference 3.9 cm, 95% CI 2.0-6.5; P=.008; Cliff δ=0.48) were found. Most of the participants (151/217, 69.6%) did not regularly use the platform and had low or very low engagement scores. However, the platform was perceived as accessible with no need for additional assistance (11/21, 52%), user-friendly (8/21, 38%), and easy to use (8/21, 38%), regardless of some usability issues. Saving recipes was the most popular feature, with 663 saved recipes.

CONCLUSIONS

This study indicated that the usability of the nutrition platform was well perceived by users and their carers. As participants managed their diabetes well, adding an education component would be specifically relevant for people less familiar with the role of diet in diabetes management. To assess the platform's effectiveness in improving diabetes-related health indicators, controlled studies with a larger and more diverse participant sample are recommended.

Pathophysiology of type 2 diabetes in sub-Saharan Africans

Sub-Saharan Africa (SSA) is the region with the highest projected rates of increase in type 2 diabetes (129% by 2045), which will exacerbate the already high prevalence of type 2 diabetes complications and comorbidities in SSA. In addition, SSA is grappling with poverty-related health problems and infectious diseases and is also undergoing the most rapid rates of urbanisation globally. These socioenvironmental and lifestyle factors may interact with genetic factors to alter the pathophysiological sequence leading to type 2 diabetes in sub-Saharan African populations. Indeed, current evidence from SSA and the diaspora suggests that the pathophysiology of type 2 diabetes in Black Africans is different from that in their European counterparts. Studies from the diaspora suggest that insulin clearance is the primary defect underlying the development of type 2 diabetes. We propose that, among Black Africans from SSA, hyperinsulinaemia due to a combination of both increased insulin secretion and reduced hepatic insulin clearance is the primary defect, which promotes obesity and insulin resistance, exacerbating the hyperinsulinaemia and eventually leading to beta cell failure and type 2 diabetes. Nonetheless, the current understanding of the pathogenesis of type 2 diabetes and the clinical guidelines for preventing and managing the disease are largely based on studies including participants of predominately White European ancestry. In this review, we summarise the existing knowledge base and data from the only non-pharmacological intervention that explores the pathophysiology of type 2 diabetes in SSA. We also highlight factors that may influence the pathogenesis of type 2 diabetes in SSA, such as social determinants, infectious diseases and genetic and epigenetic influences.

Prevalence and Risk Factors of Abnormal Glucose Metabolism and New-Onset Diabetes Mellitus after Kidney Transplantation: A Single-Center Retrospective Observational Cohort Study

Background and objectives: New-onset diabetes after transplantation (NODAT) represents a primary cause of morbidity and allograft loss. We assessed prevalence and risk factors for NODAT in a population of Italian kidney transplant (KT) recipients. Methods: Data from 522 KT performed between January 2004 and December 2014 were analyzed. Participants underwent clinical examination; blood and urine laboratory tests were obtained at baseline, one, six, and 12-month of follow-up to detect glucose homeostasis abnormalities and associated metabolic disorders. An oral glucose tolerance test (OGTT) was performed at six months in 303 subjects. Results: Most patients were Caucasian (82.4%) with a mean age of 48 ± 12 years. The prevalence of abnormal glucose metabolism (AGM) and NODAT was 12.6% and 10.7%, respectively. Comparing characteristics of patients with normal glucose metabolism (NGM) to those with NODAT, we found a significant difference in living donation (16.6% vs. 6.1%; p = 0.03) and age at transplant (46 ± 12 vs. 56 ± 9 years; p = 0.0001). Also, we observed that patients developing NODAT had received higher cumulative steroid doses (1-month: 1165 ± 593 mg vs. 904 ± 427 mg; p = 0.002; 6-month:2194 ± 1159 mg vs. 1940 ± 744 mg; p = 0.002). The NODAT group showed inferior allograft function compared to patients with NGM (1-year eGFR: 50.1 ± 16.5 vs. 57 ± 20 mL/min/1.73 m²; p = 0.02). NODAT patients were more likely to exhibit elevated systolic blood pressure and higher total cholesterol and triglyceride levels than controls. Conclusions: The prevalence of NODAT in our cohort was relatively high. Patient age and early post-transplant events such as steroid abuse are associated with NODAT development.

Racial/ethnic and socioeconomic disparities in weight outcomes, cardiovascular events, and mortality in the look AHEAD trial

BACKGROUND

Intensive lifestyle interventions (ILI) for type 2 diabetes (T2D) improve health outcomes, but participants from different races/ethnicities or socioeconomic status may not benefit equally.

METHODS

Within the Look AHEAD trial, we examined achievement of the 7% weight loss goal, as well as secondary weight, cardiovascular, and mortality outcomes, by race/ethnicity and educational attainment (EA).

RESULTS

Among 4,640 participants (31 % Black or Hispanic, 13 % with less than a high school degree), Black and Hispanic participants were less likely than White participants to achieve 7 % weight loss in both the ILI (45.8 % v. 60.7 %, p < 0.001 and 53.0 % v. 60.7 %, p = 0.01, respectively) and diabetes support and education (DSE) arms. Contrastingly, participants with less than a high school degree were more likely in the ILI but less likely in the DSE arm to achieve this goal, with a significant arm by EA interaction. Hispanic participants and those with lowest EA also experienced decreased mortality in the ILI versus the DSE arm.

CONCLUSIONS

All Look AHEAD participant subgroups achieved greater weight loss from ILI; however, Black and Hispanic participants lost less weight than White participants in both arms, while those with lowest EA benefited disproportionately from the ILI compared to participants with higher EA.

Factors Associated With Dietary Behaviors Among Malaysian Adults: Application of the Social Cognitive Theory

Background: Dietary behavior applying theory-based approaches is seldom documented in the general adult population. Thus, the objective of this study was to determine the eating behavior of Malaysian adults and the demographic factors that were associated with positive eating habits. Methods: In this cross-sectional survey, the convenience sampling technique was used to sample Malaysian adults aged 18 or older. The questionnaire was based on constructs from Bandura’s Social Cognitive Theory (SCT), which has six scales or constructs, including self-efficacy, intentions, situation, social support, behavioral strategies, and outcome expectations and expectancies. All the six constructs demonstrated adequate model fit using confirmatory analysis fit by the developers and good internal reliability using Cronbach’s alpha in this study. The data were descriptively analyzed, and subsequently, logistic regressions were performed, assessing demographic factors associated with healthy eating habits. The variables achieving a P value<0.05 were considered statistically significant. Results: A total of 461 respondents completed the questionnaire. Good social support (83.30%), outcome expectations (90.24%) and expectancies (92.41%), and the situation in relation to healthy eating (88.94%) were frequently observed among the respondents. The sentence has been revised to express the idea more clearly. "However, the observations in these dimensions were not necessarily translated into good self-efficacy (33.41%), intentions (39.91%), and behavioral strategies relating to healthy eating (53.15%). Additionally, demographic variables such as ethnicity, age, and region were significantly associated with the positive attitude observed on the questionnaire constructs. Conclusion: In summary, the findings of the study revealed that many Malaysians have poor self-efficacy, intentions, and behavioral strategies when it came to eating healthy. The demographic factors significantly associated with dietary behaviors should be targeted in future interventional studies and awareness programs.

The Effect of Lifestyle Intervention on Diabetes Prevention by Ethnicity: A Systematic Review of Intervention Characteristics Using the TIDieR Framework

Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM), but the efficacy of intervention components across different ethnic groups is less clear. This systematic review examined the effects of intervention characteristics of lifestyle interventions on diabetes incidence and weight loss by ethnicity using the Template for Intervention Description and Replication (TIDieR) framework. MEDLINE, EMBASE and other databases were searched for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American and African groups. Forty-five studies (18,789 participants) were included in the systematic review and 41 studies in meta-analysis. Meta-analysis showed a high number of intervention sessions was significantly associated with a greater reduction in diabetes incidence (P = 0.043) and weight (P = 0.015), while other intervention characteristics including intervention provider and delivery format did not alter the outcomes (all P > 0.05). Additionally, narrative synthesis showed long-term interventions (≥12 months) were associated with significant diabetes risk reduction for all ethnic groups, while short-term interventions (<12 months) were more effective in weight loss in most ethnic groups. There may be ethnic preferences for the optimal number of intervention sessions.