1
|
Zhang L, Liu J, Cao Y, Liu S, Zhao W, Wang C, Banzhao S, Liu Z, Liu L. Association between circulating levels of unsaturated fatty acids and risk for prediabetes in the NHANES 2003-2004 and 2011-2012. Diabetes Res Clin Pract 2024; 213:111728. [PMID: 38838943 DOI: 10.1016/j.diabres.2024.111728] [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: 04/03/2024] [Revised: 05/11/2024] [Accepted: 06/02/2024] [Indexed: 06/07/2024]
Abstract
AIMS This study aimed to investigate the association between serum levels of common and uncommon unsaturated fatty acids and prediabetes risk. METHODS Data were collected from the National Health and Nutrition Examination Survey for 2003-2004 and 2011-2012. Weighted proportional and multivariate logistic regression analyses were performed to assess the association of serum PUFAs and MUFAs with prediabetes risk after adjusting for potential confounders. RESULTS A total of 3575 individuals were enrolled in this study. Serum levels of PUFAs EPA (20:5 n3) and GLA (18:3 n6) were associated with increased prediabetes risk (EPA (20:5 n3): OR = 1.878, 95% CI: 1.177-2.996, Ptrend = 0.002; GLA (18:3 n6): 1.702, 95% CI: 1.140-2.541, Ptrend = 0.016). The MUFAs PA (16:1 n7) and EA (20:1 n9) were associated with the risk of prediabetes (OR in quintile5: PA (16:1 n7): 1.780, 95% CI: 1.056-3.001, Ptrend = 0.003; EA (20:1 n9): 0.587, 95% CI: 0.347-0.994, Ptrend = 0.010). Moreover, nonlinear analysis revealed that serum levels of EPA (20:5 n3) and EA (20:1 n-9) were nonlinearly associated with prediabetes risk. CONCLUSION Some serum n-3 PUFAs are positively associated with prediabetes, several serum n-6 PUFAs are inversely associated with prediabetes. Regulating individual serum USFA levels may help prevent prediabetes, thereby providing evidence for clinical and nutritional practices.
Collapse
Affiliation(s)
- Liwen Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Key Laboratory of Environment and Human Health, Shijiazhuang 050017, China
| | - Jiayi Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Key Laboratory of Environment and Human Health, Shijiazhuang 050017, China
| | - Yuxuan Cao
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Key Laboratory of Environment and Human Health, Shijiazhuang 050017, China
| | - Shan Liu
- Department of Endocrinology, The Second Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, China
| | - Weili Zhao
- Hebei Key Laboratory of Basic Medicine for Diabetes, The Second Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, China
| | - Ci Wang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Key Laboratory of Environment and Human Health, Shijiazhuang 050017, China
| | - Shangfang Banzhao
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Key Laboratory of Environment and Human Health, Shijiazhuang 050017, China
| | - Zanchao Liu
- Hebei Key Laboratory of Basic Medicine for Diabetes, The Second Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, China; Shijiazhuang Diabetes Precision Diagnosis and Treatment Technology Innovation Center, Shijiazhuang, Hebei 050000, China.
| | - Lipeng Liu
- Hebei Key Laboratory of Basic Medicine for Diabetes, The Second Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, China; College of Veterinary, Hebei Agricultural University, Baoding 071000, China.
| |
Collapse
|
2
|
Albini A, La Vecchia C, Magnoni F, Garrone O, Morelli D, Janssens JP, Maskens A, Rennert G, Galimberti V, Corso G. Physical activity and exercise health benefits: cancer prevention, interception, and survival. Eur J Cancer Prev 2024:00008469-990000000-00152. [PMID: 38920329 DOI: 10.1097/cej.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Physical activity (PA) has an established role in the promotion of health and fitness and the prevention of disease. Expected overall benefits include reduction of all-cause morbidity and death, weight control, improved quality of life, improved bone health and decreased falls of elderly subjects, , deeper cognition, and reduced risk of depression, anxiety, and sleeplessness. Currently, PA is a mainstay in the management of cardiovascular diseases, metabolic syndrome, diabetes, and bone health. Recently, the perception of its role in primary and secondary prevention, interception, and treatment of cancer, however, is also gaining importance. Regular walking, the simplest type of PA, is associated with reduced all-cause and cardiovascular disease mortality, and a role in cancer prevention is of increasing interest. Furthermore, PA improves the quality of life of cancer patients, attenuating side effects of chemotherapy, decreasing sarcopenia, increasing fitness, and inhibiting the recurrence and progression of some cancer types. It promotes emotional and psychological benefits in patients, inducing positive changes. While mechanisms, effective levels and useful amount of PA practice are well established in cardiology, they are yet to be fully determined in oncology. Nevertheless, PA is recommended to reduce cancer risk in the general population, and it has been introduced in programs for the prevention of second cancers. In perspective, it will help as integrative therapy in cancer patients and for cancer survivors. The number of beneficial effects in the cancer continuum is highlighted in this review.
Collapse
Affiliation(s)
- Adriana Albini
- European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)
| | - Ornella Garrone
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | - Danilo Morelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica
| | | | - Alain Maskens
- European Cancer Prevention Organization (ECP), Milan, Italy
| | - Gad Rennert
- Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)
| | - Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
3
|
Iqbal R, Naz S, Sheikh S, Qureshi R, Bhutta S, Yasmeen H, Azam I, Gill P. Conducting a diabetes mellitus prevention trial in women with GDM in Pakistan: a feasibility study. Pilot Feasibility Stud 2024; 10:92. [PMID: 38879496 PMCID: PMC11179295 DOI: 10.1186/s40814-024-01514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/06/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) are at a greater risk of developing type 2 diabetes mellitus (T2DM) than women without GDM. Despite this elevated risk, few trials on the prevention of T2DM among South Asian women with GDM have been reported. Therefore, this study aimed to assess the feasibility of conducting a diabetes prevention program on women with a history of GDM to inform the development of a contextually relevant definitive trial. METHODS Using a randomized controlled trial, women with GDM (n = 180) who delivered at the study hospitals (one public and one private teaching hospital, Karachi) with fasting blood glucose levels < 120 mg/dl at 6 weeks postpartum were randomized to the intervention (n = 88) or control arms (n = 92). Women in the intervention group received individualized home-based educational sessions from trained community health workers at 0, 1, 3, 6, and 9 months. In addition, they received short text messages, prerecorded messages, and printed educational material (calendars and pamphlets) for reinforcement. The intervention was centered on equipping women with knowledge, skills, and confidence to eat a healthy diet rich in fruits, vegetables, and low-fat dairy products and perform regular physical activity based on walking and household chores to reduce weight (up to 5% of their initial body weight). Women in the control arm received standard care. The feasibility outcomes of the study included screening, recruitment, and retention rates and in-depth interviews at 6 months post-intervention to explore women's experiences with the intervention. Descriptive analysis and thematic analysis were performed. RESULTS Of the 324 women screened during the antenatal care visits and after delivery, 255 (78.7%) were contactable 6 weeks postpartum, and 180 (70.6%) were eligible and randomized to intervention (n = 88) and control (n = 92) groups. Loss to follow-up in the intervention and control arms was 22.7% (n = 20/88) and 18.5% (n = 17/92), respectively. Women expressed satisfaction with home-based counseling and follow-up visits, text message reminders, and printed material in the form of a calendar through our qualitative interviews. CONCLUSIONS Home-based lifestyle modification intervention augmented with text messages and printed material is feasible. However, to evaluate the intervention's effectiveness, a larger trial is warranted to assess its long-term impact on diabetes prevention. TRIAL REGISTRATION ISRCTN, ISRCTN11387113 . Registered 5 December 2017-retrospectively registered.
Collapse
Affiliation(s)
- Romaina Iqbal
- Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan.
| | - Sabahat Naz
- Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan
| | - Sana Sheikh
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Rahat Qureshi
- Department of Obstetrics and Gynecology, The Aga Khan University, Karachi, Pakistan
| | | | | | - Iqbal Azam
- Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan
| | - Paramjit Gill
- Division of Health Sciences, University of Warwick, Coventry, UK
| |
Collapse
|
4
|
Woo HW, Kim MK, Ji-Sook K, Lee J, Shin MH, Koh SB, Kim HC, Kim YM. The association of dietary total flavonoids and their subclasses with the risk of type 2 diabetes: a prospective cohort study. Eur J Nutr 2024; 63:1339-1356. [PMID: 38418540 DOI: 10.1007/s00394-024-03341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Data from mechanistic studies suggest flavonoids may benefit glucose metabolism, but their associations with type 2 diabetes (T2D) remain unclear. This study examined the prospective associations of dietary intake of total, classes, and individual flavonoids, as well as their source foods, with T2D in the CArdioVascular disease Association Study (CAVAS). METHODS A total of 16,666 Korean men and women were enrolled at baseline, and 953 were newly diagnosed with T2D over a median follow-up of 5.96 years. Intake of flavonoids was cumulatively averaged using all food frequency questionnaires before the censoring events. A Poisson regression model was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS Women with higher total flavonoid, flavonol, isoflavone, and proanthocyanidin intake had a lower risk of T2D (fourth vs. first quartile, IRR 0.62; 95% CI 0.44-0.89; P for linearity and non-linearity < 0.05 for total flavonoids), while in men, flavanones, anthocyanins, and proanthocyanidins, but not total flavonoids, were inversely associated with T2D risk (all P interaction for sex > 0.05). The key source foods contributing to flavonoid intake were also different between men and women, except for apples: tangerines and strawberries in men and green leafy vegetables and soy products in women. CONCLUSIONS A higher intake of total flavonoids, particularly from vegetables, soybeans, and apples, may be associated with lower risk of T2D in women. However, flavonoids from fruits, rather than total flavonoids, may be inversely associated in men. The association between flavonoid intake and the risk of T2D may be contingent upon the dietary sources of flavonoids consumed.
Collapse
Affiliation(s)
- Hye Won Woo
- Department of Preventive Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Medical School Building A-Room 517-2, Sungdong-gu, 04763, Seoul, South Korea
- Institute for Health and Society, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, 04763, Seoul, South Korea
| | - Mi Kyung Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Medical School Building A-Room 517-2, Sungdong-gu, 04763, Seoul, South Korea.
- Institute for Health and Society, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, 04763, Seoul, South Korea.
| | - Kong Ji-Sook
- Department of Preventive Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Medical School Building A-Room 517-2, Sungdong-gu, 04763, Seoul, South Korea
- Institute for Health and Society, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, 04763, Seoul, South Korea
| | - Jiseon Lee
- Department of Preventive Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Medical School Building A-Room 517-2, Sungdong-gu, 04763, Seoul, South Korea
- Institute for Health and Society, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, 04763, Seoul, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, 61469, Gwangju, South Korea
| | - Sang Baek Koh
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, 26426, Wonju, South Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Yu-Mi Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Medical School Building A-Room 517-2, Sungdong-gu, 04763, Seoul, South Korea
- Institute for Health and Society, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, 04763, Seoul, South Korea
| |
Collapse
|
5
|
Zhong P, Yang S, Liu R, Zhu Z, Zhang Y, Cheng W, Wang W. Handgrip strength and risks of diabetic vascular complications: Evidence from Guangzhou Diabetic Eye Study and UK cohorts. Br J Ophthalmol 2024:bjo-2023-324893. [PMID: 38816182 DOI: 10.1136/bjo-2023-324893] [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: 11/11/2023] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The purpose is to investigate the association between handgrip strength (HGS) and the risk of future diabetic complications in multicountry cohorts. METHODS The association between HGS and diabetic complications was evaluated using cox models among 84 453 patients with pre-diabetes and diabetes from the UK Biobank with a 12-year follow-up. The association between HGS and longitudinal microcirculatory damage rates was assessed among 819 patients with diabetes from the Guangzhou Diabetic Eye Study (GDES) with a 3-year follow-up. Participants were divided into three age groups (<56, 56-65 and ≥65 years), and each group was further subdivided into three HGS tertiles. RESULTS A 5 kg reduction in HGS was associated with increased risk for all-cause mortality (women, HR=1.10, 95% CI: 1.05 to 1.14; p<0.001; men, HR=1.13, 95% CI: 1.11 to 1.15; p<0.001). Women and men in the lowest HGS group exhibited 1.6-times and 1.3-1.5-times higher risk of myocardial infarction and stroke compared with the highest HGS group. In men, there was a higher risk of developing end-stage renal disease (HR=1.83, 95% CI: 1.30 to 2.57; p=0.001), while this was not observed in women. Both sexes in the lowest HGS group had a 1.3-times higher risk of diabetic retinopathy compared with the highest HGS group. In the GDES group, individuals with the lowest HGS showed accelerated microcirculatory damage in retina (all p<0.05). CONCLUSIONS Reduced HGS is significantly associated with a higher risk of diabetic complications and accelerated microvascular damage. HGS could serve as a practical indicator of vascular health in patients with pre-diabetes and diabetes.
Collapse
Affiliation(s)
- Pingting Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Riqian Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ziyu Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yongjie Zhang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Weijing Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan Province, China
| |
Collapse
|
6
|
Stowell M, Dobson R, Garner K, Baig M, Nehren N, Whittaker R. Digital interventions for self-management of prediabetes: A scoping review. PLoS One 2024; 19:e0303074. [PMID: 38728296 PMCID: PMC11086829 DOI: 10.1371/journal.pone.0303074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Rates of prediabetes, which can lead to type 2 diabetes, are increasing worldwide. Interventions for prediabetes mainly focus on lifestyle changes to diet and exercise. While these interventions are effective, they are often delivered face-to-face, which may pose a barrier to those with limited access to healthcare. Given the evidence for digital interventions addressing other noncommunicable diseases, these may also be effective for prediabetes self-management. The aim of this scoping review was to assess the breadth of evidence around digital interventions for prediabetes self-management. METHODS We developed a targeted search strategy and relevant studies were identified through searches conducted in four bibliographic databases (Medline, Embase, PsycInfo, and Scopus). Published studies were eligible if they included a digital intervention to support adults aged 18+ with prediabetes self-management. Titles and abstracts were first screened for relevance by one researcher. Full texts of selected records were assessed against the review criteria independently by two researchers for inclusion in the final analysis. RESULTS Twenty-nine studies were included, of which nine were randomised controlled trials. Most efficacy studies reported significant changes in at least one primary and/or secondary outcome, including participants' glycaemic control, weight loss and/or physical activity levels. About one-third of studies reported mixed outcomes or early significant outcomes that were not sustained at long-term follow-up. Interventions varied in length, digital modalities, and complexity. Delivery formats included text messages, mobile apps, virtually accessible dietitians/health coaches, online peer groups, and web-based platforms. Approximately half of studies assessed participant engagement/acceptability outcomes. CONCLUSION Whilst the evidence here suggests that digital interventions to support prediabetes self-management are acceptable and have the potential to reduce one's risk of progression to type 2 diabetes, more research is needed to understand which interventions, and which components specifically, have the greatest reach to diverse populations, are most effective at promoting user engagement, and are most effective in the longer term.
Collapse
Affiliation(s)
- Melanie Stowell
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Katie Garner
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | | | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| |
Collapse
|
7
|
Roomy MA, Hussain K, Behbehani HM, Abu-Farha J, Al-Harris R, Ambi AM, Abdalla MA, Al-Mulla F, Abu-Farha M, Abubaker J. Therapeutic advances in obesity management: an overview of the therapeutic interventions. Front Endocrinol (Lausanne) 2024; 15:1364503. [PMID: 38715796 PMCID: PMC11074390 DOI: 10.3389/fendo.2024.1364503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/09/2024] [Indexed: 05/23/2024] Open
Abstract
Obesity has become a global epidemic in the modern world, significantly impacting the global healthcare economy. Lifestyle interventions remain the primary approach to managing obesity, with medical therapy considered a secondary option, often used in conjunction with lifestyle modifications. In recent years, there has been a proliferation of newer therapeutic agents, revolutionizing the treatment landscape for obesity. Notably, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, liraglutide, and the recently approved dual GLP-1/GIP RAs agonist tirzepatide, have emerged as effective medications for managing obesity, resulting in significant weight loss. These agents not only promote weight reduction but also improve metabolic parameters, including lipid profiles, glucose levels, and central adiposity. On the other hand, bariatric surgery has demonstrated superior efficacy in achieving weight reduction and addressing overall metabolic imbalances. However, with ongoing technological advancements, there is an ongoing debate regarding whether personalized medicine, targeting specific components, will shape the future of developing novel therapeutic agents for obesity management.
Collapse
Affiliation(s)
- Moody Al Roomy
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Kainat Hussain
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Hawraa M. Behbehani
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jenna Abu-Farha
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Rayan Al-Harris
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Aishwarya Mariam Ambi
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohammed Altigani Abdalla
- Department of Translational Research, Dasman Diabetes Institute, Kuwait City, Kuwait
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Fahd Al-Mulla
- Department of Translational Research, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohamed Abu-Farha
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Translational Research, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jehad Abubaker
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| |
Collapse
|
8
|
Tao HW, Han WW, Fang F, Miao MY, Du HZ, Li ZN, Chen JS, Qin LQ, Chen GC. Plant-based diets, mediating biomarkers, and mortality risk among adults with diabetes or prediabetes. Food Funct 2024; 15:4223-4232. [PMID: 38517343 DOI: 10.1039/d3fo04793h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Background: A healthy eating pattern characterized by a higher intake of healthy plant foods has been associated with a lower risk of premature mortality, but whether this applies to individuals with varying glycemic status remains unclear. Methods: This study included 4621 participants with diabetes and 8061 participants with prediabetes from the US National Health and Nutrition Examination Survey (2007-2016). Using the dietary data assessed by two 24 h dietary recalls, a healthful plant-based diet index (hPDI) and an unhealthful plant-based diet index (uPDI) were created based on 15 food groups and were assessed for their relationships with mortality risk. Results: Over a median follow-up of 7.2 years, there were 1021 deaths in diabetes and 896 deaths in prediabetes. A higher hPDI (highest vs. lowest quartile) was associated with a 41% (HR = 0.59, 95% CI: 0.49-0.72; P-trend < 0.001) lower risk of all-cause mortality in diabetes and a 31% (HR = 0.69, 95% CI: 0.55-0.85; P-trend < 0.001) lower risk in prediabetes. A higher uPDI was associated with an 88% (HR = 1.88, 95% CI: 1.55-2.28; P-trend < 0.001) higher risk of mortality in diabetes and a 63% (HR = 1.63, 95% CI: 1.33-1.99; P-trend < 0.001) higher risk in prediabetes. Mediation analysis suggested that C-reactive protein and γ-glutamine transaminase explained 6.0% to 10.9% of the relationships between hPDI or uPDI and all-cause mortality among participants with diabetes. Conclusions: For adults with diabetes as well as those with prediabetes, adhering to a plant-based diet rich in healthier plant foods is associated with a lower mortality risk, whereas a diet that incorporates less healthy plant foods is associated with a higher mortality risk.
Collapse
Affiliation(s)
- Hao-Wei Tao
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou 215123, China.
| | - Wen-Wen Han
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou 215123, China.
| | - Fei Fang
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou 215123, China.
| | - Meng-Yuan Miao
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou 215123, China.
| | - Hong-Zhen Du
- Department of Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Zeng-Ning Li
- Department of Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Nutrition and Health, Shijiazhuang, China
- Hospital of Stomatology of Hebei Medical University Shijiazhuang, China
| | - Jing-Si Chen
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou 215123, China.
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou 215123, China.
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou 215123, China.
| |
Collapse
|
9
|
Jung W, Cho IY, Jung J, Cho MH, Koo HY, Park YMM, Baek JH, Han K, Shin DW. Changes in physical activity and diabetes risk after cancer diagnosis: a nationwide cohort study. J Cancer Surviv 2024:10.1007/s11764-024-01606-2. [PMID: 38647592 DOI: 10.1007/s11764-024-01606-2] [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: 01/20/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Physical activity has the potential to reduce the risk of diabetes after cancer diagnosis. However, current evidence supporting its effects is limited. This study aims to examine the associations between changes in physical activity and subsequent risk of diabetes among cancer survivors. METHODS A total of 264,250 cancer survivors (mean age 56.7 (12.5) years, 44.2% males) without a prior history of diabetes were assessed for adherence to physical activity both before and after their diagnosis. The primary outcome was incident diabetes. The Fine-Gray proportional sub-distribution hazards model was used to calculate sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) for diabetes risk, considering death as a competing risk. RESULTS Over a follow-up of 1,065,802 person-years, maintaining regular physical activity from pre-diagnosis was associated with a 10% reduced risk of diabetes after cancer diagnosis (sHR 0.90, 95% CI 0.85-0.96), considering traditional diabetes risk factors, sociodemographics, and primary cancer sites. Cancer survivors who became active and inactive after their cancer diagnosis exhibited a marginally decreased risk of diabetes (sHR 0.98, 95% CI 0.93-1.03; sHR 0.97, 95% CI 0.92-1.03). The strength and direction of the association varied depending on the primary site of cancer. CONCLUSIONS Regular physical activity starting before a cancer diagnosis is associated with a lower risk of diabetes following the diagnosis, independent of established diabetes risk factors. IMPLICATIONS FOR CANCER SURVIVORS The study underscores the importance of engaging in sufficient physical activity to mitigate the risk of diabetes in cancer survivors.
Collapse
Affiliation(s)
- Wonyoung Jung
- Department of Family Medicine/Obesity and Metabolic Health Center, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Young Cho
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinhyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hee Cho
- Samsung C&T Medical Clinic, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong-Moon Mark Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jong-Ha Baek
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Republic of Korea.
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| |
Collapse
|
10
|
Kong R, Li S. Effects of childhood obesity on heart failure and its associated risk factors in the European population: A Mendelian randomization study. Nutr Metab Cardiovasc Dis 2024; 34:1080-1087. [PMID: 38233270 DOI: 10.1016/j.numecd.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/10/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND AND AIMS Observational studies have shown that obesity considerably affects the cardiovascular system. Thus we conducted this Mendelian randomization (MR) analysis to evaluate the causal effect of childhood obesity on heart failure (HF) and its risk factors. METHODS AND RESULTS We obtained genetic instruments from genome-wide association studies (GWAS) that investigated childhood obesity, HF, type 2 diabetes mellitus (T2DM), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), chronic kidney disease (CKD), valvular heart disease, myocarditis, hypertrophic cardiomyopathy, and hyperthyroidism. Inverse variance weighting (IVW), weighted median analysis, MR-Egger, and MR-pleiotropy residual sum and outlier (MR-PRESSO) were employed for MR analyses. In addition, the leave-one-out sensitivity test, MR-PRESSO global test, and Cochran's Q test were used for sensitivity analyses. Genetic evaluations showed that childhood obesity increases the risk of HF (odds ratio [OR] = 1.11, 95%CI: 1.05-1.17, p = 1.26 × 10-4), T2DM (OR = 1.17, 95%CI: 1.12-1.23, p = 8.80 × 10-12), AF (OR = 1.08, 95%CI: 1.05-1.12, p = 2.66 × 10-7), MI (OR = 1.08, 95%CI: 1.04-1.13, p = 3.35 × 10-4), and CAD (OR = 1.08, 95%CI: 1.03-1.13, p = 1.48 × 10-3). We found no association between childhood obesity and CKD, valvular heart disease, myocarditis, hypertrophic cardiomyopathy, or hyperthyroidism. Sensitivity analysis and Bonferroni's correction showed consistent results. CONCLUSIONS Our study provides new evidence for the relationship between childhood obesity and HF and its risk factors. The results indicate that individuals with a history of childhood obesity require more clinical attention to prevent the development of HF.
Collapse
Affiliation(s)
- Renjing Kong
- Department of Geriatrics, The Second Xiangya Hospital, Institute of Aging and Age-Related Disease Research, Central South University, Changsha, Hunan 410011, China
| | - Shuang Li
- Department of Geriatrics, The Second Xiangya Hospital, Institute of Aging and Age-Related Disease Research, Central South University, Changsha, Hunan 410011, China.
| |
Collapse
|
11
|
Lei X, Ishida E, Yoshino S, Matsumoto S, Horiguchi K, Yamada E. Calorie Restriction Using High-Fat/Low-Carbohydrate Diet Suppresses Liver Fat Accumulation and Pancreatic Beta-Cell Dedifferentiation in Obese Diabetic Mice. Nutrients 2024; 16:995. [PMID: 38613031 PMCID: PMC11013071 DOI: 10.3390/nu16070995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
In diabetes, pancreatic β-cells gradually lose their ability to secrete insulin with disease progression. β-cell dysfunction is a contributing factor to diabetes severity. Recently, islet cell heterogeneity, exemplified by β-cell dedifferentiation and identified in diabetic animals, has attracted attention as an underlying molecular mechanism of β-cell dysfunction. Previously, we reported β-cell dedifferentiation suppression by calorie restriction, not by reducing hyperglycemia using hypoglycemic agents (including sodium-glucose cotransporter inhibitors), in an obese diabetic mice model (db/db). Here, to explore further mechanisms of the effects of food intake on β-cell function, db/db mice were fed either a high-carbohydrate/low-fat diet (db-HC) or a low-carbohydrate/high-fat diet (db-HF) using similar calorie restriction regimens. After one month of intervention, body weight reduced, and glucose intolerance improved to a similar extent in the db-HC and db-HF groups. However, β-cell dedifferentiation did not improve in the db-HC group, and β-cell mass compensatory increase occurred in this group. More prominent fat accumulation occurred in the db-HC group livers. The expression levels of genes related to lipid metabolism, mainly regulated by peroxisome proliferator-activated receptor α and γ, differed significantly between groups. In conclusion, the fat/carbohydrate ratio in food during calorie restriction in obese mice affected both liver lipid metabolism and β-cell dedifferentiation.
Collapse
Affiliation(s)
| | - Emi Ishida
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Graduate School of Medicine, Gunma University, Maebashi 371-8511, Gunma, Japan
| | | | | | | | | |
Collapse
|
12
|
Bergman M, Manco M, Satman I, Chan J, Schmidt MI, Sesti G, Vanessa Fiorentino T, Abdul-Ghani M, Jagannathan R, Kumar Thyparambil Aravindakshan P, Gabriel R, Mohan V, Buysschaert M, Bennakhi A, Pascal Kengne A, Dorcely B, Nilsson PM, Tuomi T, Battelino T, Hussain A, Ceriello A, Tuomilehto J. International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes. Diabetes Res Clin Pract 2024; 209:111589. [PMID: 38458916 DOI: 10.1016/j.diabres.2024.111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Many individuals with intermediate hyperglycaemia (IH), including impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT), as presently defined, will progress to type 2 diabetes (T2D). There is confirmatory evidence that T2D can be prevented by lifestyle modification and/or medications, in people with IGT diagnosed by 2-h plasma glucose (PG) during a 75-gram oral glucose tolerance test (OGTT). Over the last 40 years, a wealth of epidemiological data has confirmed the superior value of 1-h plasma glucose (PG) over fasting PG (FPG), glycated haemoglobin (HbA1c) and 2-h PG in populations of different ethnicity, sex and age in predicting diabetes and associated complications including death. Given the relentlessly rising prevalence of diabetes, a more sensitive, practical method is needed to detect people with IH and T2D for early prevention or treatment in the often lengthy trajectory to T2D and its complications. The International Diabetes Federation (IDF) Position Statement reviews findings that the 1-h post-load PG ≥ 155 mg/dL (8.6 mmol/L) in people with normal glucose tolerance (NGT) during an OGTT is highly predictive for detecting progression to T2D, micro- and macrovascular complications, obstructive sleep apnoea, cystic fibrosis-related diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, and mortality in individuals with risk factors. The 1-h PG of 209 mg/dL (11.6 mmol/L) is also diagnostic of T2D. Importantly, the 1-h PG cut points for diagnosing IH and T2D can be detected earlier than the recommended 2-h PG thresholds. Taken together, the 1-h PG provides an opportunity to avoid misclassification of glycaemic status if FPG or HbA1c alone are used. The 1-h PG also allows early detection of high-risk people for intervention to prevent progression to T2D which will benefit the sizeable and growing population of individuals at increased risk of T2D. Using a 1-h OGTT, subsequent to screening with a non-laboratory diabetes risk tool, and intervening early will favourably impact the global diabetes epidemic. Health services should consider developing a policy for screening for IH based on local human and technical resources. People with a 1-h PG ≥ 155 mg/dL (8.6 mmol/L) are considered to have IH and should be prescribed lifestyle intervention and referred to a diabetes prevention program. People with a 1-h PG ≥ 209 mg/dL (11.6 mmol/L) are considered to have T2D and should have a repeat test to confirm the diagnosis of T2D and then referred for further evaluation and treatment. The substantive data presented in the Position Statement provides strong evidence for redefining current diagnostic criteria for IH and T2D by adding the 1-h PG.
Collapse
Affiliation(s)
- Michael Bergman
- NYU Grossman School of Medicine, Departments of Medicine and of Population Health, Division of Endocrinology, Diabetes and Metabolism, VA New York Harbor Healthcare System, New York, NY, USA.
| | - Melania Manco
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ilhan Satman
- Istanbul University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
| | - Juliana Chan
- The Chinese University of Hong Kong, Faculty of Medicine, Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Hong Kong, China
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, 00189 Rome, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio Texas, USA
| | - Ram Jagannathan
- Hubert Department of Global Health Rollins, School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Rafael Gabriel
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University, Clinic Saint-Luc, Brussels, Belgium
| | - Abdullah Bennakhi
- Dasman Diabetes Institute Office of Regulatory Affairs, Ethics Review Committee, Kuwait
| | - Andre Pascal Kengne
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - Brenda Dorcely
- NYU Grossman School of Medicine, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York, NY, USA
| | - Peter M Nilsson
- Department of Clinical Sciences and Lund University Diabetes Centre, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Tiinamaija Tuomi
- Folkhälsan Research Center, Helsinki, Finland; Abdominal Center, Endocrinology, Helsinki University Central Hospital, Research Program for Diabetes and Obesity, Center of Helsinki, Helsinki, Finland
| | | | - Akhtar Hussain
- Faculty of Health Sciences, Nord University, Bodø, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation (IDF), Brussels, Belgium; Diabetes in Asia Study Group, Post Box: 752, Doha-Qatar; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Jaakko Tuomilehto
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain; Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
13
|
Brieger L, Schramm S, Schmidt B, Roggenbuck U, Erbel R, Stang A, Kowall B. Aggregation of type-2 diabetes, prediabetes, and metabolic syndrome in German couples. Sci Rep 2024; 14:2984. [PMID: 38316913 PMCID: PMC10844497 DOI: 10.1038/s41598-024-53417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
We aimed to examine the concordance of type-2 diabetes, prediabetes and the metabolic syndrome in couples. In cross-sectional analyses, we used data from 1173 couples with index persons from the Heinz Nixdorf Recall Study (2011-2015), a population-based cohort study in Western Germany, and partners from the associated Heinz Nixdorf Multigeneration Study (2013-2016). Mean age (standard deviation) was 67.2 (6.6) years in index persons, and 67.8 (7.7) years in partners. The exposure was the presence of diabetes, prediabetes or metabolic syndrome in index persons, the outcome was the presence of the same health status in partners. Diabetes was defined by either self-reported diagnosis, intake of antidiabetic drugs or insulin, or HbA1c ≥ 6.5%. If the index person had prediabetes or diabetes, the partner was 1.46 (95% CI 1.07-2.00) times more likely to have diabetes than partners of index persons without the condition in the crude model (adjusted model: 1.33 (0.97-1.83)). For self-reported diabetes and for the metabolic syndrome, the corresponding prevalence ratios were 1.33 (0.90-1.97) and 1.17 (1.03-1.32), respectively (adjusted models: 1.23 (0.77-1.94), 1.04 (0.91-1.18)). In German couples, there was weak to moderate concordance of type-2 diabetes, prediabetes and the metabolic syndrome in crude, but poor concordance in adjusted models.
Collapse
Affiliation(s)
- Lara Brieger
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Ulla Roggenbuck
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
- School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
| |
Collapse
|
14
|
Lugner M, Rawshani A, Helleryd E, Eliasson B. Identifying top ten predictors of type 2 diabetes through machine learning analysis of UK Biobank data. Sci Rep 2024; 14:2102. [PMID: 38267466 PMCID: PMC10808323 DOI: 10.1038/s41598-024-52023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
The study aimed to identify the most predictive factors for the development of type 2 diabetes. Using an XGboost classification model, we projected type 2 diabetes incidence over a 10-year horizon. We deliberately minimized the selection of baseline factors to fully exploit the rich dataset from the UK Biobank. The predictive value of features was assessed using shap values, with model performance evaluated via Receiver Operating Characteristic Area Under the Curve, sensitivity, and specificity. Data from the UK Biobank, encompassing a vast population with comprehensive demographic and health data, was employed. The study enrolled 450,000 participants aged 40-69, excluding those with pre-existing diabetes. Among 448,277 participants, 12,148 developed type 2 diabetes within a decade. HbA1c emerged as the foremost predictor, followed by BMI, waist circumference, blood glucose, family history of diabetes, gamma-glutamyl transferase, waist-hip ratio, HDL cholesterol, age, and urate. Our XGboost model achieved a Receiver Operating Characteristic Area Under the Curve of 0.9 for 10-year type 2 diabetes prediction, with a reduced 10-feature model achieving 0.88. Easily measurable biological factors surpassed traditional risk factors like diet, physical activity, and socioeconomic status in predicting type 2 diabetes. Furthermore, high prediction accuracy could be maintained using just the top 10 biological factors, with additional ones offering marginal improvements. These findings underscore the significance of biological markers in type 2 diabetes prediction.
Collapse
Affiliation(s)
- Moa Lugner
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Araz Rawshani
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Edvin Helleryd
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
15
|
van Leersum CM, Konrad KE, Bults M, den Ouden ME. Living with my diabetes - introducing eHealth into daily practices of patients with type 2 diabetes mellitus. Digit Health 2024; 10:20552076241257052. [PMID: 39148810 PMCID: PMC11325462 DOI: 10.1177/20552076241257052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/07/2024] [Indexed: 08/17/2024] Open
Abstract
Objective Diabetes patients can draw on an increasing number of eHealth apps to support them in the self-management of their disease. While studies so far have focused on patients with type 1 diabetes, we explored how patients with type 2 diabetes mellitus (T2DM) integrate eHealth apps into their practices aimed at managing and coping with the disease, which aspects were considered particularly valuable and which challenges users encountered. Methods Semi-structured interviews and focus group sessions were conducted to explore how patients cope with T2DM in their daily lives and their attitude towards eHealth. In a further step, four eHealth apps were tested by patients and their expectations and experiences studied by way of qualitative interviews and focus groups. Results The analysis showed that the study participants valued in particular the possibility to use eHealth apps to sense and gain a better understanding of their own body, to learn about specific responses of their body to nutrition and physical activity, and to support changes in daily routines and lifestyle. Key challenges encountered related to difficulties in interpreting the data, matching the data to other bodily sensations, getting overly occupied with the disease and difficulties in integrating the apps into personal, family, and care practices. Conclusion Under certain conditions, eHealth can play an important role for patients in developing a nuanced, personal understanding of their body and coping with T2DM. A prerequisite is that eHealth needs to be fitted into the specific practices of users, and patients desire a strong role by their care professionals in providing support in interpretation of data.
Collapse
Affiliation(s)
- Catharina M van Leersum
- Department of Technology, Policy, and Society, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
- Faculty of Humanities, Open Universiteit Nederland, Heerlen, The Netherlands
| | - Kornelia E Konrad
- Department of Technology, Policy, and Society, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Marloes Bults
- Technology, Health & Care Research Group, Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Marjolein Em den Ouden
- Technology, Health & Care Research Group, Saxion University of Applied Sciences, Enschede, The Netherlands
| |
Collapse
|
16
|
Carrasco-Zanini J, Pietzner M, Wheeler E, Kerrison ND, Langenberg C, Wareham NJ. Multi-omic prediction of incident type 2 diabetes. Diabetologia 2024; 67:102-112. [PMID: 37889320 PMCID: PMC10709231 DOI: 10.1007/s00125-023-06027-x] [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: 06/07/2023] [Accepted: 08/30/2023] [Indexed: 10/28/2023]
Abstract
AIMS/HYPOTHESIS The identification of people who are at high risk of developing type 2 diabetes is a key part of population-level prevention strategies. Previous studies have evaluated the predictive utility of omics measurements, such as metabolites, proteins or polygenic scores, but have considered these separately. The improvement that combined omics biomarkers can provide over and above current clinical standard models is unclear. The aim of this study was to test the predictive performance of genome, proteome, metabolome and clinical biomarkers when added to established clinical prediction models for type 2 diabetes. METHODS We developed sparse interpretable prediction models in a prospective, nested type 2 diabetes case-cohort study (N=1105, incident type 2 diabetes cases=375) with 10,792 person-years of follow-up, selecting from 5759 features across the genome, proteome, metabolome and clinical biomarkers using least absolute shrinkage and selection operator (LASSO) regression. We compared the predictive performance of omics-derived predictors with a clinical model including the variables from the Cambridge Diabetes Risk Score and HbA1c. RESULTS Among single omics prediction models that did not include clinical risk factors, the top ten proteins alone achieved the highest performance (concordance index [C index]=0.82 [95% CI 0.75, 0.88]), suggesting the proteome as the most informative single omic layer in the absence of clinical information. However, the largest improvement in prediction of type 2 diabetes incidence over and above the clinical model was achieved by the top ten features across several omic layers (C index=0.87 [95% CI 0.82, 0.92], Δ C index=0.05, p=0.045). This improvement by the top ten omic features was also evident in individuals with HbA1c <42 mmol/mol (6.0%), the threshold for prediabetes (C index=0.84 [95% CI 0.77, 0.90], Δ C index=0.07, p=0.03), the group in whom prediction would be most useful since they are not targeted for preventative interventions by current clinical guidelines. In this subgroup, the type 2 diabetes polygenic risk score was the major contributor to the improvement in prediction, and achieved a comparable improvement in performance when added onto the clinical model alone (C index=0.83 [95% CI 0.75, 0.90], Δ C index=0.06, p=0.002). However, compared with those with prediabetes, individuals at high polygenic risk in this group had only around half the absolute risk for type 2 diabetes over a 20 year period. CONCLUSIONS/INTERPRETATION Omic approaches provided marginal improvements in prediction of incident type 2 diabetes. However, while a polygenic risk score does improve prediction in people with an HbA1c in the normoglycaemic range, the group in whom prediction would be most useful, even individuals with a high polygenic burden in that subgroup had a low absolute type 2 diabetes risk. This suggests a limited feasibility of implementing targeted population-based genetic screening for preventative interventions.
Collapse
Affiliation(s)
- Julia Carrasco-Zanini
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
| | - Maik Pietzner
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
| | - Eleanor Wheeler
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
| | - Nicola D Kerrison
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge, UK.
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK.
| | - Nicholas J Wareham
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge, UK.
| |
Collapse
|
17
|
Qiu J, Kuang M, Zou Y, Yang R, Shangguan Q, Liu D, Sheng G, Wang W. The predictive significance of lipid accumulation products for future diabetes in a non-diabetic population from a gender perspective: an analysis using time-dependent receiver operating characteristics. Front Endocrinol (Lausanne) 2023; 14:1285637. [PMID: 38034005 PMCID: PMC10682705 DOI: 10.3389/fendo.2023.1285637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objective The increasing prevalence of diabetes is strongly associated with visceral adipose tissue (VAT), and gender differences in VAT remarkably affect the risk of developing diabetes. This study aimed to assess the predictive significance of lipid accumulation products (LAP) for the future onset of diabetes from a gender perspective. Methods A total of 8,430 male and 7,034 female non-diabetic participants in the NAGALA (NAfld in the Gifu Area, Longitudinal Analysis) program were included. The ability of LAP to assess the risk of future new-onset diabetes in both genders was analyzed using multivariate Cox regression. Subgroup analysis was conducted to explore the impact of potential modifiers on the association between LAP and diabetes. Additionally, time-dependent receiver operator characteristics (ROC) curves were used to assess the predictive power of LAP in both genders for new-onset diabetes over the next 2-12 years. Results Over an average follow-up of 6.13 years (maximum 13.14 years), 373 participants developed diabetes. Multivariate Cox regression analysis showed a significant gender difference in the association between LAP and future diabetes risk (P-interaction<0.05): the risk of diabetes associated with LAP was greater in females than males [hazard ratios (HRs) per standard deviation (SD) increase: male 1.20 (1.10, 1.30) vs female 1.35 (1.11, 1.64)]. Subgroup analysis revealed no significant modifying effect of factors such as age, body mass index (BMI), smoking history, drinking history, exercise habits, and fatty liver on the risk of diabetes associated with LAP (All P-interaction <0.05). Time-dependent ROC analysis showed that LAP had greater accuracy in predicting diabetes events occurring within the next 2-12 years in females than males with more consistent predictive thresholds in females. Conclusions This study highlighted a significant gender difference in the association between LAP and future diabetes risk. The risk of diabetes associated with LAP was greater in females than in males. Furthermore, LAP showed superior predictive ability for diabetes at different time points in the future in females and had more consistent and stable predictive thresholds in females, particularly in the medium and long term.
Collapse
Affiliation(s)
- Jiajun Qiu
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Maobin Kuang
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Ruijuan Yang
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Qing Shangguan
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Dingyang Liu
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Wei Wang
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| |
Collapse
|
18
|
Piras A, Raffi M. A Narrative Literature Review on the Role of Exercise Training in Managing Type 1 and Type 2 Diabetes Mellitus. Healthcare (Basel) 2023; 11:2947. [PMID: 37998439 PMCID: PMC10671220 DOI: 10.3390/healthcare11222947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia associated with impaired carbohydrate, lipid, and protein metabolism, with concomitant absence of insulin secretion or reduced sensitivity to its metabolic effects. Patients with diabetes mellitus have a 30% more risk of developing heart failure and cardiovascular disease compared to healthy people. Heart and cardiovascular problems are the first cause of death worldwide and the main complications which lead to high healthcare costs. Such complications can be delayed or avoided by taking prescribed medications in conjunction with a healthy lifestyle (i.e., diet and physical activity). The American College of Sports Medicine and the American Diabetes Association recommend that diabetic people reduce total sedentary time by incorporating physical activity into their weekly routine. This narrative literature review aims to summarize and present the main guidelines, pre-exercise cardiovascular screening recommendations, and considerations for patients with diabetes and comorbidities who are planning to participate in physical activity programs.
Collapse
Affiliation(s)
- Alessandro Piras
- Department of Life Quality Studies, University of Bologna, 40126 Bologna, Italy
| | - Milena Raffi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy;
| |
Collapse
|
19
|
Lim S, Takele WW, Vesco KK, Redman LM, Hannah W, Bonham MP, Chen M, Chivers SC, Fawcett AJ, Grieger JA, Habibi N, Leung GKW, Liu K, Mekonnen EG, Pathirana M, Quinteros A, Taylor R, Ukke GG, Zhou SJ, Josefson J. Participant characteristics in the prevention of gestational diabetes as evidence for precision medicine: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2023; 3:137. [PMID: 37794119 PMCID: PMC10551015 DOI: 10.1038/s43856-023-00366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with responses to interventions in gestational diabetes mellitus (GDM) prevention. METHODS We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022. RESULTS From 10347 studies, 116 studies (n = 40940 women) are included. Physical activity results in greater GDM reduction in participants with a normal body mass index (BMI) at baseline compared to obese BMI (risk ratio, 95% confidence interval: 0.06 [0.03, 0.14] vs 0.68 [0.26, 1.60]). Combined diet and physical activity interventions result in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) than those with PCOS (0.62 [0.47, 0.82] vs 1.12 [0.78-1.61]) and in those without a history of GDM than those with unspecified GDM history (0.62 [0.47, 0.81] vs 0.85 [0.76, 0.95]). Metformin interventions are more effective in participants with PCOS than those with unspecified status (0.38 [0.19, 0.74] vs 0.59 [0.25, 1.43]), or when commenced preconception than during pregnancy (0.21 [0.11, 0.40] vs 1.15 [0.86-1.55]). Parity, history of having a large-for-gestational-age infant or family history of diabetes have no effect on intervention responses. CONCLUSIONS GDM prevention through metformin or lifestyle differs according to some individual characteristics. Future research should include trials commencing preconception and provide results disaggregated by a priori defined participant characteristics including social and environmental factors, clinical traits, and other novel risk factors to predict GDM prevention through interventions.
Collapse
Affiliation(s)
- Siew Lim
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Wubet Worku Takele
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kimberly K Vesco
- Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Oakland, USA
| | | | - Wesley Hannah
- Madras Diabetes Research Foundation Chennai, Chennai, India
- Deakin University, Melbourne, Australia
| | - Maxine P Bonham
- Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Sian C Chivers
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Andrea J Fawcett
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Clinical & Organizational Development, University of Chicago, Chicago, IL, USA
| | - Jessica A Grieger
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Nahal Habibi
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Gloria K W Leung
- Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
| | - Kai Liu
- Department of Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
| | | | - Maleesa Pathirana
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Alejandra Quinteros
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Rachael Taylor
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Gebresilasea G Ukke
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shao J Zhou
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
- American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) Precision Medicine in Diabetes Initiative (PMDI) led by Paul Franks, Malmo, Sweden
| | - Jami Josefson
- Northwestern University/ Lurie Children's Hospital of Chicago, Chicago, USA.
| |
Collapse
|
20
|
Vajje J, Khan S, Kaur A, Kataria H, Sarpoolaki S, Goudel A, Bhatti AH, Allahwala D. Comparison of the Efficacy of Metformin and Lifestyle Modification for the Primary Prevention of Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Cureus 2023; 15:e47105. [PMID: 38021728 PMCID: PMC10646693 DOI: 10.7759/cureus.47105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
This meta-analysis aimed to compare the effectiveness of metformin versus lifestyle interventions in preventing diabetes in individuals with prediabetes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted a comprehensive search of databases (PubMed, Cochrane Library, EMBASE) up to September 1, 2023. Five eligible studies were included. The results showed that there was no significant difference in the risk of developing diabetes between the metformin and lifestyle intervention groups (RR: 1.14, 95% CI: 0.77-1.68). Similarly, when comparing metformin with lifestyle intervention, the risk of diabetes was slightly higher in the metformin group, but this difference was not statistically significant (RR: 1.31, 95% CI: 0.93-1.86). When comparing metformin with lifestyle intervention to lifestyle intervention alone, no significant difference was observed in the incidence of diabetes (RR: 0.88, 95% CI: 0.74-1.04). In conclusion, our analysis found that the incidence of type 2 diabetes was slightly higher in patients receiving metformin alone compared to lifestyle intervention, but this difference did not reach statistical significance. Further trials are necessary to better evaluate these interventions for preventing type 2 diabetes in high-risk individuals.
Collapse
Affiliation(s)
- Jaahnavi Vajje
- Internal Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND
| | - Saima Khan
- Internal Medicine, Sir Syed College of Medical Sciences for Girls, Waterbury, USA
| | - Avneet Kaur
- Internal Medicine, Government Medical College, Patiala, Patiala, IND
| | - Heemali Kataria
- Internal Medicine, Government Medical College, Surat, Surat, IND
| | | | - Aastha Goudel
- Medicine, Zainul Haque Sikder Women's Medical College and Hospital, Dhaka, NPL
| | | | | |
Collapse
|
21
|
Kurian J, Mavathur Nanjundaiah R. Reinstating acute-phase insulin release among sedentary adults at high risk for type 2 diabetes with Yoga and Walking based lifestyle modification. J Bodyw Mov Ther 2023; 36:300-306. [PMID: 37949576 DOI: 10.1016/j.jbmt.2023.08.003] [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: 02/15/2023] [Revised: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND We compared the impact of 2 lifestyle modifying physical activities, yoga (YBLM) or walking (WBLM) on impaired beta cell function (IBF) or insulin resistance (IR) in restoring acute phase insulin release (APIR) among prediabetes at high risk for type 2 diabetes (HRDM). METHOD Male and female adults (N = 42, 38.1 ± 4.8 years) with abdominal obesity (Male:103 ± 8.1 cm) Female: 92 ± 11.1 cm), randomized into YBLM (n = 20) and WBLM (n = 22), were monitored for the practice of the intervention, 45 min a day/5 days a week for 12 weeks. Blood sample was collected at 0th minute to estimate the level of Fasting Blood Glucose (FBG), Sr. Insulin and lipid profile and at 10th minute (APIR). IBF, IR and sensitivity (IS) reading were checked in HOMA-2 calculator. RESULT Wilcoxon sign rank t-test denoted an improved APIR among the subjects with IBF (p = 0.008) and not among the subjects with IR (p = 0.332). However, regression analysis yielded an improved APIR among subjects with IBF (F(1,10) = 7.816, p = 0.002) with the management of body weight and lipid profile and IR (F(1,13) = 17.003, p = 0.001) being found influenced with selected lipid components. In all, during the post assessment period, an impressive boost in APIR was manifested among people shifted to Normoglycemia (n = 14, 35.9%). CONCLUSION Intriguingly, we postulate the potential role of YBLM over WBLM in the management of lipid profile and body weight on accelerating APIR either through improved Beta cell compensation or by sensitizing skeletal muscles regulating IR, helping improve glucose tolerance resulting in either remission or management of prediabetes.
Collapse
Affiliation(s)
- Jintu Kurian
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Jigani, Bangalore, 560105, India.
| | - Ramesh Mavathur Nanjundaiah
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Jigani, Bangalore, 560105, India.
| |
Collapse
|
22
|
Mousavi SS, Namayandeh SM, Fallahzadeh H, Rahmanian M, Mollahosseini M. Comparing the effectiveness of metformin with lifestyle modification for the primary prevention of type II diabetes: a systematic review and meta-analysis. BMC Endocr Disord 2023; 23:198. [PMID: 37723440 PMCID: PMC10506297 DOI: 10.1186/s12902-023-01445-9] [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: 11/12/2022] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Concerning ascending trend in the prevalence of chronic type II diabetes, prevention and the development of an effective approach after the recognition of at-risk individuals is crucial. This study aims to investigate comparing the influence of lifestyle modification and metformin interventions in the prevention of type II diabetes developments. METHOD The search was conducted using PubMed, Google Scholar, Scopus and Web of Science databases. The inclusion criteria include randomized controlled trials (RCT) which studied both lifestyle modification and metformin interventions in the population above 18 years old without a history of any type of diabetes. After excluding studies with intervention time of fewer than 6 months, a systematic review and meta-analysis were performed to evaluate relative risk (RR) with a confidence interval (CI) of 95% of type II diabetes development. RESULTS Data from 5 studies were included in the meta-analysis. The population also consists of individuals with a mean age of 50 years old with BMI and FBS of 35.5 and 104.7 mg/dl respectively. Participants range of prevention years was between 2-3 years with a mean of 2.8 years. Lifestyle modification decreases the probability of the incidence of type II diabetes by 25.3% (RR: 0.747, 95% CI, 0.6-0.92) compared to the metformin intervention (p-value = 0.007). Our results indicate that long-term lifestyle modifications can prevent diabetes type II and decrease diabetes mellitus incidence down to one-quarter in comparison to metformin. CONCLUSION Lifestyle modification can be more efficacious than metformin in diminishing the incidence of type II diabetes. Therefore, lifestyle modification can be a therapeutic strategy for controlling type II diabetes incidence, especially in high-risk individuals.
Collapse
Affiliation(s)
- Sayedah Sarah Mousavi
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Shohaday-E-Gomnam Blvd., Alem Sq., Yazd, Iran
| | - Seyedeh Mahdieh Namayandeh
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Shohaday-E-Gomnam Blvd., Alem Sq., Yazd, Iran.
| | - Hossein Fallahzadeh
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Shohaday-E-Gomnam Blvd., Alem Sq., Yazd, Iran
| | - Masoud Rahmanian
- Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Shohaday-E-Gomnam Blvd., Alem Sq., Yazd, Iran
| | - Mehdi Mollahosseini
- Department of Community Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Shohaday-E-Gomnam Blvd., Alem Sq., Yazd, Iran
| |
Collapse
|
23
|
Ha KH, Kim DJ, Han SJ. Associations of updated cardiovascular health metrics, including sleep health, with incident diabetes and cardiovascular events in older adults with prediabetes: A nationwide population-based cohort study. Diabetes Res Clin Pract 2023; 203:110820. [PMID: 37422164 DOI: 10.1016/j.diabres.2023.110820] [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: 04/25/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
AIMS To investigate the association of updated cardiovascular health (CVH) metrics, including sleep health, with the risk of diabetes and major adverse cardiovascular events (MACE) in older adults with prediabetes. METHODS A total of 7,948 older adults with prediabetes aged ≥ 65 years were included in this study. CVH was assessed using seven baseline metrics according to the modified American Heart Association recommendations. RESULTS During a median follow-up time of 11.9 years, 2,405 (30.3%) cases of diabetes and 2,039 (25.6%) MACE were recorded. Compared with the poor composite CVH metrics group, the multivariable-adjusted hazard ratios (HRs) in the intermediate and ideal composite CVH metrics groups were respectively 0.87 (95% confidence intervals [CI] = 0.78-0.96) and 0.72 (95% CI = 0.65-0.79) for diabetes events and 0.99 (95% CI = 0.88-1.11) and 0.88 (95% CI = 0.79-0.97) for MACE. The ideal composite CVH metrics group had a lower risk of diabetes and MACE in older adults aged 65-74 years, but not in those aged ≥ 75 years. CONCLUSIONS Ideal composite CVH metrics in older adults with prediabetes were associated with a lower risk of diabetes and MACE.
Collapse
Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
| |
Collapse
|
24
|
Seah JYH, Yao J, Hong Y, Lim CGY, Sabanayagam C, Nusinovici S, Gardner DSL, Loh M, Müller-Riemenschneider F, Tan CS, Yeo KK, Wong TY, Cheng CY, Ma S, Tai ES, Chambers JC, van Dam RM, Sim X. Risk prediction models for type 2 diabetes using either fasting plasma glucose or HbA1c in Chinese, Malay, and Indians: Results from three multi-ethnic Singapore cohorts. Diabetes Res Clin Pract 2023; 203:110878. [PMID: 37591346 DOI: 10.1016/j.diabres.2023.110878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
AIMS To assess three well-established type 2 diabetes (T2D) risk prediction models based on fasting plasma glucose (FPG) in Chinese, Malays, and Indians, and to develop simplified risk models based on either FPG or HbA1c. METHODS We used a prospective multiethnic Singapore cohort to evaluate the established models and develop simplified models. 6,217 participants without T2D at baseline were included, with an average follow-up duration of 8.3 years. The simplified risk models were validated in two independent multiethnic Singapore cohorts (N = 12,720). RESULTS The established risk models had moderate-to-good discrimination (area under the receiver operating characteristic curves, AUCs 0.762 - 0.828) but a lack of fit (P-values < 0.05). Simplified risk models that included fewer predictors (age, BMI, systolic blood pressure, triglycerides, and HbA1c or FPG) showed good discrimination in all cohorts (AUCs ≥ 0.810), and sufficiently captured differences between the ethnic groups. While recalibration improved fit the simplified models in validation cohorts, there remained evidence of miscalibration in Chinese (p ≤ 0.012). CONCLUSIONS Simplified risk models including HbA1c or FPG had good discrimination in predicting incidence of T2D in three major Asian ethnic groups. Risk functions with HbA1c performed as well as those with FPG.
Collapse
Affiliation(s)
- Jowy Yi Hong Seah
- Centre for Population Health Research and Implementation, SingHealth, Singapore 150167, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jiali Yao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Yueheng Hong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Charlie Guan Yi Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
| | - Daphne Su-Lyn Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore
| | - Marie Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; Research Division, National Skin Centre, Singapore 308205, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore 169609, Singapore; Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore; Center for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - Stefan Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore 169854, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - John C Chambers
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, United States.
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
| |
Collapse
|
25
|
Withers TM, Garner NJ, Thorley CS, Kellett J, Price L, Auckland S, Sheldon J, Howe A, Pascale M, Smith JR, Sampson MJ, Greaves CJ. Intervention fidelity assessment: A sub-study of the Norfolk Diabetes Prevention Study (NDPS). Br J Health Psychol 2023; 28:740-752. [PMID: 36775261 DOI: 10.1111/bjhp.12651] [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: 05/10/2022] [Accepted: 01/20/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Previous research has shown that lifestyle modification can delay or prevent the onset of type 2 diabetes in high-risk individuals. The Norfolk Diabetes Prevention Study (NDPS) was a parallel, three-arm, randomized controlled trial with up to 46 months follow-up that tested a group-delivered, theory-based lifestyle intervention to reduce the incidence of type 2 diabetes in high-risk groups. The current study aimed to evaluate if the NDPS intervention was delivered to an acceptable standard and if any part(s) of the delivery required improvement. METHODS A sub-sample of 30, 25 for inter-rater reliability and audio-recordings of the NDPS intervention education sessions were assessed independently by two reviewers (CT, TW) using a 12-item checklist. Each item was scored on a 0-5 scale, with a score of 3 being defined as 'adequate delivery'. Inter-rater reliability was assessed. Analysis of covariance (ANCOVA) was used to assess changes in intervention fidelity as the facilitators gained experience. RESULTS Inter-rater agreement was acceptable (86%). A mean score of 3.47 (SD = .38) was achieved across all items of the fidelity checklist and across all intervention facilitators (n = 6). There was an apparent trend for intervention fidelity scores to decrease with experience; however, this trend was non-significant (p > .05) across all domains in this small sample. CONCLUSION The NDPS was delivered to an acceptable standard by all Diabetes Prevention Facilitators. Further research is needed to better understand how the intervention's delivery characteristics can be optimized and how they might vary over time.
Collapse
Affiliation(s)
- Thomas M Withers
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nikki J Garner
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- University of Exeter Medical School, Exeter, UK
| | - Chris S Thorley
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jo Kellett
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Lucy Price
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Sara Auckland
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Jo Sheldon
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Melanie Pascale
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | | | - Mike J Sampson
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, 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 and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
26
|
Li L, Cheng Y, Ji W, Liu M, Hu Z, Yang Y, Wang Y, Zhou Y. Machine learning for predicting diabetes risk in western China adults. Diabetol Metab Syndr 2023; 15:165. [PMID: 37501094 PMCID: PMC10373320 DOI: 10.1186/s13098-023-01112-y] [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: 03/09/2023] [Accepted: 06/15/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Diabetes mellitus is a global epidemic disease. Long-time exposure of patients to hyperglycemia can lead to various type of chronic tissue damage. Early diagnosis of and screening for diabetes are crucial to population health. METHODS We collected the national physical examination data in Xinjiang, China, in 2020 (a total of more than 4 million people). Three types of physical examination indices were analyzed: questionnaire, routine physical examination and laboratory values. Integrated learning, deep learning and logistic regression methods were used to establish a risk model for type-2 diabetes mellitus. In addition, to improve the convenience and flexibility of the model, a diabetes risk score card was established based on logistic regression to assess the risk of the population. RESULTS An XGBoost-based risk prediction model outperformed the other five risk assessment algorithms. The AUC of the model was 0.9122. Based on the feature importance ranking map, we found that hypertension, fasting blood glucose, age, coronary heart disease, ethnicity, parental diabetes mellitus, triglycerides, waist circumference, total cholesterol, and body mass index were the most important features of the risk prediction model for type-2 diabetes. CONCLUSIONS This study established a diabetes risk assessment model based on multiple ethnicities, a large sample and many indices, and classified the diabetes risk of the population, thus providing a new forecast tool for the screening of patients and providing information on diabetes prevention for healthy populations.
Collapse
Affiliation(s)
- Lin Li
- Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Yinlin Cheng
- Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Weidong Ji
- Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Mimi Liu
- Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Zhensheng Hu
- Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Yining Yang
- People's Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xijiang, China.
| | - Yushan Wang
- Center of Health Management, The First Affiliated Hospital of Xinjiang Medical University, No. 393, Xinyi Road, Xinshi District, Urumqi, 830054, Xinjiang, China.
| | - Yi Zhou
- Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong, China.
| |
Collapse
|
27
|
Livadas S, Paparodis R, Anagnostis P, Gambineri A, Bjekić-Macut J, Petrović T, Yildiz BO, Micić D, Mastorakos G, Macut D. Assessment of Type 2 Diabetes Risk in Young Women with Polycystic Ovary Syndrome. Diagnostics (Basel) 2023; 13:2067. [PMID: 37370962 DOI: 10.3390/diagnostics13122067] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/23/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Women with polycystic ovary syndrome (PCOS) are at increased risk for dysglycemia and type 2 diabetes compared to healthy BMI-matched women of reproductive age: robust evidence exists supporting this notion. The presence of altered glycemic status in young women with the syndrome presents a distinct challenge for the clinician for several reasons. Firstly, the reported incidence of this disorder varies among the limited available studies. Furthermore, there is a lack of consensus on the best screening method, which women to screen, at what frequency, and which strategies need to be implemented to reduce the above risk. We provide data regarding the prevalence of dysglycemia in young women suffering from PCOS and the pathophysiological mechanisms underlying the disorder. In addition, we present evidence suggesting universal screening with the oral glucose tolerance test in young women with the syndrome, irrespective of age or BMI status, to identify and manage glycemic abnormalities in a timely manner. Regarding follow-up, oral glucose testing should be carried out at regular intervals if there are initial abnormal findings or predisposing factors. Finally, the efficacy of a well-balanced diet in conjunction with regular exercise and the use of non-pharmacologic agents in this specific population is discussed.
Collapse
Affiliation(s)
| | - Rodis Paparodis
- Center for Diabetes and Endocrine Research, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 57429 Thessaloniki, Greece
| | - Alessandra Gambineri
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, 40138 Bologna, Italy
| | - Jelica Bjekić-Macut
- Department of Endocrinology, UMC Bežanijska kosa, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tijana Petrović
- Department of Endocrinology, UMC Bežanijska kosa, 11080 Belgrade, Serbia
| | - Bulent O Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Dragan Micić
- Department of Medical Sciences, Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| |
Collapse
|
28
|
Verma R, Bhardwaj S, Lathia T, Kalra S, Ranadive R, Tanna S, Padsalge M, Juneja A, Samundra K, Thakkar PB, Jain V, Kini V, Kothari S, Guntur S, Joshi S, Singal A. Personalized glycemic response led digital therapeutics program improves time in range in a period of 14 days. Int J Diabetes Dev Ctries 2023; 43:425-432. [PMID: 35892065 PMCID: PMC9303844 DOI: 10.1007/s13410-022-01111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Lifestyle modification is an integral aspect for the management of type 2 diabetes (T2D). However, it is difficult to ensure the accuracy of personalized lifestyle advice. The study aims to analyse the real-world effectiveness of personalized glycemic response based Diabefly-Pro digital therapeutics for better glycemic control. Methods Data from continuous glucose monitoring (CGM) of 64 participants with T2D was analysed. All participants were provided with modified lifestyle plan based on their personalized glycemic response. The CGM data was analysed for a period of 7 days, before and after the introduction of modified lifestyle plan. Primary outcome of the study was change in time in range (TIR). Secondary outcomes of the study were change in mean blood glucose, time above range (TAR), time below range (TBR) and glucose management indicator (GMI). Results Significant improvement in glycemic control was observed after the introduction of personalized lifestyle plan. Median reduction in mean blood glucose was from 139.5 (118.3 to 169.3) mg/dL to 122.0 (101.5 to 148.8) mg/dL (p < 0.0001). TIR and GMI improved from 70.50 (50.75 to 83.50) % to 75.00 (58.25 to 89.00) % (p = 0.0001) and 6.64 (6.13 to 7.35) % to 6.23 (5.74 to 6.86) % (p < 0.0001) respectively. TAR reduced significantly from 17.00 (4.25 to 38.0) % to 6.00 (1.25 to 26.0) % (p < 0.0001). No significant increase in TBR was observed (p = 0.198). Conclusion Personalized glycemic response-based Diabefly-Pro digital therapeutics program was effective in achieving better glycemic control in people with T2D.
Collapse
Affiliation(s)
- Ritika Verma
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Shefali Bhardwaj
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | | | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology, Haryana, India
| | - Ruchira Ranadive
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | | | | | | | | | | | - Vandana Jain
- Advanced Eye Hospital and Institute, Navi Mumbai, India
| | - Vishal Kini
- Care n Cure Speciality Clinic, Navi Mumbai, India
| | | | - Saimala Guntur
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Shilpa Joshi
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| | - Arbinder Singal
- Fitterfly Healthtech Pvt Ltd, Akshar Blue Chip Corporate Park Turbhe MIDC, Navi Mumbai, 400705 India
| |
Collapse
|
29
|
Dallosso H, Khunti K, Gray LJ, Hulley K, Ghaly M, Patel N, Kai J, Aujla N, Davies MJ, Yates T. Implementation of a diabetes prevention programme in a multi-ethnic community in primary care in England: An evaluation using constructs from the RE-AIM Framework. Prim Care Diabetes 2023:S1751-9918(23)00096-7. [PMID: 37246032 DOI: 10.1016/j.pcd.2023.05.001] [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: 03/30/2021] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023]
Abstract
AIMS To implement a diabetes prevention programme in primary care METHODS: The programme was implemented for 12 months in two neighbouring towns, served by eight general practices. Practices requested a referral pathway involving an external administrator running electronic searches and sending postal invitations. If interested, people called and booked a place on the programme. Practices were also provided with resources to refer people directly. Six Educators were trained to deliver the programme. The RE-AIM constructs "Adoption", "Reach" and "Uptake" were assessed. RESULTS All practices engaged in the searches and postal invitations. Overall, 3.9 % of those aged ≥ 25 years had an HbA1c level indicative of non-diabetic hyperglycaemia (NDH) and were invited. Overall uptake (attended as percentage of invited) was 16 % (practice range 10.5-26.6 %) and was highest in two practices where the invitation was followed by a telephone call. Four people were referred directly by their practice. Groups at risk of being excluded were the Bengali population and those unable to attend because of issues such as health, mobility and frailty. CONCLUSIONS Comprehensive electronic searches meant everyone previously diagnosed with NDH was invited to attend. Follow-up telephone call improved uptake and providing practices with resources to make these calls themselves would likely increase uptake further.
Collapse
Affiliation(s)
- Helen Dallosso
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Applied Research Collaboration East Midlands, UK
| | - Kamlesh Khunti
- NIHR Applied Research Collaboration East Midlands, UK; Diabetes Research Centre, University of Leicester, Leicester, UK.
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kerry Hulley
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Applied Research Collaboration East Midlands, UK
| | - Mel Ghaly
- Charnwood Medical Group Practice, Loughborough, UK
| | - Naina Patel
- Research Development Service, University of Leicester, Leicester, UK
| | - Joe Kai
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Navneet Aujla
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
30
|
Cereijo L, Gullón P, Del Cura I, Valadés D, Bilal U, Franco M, Badland H. Exercise facility availability and incidence of type 2 diabetes and complications in Spain: A population-based retrospective cohort 2015-2018. Health Place 2023; 81:103027. [PMID: 37087897 DOI: 10.1016/j.healthplace.2023.103027] [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: 09/23/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND To study the association between exercise facility availability and type 2 diabetes incidence and its complications, and to explore effect modification by socioeconomic status (SES) and sex in the Madrid adult population. METHODS A multilevel longitudinal design, based on a population-based retrospective cohort including 1,214,281 residents of Madrid (Spain) aged 40-75 years from 2015 to 2018. Outcomes were type 2 diabetes incidence and macrovascular (cardiac ischemia and/or stroke) and microvascular (chronic kidney disease, retinopathy, and/or peripheral vascular disease) complications in those with diabetes at baseline. Exercise facility availability was defined as the count of exercise facilities in a 1000 m street network buffer around each participant's residence. Poisson regression models with robust standard errors were used to estimate the risk ratios (RR). Interactions were explored with SES tertiles and by sex. RESULTS Residents living in areas with lower exercise facility availability showed higher risk of type 2 diabetes (RRtertile3vs1 = 1.25, CI95% 1.21-1.30) as well as macrovascular (RRTertile3vs1 = 1.09 CI95% 1.00-1.19), and microvascular (RRTertile3vs1 = 1.10 CI95% 1.01-1.19) complications. Associations were strongest in low SES areas for type 2 diabetes (RRtertile3vs1-LOW-SES = 1.22, CI95% 1.12-1.32; RRtertile3vs1-HIGH-SES = 0.91, CI95% 0.85-0.98) and microvascular complications (RRtertile3vs1-LOW-SES = 1.12, CI95% 0,94-1,33; RRtertile3vs1-HIGH-SES = 0.88, CI95% 0.73-1.05). CONCLUSIONS Living in areas with lower availability of exercise facilities was associated with a greater risk of type 2 diabetes and its complications. Increasing exercise opportunities, particularly in low SES areas, could help reduce the social gradient of diabetes and its complications.
Collapse
Affiliation(s)
- Luis Cereijo
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de investigación en epidemiología y salud pública, Alcalá de Henares, Madrid, Spain; Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Grupo de investigación en gestión y entrenamiento deportivo, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - Pedro Gullón
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de investigación en epidemiología y salud pública, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - Isabel Del Cura
- Unidad de investigación de atención primaria, Gerencia de Atención Primaria, Madrid, Spain; Departamento de especialidades médicas y salud pública, University Rey Juan Carlos, Madrid, Spain; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC) & Red de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPs) ISCIII, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon. IiSGM, Madrid, Spain.
| | - David Valadés
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Grupo de investigación en gestión y entrenamiento deportivo, Alcalá de Henares, Madrid, Spain.
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Manuel Franco
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de investigación en epidemiología y salud pública, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hannah Badland
- Centre for Urban Research, RMIT University, Melbourne, Australia.
| |
Collapse
|
31
|
Lim S, Takele WW, Vesco KK, Redman L, Josefson J. A systematic review and meta-analysis of participant characteristics in the prevention of gestational diabetes: a summary of evidence for precision medicine. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.16.23288650. [PMID: 37131714 PMCID: PMC10153349 DOI: 10.1101/2023.04.16.23288650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background and aims Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with interventions in gestational diabetes mellitus (GDM) prevention. Methods We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022. Results From 10347 studies, 116 studies (n=40940 women) were included. Physical activity resulted in greater GDM reduction in participants with a normal body mass index (BMI) at baseline compared to obese BMI (risk ratio, 95% confidence interval: 0.06 [0.03, 0.14] vs 0.68 [0.26, 1.60]). Diet and physical activity interventions resulted in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) than those with PCOS (0.62 [0.47, 0.82] vs 1.12 [0.78-1.61]) and in those without a history of GDM than those with unspecified history (0.62 [0.47, 0.81] vs 0.85 [0.76, 0.95]). Metformin interventions were more effective in participants with PCOS than those with unspecified status (0.38 [0.19, 0.74] vs 0.59 [0.25, 1.43]), or when commenced preconception than during pregnancy (0.22 [0.11, 0.45] vs 1.15 [0.86-1.55]). Parity, history of having a large-for-gestational-age infant or family history of diabetes had no effect. Conclusions GDM prevention through metformin or lifestyle differs according to some individual characteristics. Future research should include trials commencing preconception and provide results stratified by participant characteristics including social and environmental factors, clinical traits, and other novel risk factors to predict GDM prevention through interventions. Plain language summary Precision prevention involves using a group’s unique context to determine their responses to preventive interventions. This study aimed to evaluate the participant characteristics associated with interventions in GDM prevention. We searched medical literature databases to identify lifestyle (diet, physical activity), metformin, myoinositol/inositol and probiotics interventions. A total of 116 studies (n=40903 women) were included. Diet and physical activity interventions resulted in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) and those without a history of GDM. Metformin interventions resulted in greater GDM reduction in participants with PCOS or when started during the preconception period. Future research should include trials starting in the preconception period, and provide results stratified by participant characteristics to predict GDM prevention through interventions.
Collapse
|
32
|
Gregg EW, Buckley J, Ali MK, Davies J, Flood D, Mehta R, Griffiths B, Lim LL, Manne-Goehler J, Pearson-Stuttard J, Tandon N, Roglic G, Slama S, Shaw JE. Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact. Lancet 2023; 401:1302-1312. [PMID: 36931289 PMCID: PMC10420388 DOI: 10.1016/s0140-6736(23)00001-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/17/2022] [Accepted: 12/20/2022] [Indexed: 03/15/2023]
Abstract
The Global Diabetes Compact is a WHO-driven initiative uniting stakeholders around goals of reducing diabetes risk and ensuring that people with diabetes have equitable access to comprehensive, affordable care and prevention. In this report we describe the development and scientific basis for key health metrics, coverage, and treatment targets accompanying the Compact. We considered metrics across four domains: factors at a structural, system, or policy level; processes of care; behaviours and biomarkers such as glycated haemoglobin (HbA1c); and health events and outcomes; and three risk tiers (diagnosed diabetes, high risk, or whole population), and reviewed and prioritised them according to their health importance, modifiability, data availability, and global inequality. We reviewed the global distribution of each metric to set targets for future attainment. This process led to five core national metrics and target levels for UN member states: (1) of all people with diabetes, at least 80% have been clinically diagnosed; and, for people with diagnosed diabetes, (2) 80% have HbA1c concentrations below 8·0% (63·9 mmol/mol); (3) 80% have blood pressure lower than 140/90 mm Hg; (4) at least 60% of people 40 years or older are receiving therapy with statins; and (5) each person with type 1 diabetes has continuous access to insulin, blood glucose meters, and test strips. We also propose several complementary metrics that currently have limited global coverage, but warrant scale-up in population-based surveillance systems. These include estimation of cause-specific mortality, and incidence of end-stage kidney disease, lower-extremity amputations, and incidence of diabetes. Primary prevention of diabetes and integrated care to prevent long-term complications remain important areas for the development of new metrics and targets. These metrics and targets are intended to drive multisectoral action applied to individuals, health systems, policies, and national health-care access to achieve the goals of the Global Diabetes Compact. Although ambitious, their achievement can result in broad health benefits for people with diabetes.
Collapse
Affiliation(s)
- Edward W Gregg
- School of Population Health, RCSI, University of Medicine and Health Sciences, Dublin, Ireland; School of Public Health, Imperial College London, London, UK.
| | - James Buckley
- School of Public Health, Imperial College London, London, UK
| | - Mohammed K Ali
- Hubert Department of Global Health and Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Roopa Mehta
- Unidad de Investigacion en Enfermedades Metabolicas, Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ben Griffiths
- School of Public Health, Imperial College London, London, UK
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Jonathan Pearson-Stuttard
- School of Public Health, Imperial College London, London, UK; Health Analytics, Lane Clark & Peacock, London, UK
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Gojka Roglic
- Department of Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Slim Slama
- Department of Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute and School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
33
|
Osmanović Barilar J, Babić Perhoč A, Knezović A, Homolak J, Virag D, Šalković-Petrišić M. The Effect of the Sodium—Glucose Cotransporter Inhibitor on Cognition and Metabolic Parameters in a Rat Model of Sporadic Alzheimer’s Disease. Biomedicines 2023; 11:biomedicines11041025. [PMID: 37189641 DOI: 10.3390/biomedicines11041025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Type 2 diabetes mellitus increases the risk of sporadic Alzheimer’s disease (sAD), and antidiabetic drugs, including the sodium–glucose cotransporter inhibitors (SGLTI), are being studied as possible sAD therapy. We have explored whether the SGLTI phloridzin may influence metabolic and cognitive parameters in a rat model of sAD. Adult male Wistar rats were randomized to a control (CTR), an sAD-model group induced by intracerebroventricular streptozotocin (STZ-icv; 3 mg/kg), a CTR+SGLTI, or an STZ-icv+SGLTI group. Two-month-long oral (gavage) SGLTI treatment (10 mg/kg) was initiated 1 month after STZ-icv and cognitive performance tested prior to sacrifice. SGLTI treatment significantly decreased plasma glucose levels only in the CTR group and failed to correct STZ-icv-induced cognitive deficit. In both the CTR and STZ-icv groups, SGLTI treatment diminished weight gain, decreased amyloid beta (Aβ) 1-42 in duodenum, and decreased the plasma levels of total glucagon-like peptide 1 (GLP-1), while the levels of active GLP-1, as well as both total and active glucose-dependent insulinotropic polypeptide, remained unchanged, compared to their respective controls. The increment in GLP-1 levels in the cerebrospinal fluid and its effect on Aβ 1-42 in duodenum could be one of the molecular mechanisms by which SGLTIs indirectly induce pleiotropic beneficial effects.
Collapse
|
34
|
Hou L, Ge L, Wang Q, He J, Qin T, Cao L, Cao C, Liu D, Liu X, Yang K. Nutritional Recommendations for Type 2 Diabetes: An International Review of 15 Guidelines. Can J Diabetes 2023; 47:197-206. [PMID: 36184370 DOI: 10.1016/j.jcjd.2022.08.005] [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: 09/27/2021] [Revised: 06/13/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recommendations from clinical practice guidelines (CPGs) for individuals with type 2 diabetes mellitus (T2DM) may be inconsistent, and little is known about their quality. Our aim in this study was to systematically review the consistency of globally available CPGs containing nutritional recommendations for T2DM and to assess the quality of their methodology and reporting. METHODS PubMed, China Biology Medicine and 4 main guideline websites were searched. Four researchers independently assessed quality of the methodology and reporting using the Appraisal of Guidelines for Research and Evaluation, second edition (AGREE II) instrument and the Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist. RESULTS Fifteen CPGs include 65 nutritional recommendations with 6 sections: 1) body weight and energy balance; 2) dietary eating patterns; 3) macronutrients; 4) micronutrients and supplements; 5) alcohol; and 6) specific, functional foods. Current nutritional recommendations for individuals with T2DM on specific elements and amounts are not completely consistent in different CPGs and fail to assign the specific supporting evidence and strength of recommendations. To use nutritional recommendations to guide and manage individuals with T2DM, it is important to address the current challenges by establishing a solid evidence base and indicating the strength of recommendations. Overall, 8 CPGs classified as recommended for clinical practice used AGREE II. Fifteen CPGs adhere to <60% of RIGHT checklist items. CONCLUSIONS High-quality evidence is needed to potentially close knowledge gaps and strengthen the recommendation. The AGREE II instrument, along with the RIGHT checklist, should be endorsed and used by CPG developers to ensure higher quality and adequate use of their products.
Collapse
Affiliation(s)
- Liangying Hou
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Juanjuan He
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Tianzhu Qin
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liujiao Cao
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Changhao Cao
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Diru Liu
- Department of Nutrition and Healthy Food, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xingrong Liu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| |
Collapse
|
35
|
Ravindrarajah R, Sutton M, Reeves D, Cotterill S, Mcmanus E, Meacock R, Whittaker W, Soiland-Reyes C, Heller S, Bower P, Kontopantelis E. Referral to the NHS Diabetes Prevention Programme and conversion from nondiabetic hyperglycaemia to type 2 diabetes mellitus in England: A matched cohort analysis. PLoS Med 2023; 20:e1004177. [PMID: 36848393 PMCID: PMC9970065 DOI: 10.1371/journal.pmed.1004177] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 01/19/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The NHS Diabetes Prevention Programme (NDPP) is a behaviour change programme for adults who are at risk of developing type 2 diabetes mellitus (T2DM): people with raised blood glucose levels, but not in the diabetic range, diagnosed with nondiabetic hyperglycaemia (NDH). We examined the association between referral to the programme and reducing conversion of NDH to T2DM. METHODS AND FINDINGS Cohort study of patients attending primary care in England using clinical Practice Research Datalink data from 1 April 2016 (NDPP introduction) to 31 March 2020 was used. To minimise confounding, we matched patients referred to the programme in referring practices to patients in nonreferring practices. Patients were matched based on age (≥3 years), sex, and ≥365 days of NDH diagnosis. Random-effects parametric survival models evaluated the intervention, controlling for numerous covariates. Our primary analysis was selected a priori: complete case analysis, 1-to-1 practice matching, up to 5 controls sampled with replacement. Various sensitivity analyses were conducted, including multiple imputation approaches. Analysis was adjusted for age (at index date), sex, time from NDH diagnosis to index date, BMI, HbA1c, total serum cholesterol, systolic blood pressure, diastolic blood pressure, prescription of metformin, smoking status, socioeconomic status, a diagnosis of depression, and comorbidities. A total of 18,470 patients referred to NDPP were matched to 51,331 patients not referred to NDPP in the main analysis. Mean follow-up from referral was 482.0 (SD = 317.3) and 472.4 (SD = 309.1) days, for referred to NDPP and not referred to NDPP, respectively. Baseline characteristics in the 2 groups were similar, except referred to NDPP were more likely to have higher BMI and be ever-smokers. The adjusted HR for referred to NDPP, compared to not referred to NDPP, was 0.80 (95% CI: 0.73 to 0.87) (p < 0.001). The probability of not converting to T2DM at 36 months since referral was 87.3% (95% CI: 86.5% to 88.2%) for referred to NDPP and 84.6% (95% CI: 83.9% to 85.4%) for not referred to NDPP. Associations were broadly consistent in the sensitivity analyses, but often smaller in magnitude. As this is an observational study, we cannot conclusively address causality. Other limitations include the inclusion of controls from the other 3 UK countries, data not allowing the evaluation of the association between attendance (rather than referral) and conversion. CONCLUSIONS The NDPP was associated with reduced conversion rates from NDH to T2DM. Although we observed smaller associations with risk reduction, compared to what has been observed in RCTs, this is unsurprising since we examined the impact of referral, rather than attendance or completion of the intervention.
Collapse
Affiliation(s)
- Rathi Ravindrarajah
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Matt Sutton
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR School for Primary Care Research, Keele, United Kingdom
| | - David Reeves
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR School for Primary Care Research, Keele, United Kingdom
| | - Sarah Cotterill
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Emma Mcmanus
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR School for Primary Care Research, Keele, United Kingdom
| | - Rachel Meacock
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR School for Primary Care Research, Keele, United Kingdom
| | - William Whittaker
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Claudia Soiland-Reyes
- Research and Innovation Department, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Peter Bower
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR School for Primary Care Research, Keele, United Kingdom
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Keele, United Kingdom
- Division of Informatics, Imaging, and Data Sciences, University of Manchester, Manchester, United Kingdom
- * E-mail:
| |
Collapse
|
36
|
Hill J, Yako Y, George C, Musarurwa H, Jordaan E, Kengne AP. A study protocol for a cluster randomized controlled trial to test the applicability of the South African diabetes prevention program in the Eastern Cape Province of South Africa. BMC Public Health 2023; 23:214. [PMID: 36721261 PMCID: PMC9890849 DOI: 10.1186/s12889-022-14884-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Convincing evidence supports the effectiveness of lifestyle interventions in preventing the occurrence of diabetes in high-income countries, however little is known about appropriate interventions for use in African countries, where there are higher relative increases in diabetes prevalence. The South African Diabetes Prevention Programme (SA-DPP) was initiated with the aim of preventing or delaying the occurrence of diabetes among South Africans (SAs), through interventions, targeting lifestyle changes related to diet and physical activity. The purpose of the current project is to implement and evaluate the suitability and applicability of the SA-DPP developed and tailored in urban populations in the Western Cape Province, in peri-urban populations in the Eastern Cape Province of SA. METHODS The SA-DPP, which is an cluster randomized control trial, will be implemented in adults aged 30-65 years residing in the OR Tambo district, Eastern Cape, SA. Participants will be recruited using self-selected sampling techniques and 24 clusters across peri-urban communities will be randomly allocated to participate in the lifestyle intervention, facilitated by non-professional health workers (NPHW). The diabetes risk screening will follow a two-staged approach, including the community-based screening, using the African diabetes risk score (ADRS), followed by a clinic-based risk status assessment by an oral glucose tolerance test (OGTT) to exclude unknown diabetes. The lifestyle-change objectives of the current programme relate to, 1) < 30% of total energy intake from fat; 2) < 10% of total energy intake from saturated fat; 3) > 15 g of fibre/1000 kcal; 4) > 4 h/week moderate level of physical activity; and 5) > 2% body mass index (BMI) reduction. DISCUSSION The SA-DPP could represent a successful model for the prevention of diabetes and potentially other lifestyle-related diseases in SA and other countries in the region that are confronted with similar challenges. TRIAL REGISTRATION PACTR202205591282906.
Collapse
Affiliation(s)
- Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Yandiswa Yako
- grid.412870.80000 0001 0447 7939Department Human Biology, Faulty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Cindy George
- grid.415021.30000 0000 9155 0024Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Hannibal Musarurwa
- grid.412870.80000 0001 0447 7939Department Human Biology, Faulty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Esme Jordaan
- grid.415021.30000 0000 9155 0024Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andre P. Kengne
- grid.415021.30000 0000 9155 0024Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
37
|
George C, Hill J, Nqebelele U, Peer N, Kengne AP. Leveraging the South African Diabetes Prevention Programme to screen for chronic kidney disease: an observational study. BMJ Open 2023; 13:e068672. [PMID: 36609330 PMCID: PMC9827250 DOI: 10.1136/bmjopen-2022-068672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate the viability of leveraging an existing screening programme (the South African Diabetes Prevention Programme (SA-DPP)) to screen for chronic kidney disease (CKD), by assessing the yield of CKD cases among those participating in the programme. DESIGN Observational study conducted between 2017 and 2019. SETTING 16 resource-poor communities in Cape Town, South Africa. PARTICIPANTS 690 participants, aged between 25 and 65 years, identified as at high risk for type 2 diabetes mellitus (T2DM) by the African Diabetes Risk Score. PRIMARY OUTCOME MEASURE The prevalence of CKD among those participating in the SA-DPP. RESULTS Of the 2173 individuals screened in the community, 690 participants underwent further testing. Of these participants, 9.6% (n=66) and 18.1% (n=125) had screen-detected T2DM and CKD (defined as an estimated glomerular filtration rate (eGFR) of<60 mL/min/1.73 m2 and/or albumin-to-creatinine ratio >3 mg/mmol), respectively. Of those with CKD, 73.6% (n=92), 17.6% (n=22) and 8.8% (n=11) presented with stages 1, 2 and 3, respectively. Of the participants with an eGFR <60 mL/min/1.73 m2, 36.4% had no albuminuria and of those with normal kidney function (eGFR ≥90 mL/min/1.73 m2), 10.2% and 3.8% had albuminuria stages 2 and 3, respectively. Of those with T2DM and hypertension, 22.7% and 19.8% had CKD, respectively. CONCLUSION The fact that almost one in five participants identified as high risk for T2DM had CKD underscores the value of including markers of kidney function in an existing screening programme. By using an opportunistic approach to screen high-risk individuals, those with CKD can be identified and appropriately treated to reduce disease progression.
Collapse
Affiliation(s)
- Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Unati Nqebelele
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - A P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| |
Collapse
|
38
|
Zhang X, Yue Y, Liu S, Cong X, Wang W, Li J. Relationship between BMI and risk of impaired glucose tolerance and impaired fasting glucose in Chinese adults: a prospective study. BMC Public Health 2023; 23:14. [PMID: 36597050 PMCID: PMC9811686 DOI: 10.1186/s12889-022-14912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Current studies in most Western countries have largely focused on body mass index (BMI) as an important risk factor for impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), which have different pathophysiological bases. In people with obesity, the prevalence of IGT is higher and the prevalence of IFG is lower. The prevalence of IGT in the Asian population is higher than that in the white population, and the obesity rate in China is still increasing. However, few cohort studies explore the relationship between BMI and the incidence of IGT and IFG in China. We aimed to explore the relationship between BMI and the risk of IGT and IFG in Chinese adults and analyze the differences between them. METHODS The baseline data were obtained from the 2010 China Chronic Disease and Risk Factor Surveillance, of which 20 surveillance sites were followed up from 2016 to 2017. Finally, in this study, a total of 5,578 studies were grouped into BMI categories of underweight (BMI < 18.5 kg/m2), normal weight (18.5-23.9 kg/m2), overweight (24.0-27.9 kg/m2), and obesity (≥ 28.0 kg/m2). We used the unconditional logistic regression model to analyze the relationship between BMI and the risk of IGT and IFG. RESULTS During an average follow-up of 6.4 years, 562 developed IGT and 257 developed IFG. After age, gender, urban and rural areas, physical activity, family history of diabetes, hypertension, abdominal obesity, dyslipidemia, and other factors were adjusted, overweight increased the risk of IGT by 35% [odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08-1.70], and obesity increased the risk of IGT by 77% (OR 1.77, 95% CI 1.27-1.47). After the factors consistent with the above were adjusted, only obesity increased the risk of IFG by 122% (OR 2.22, 95% CI 1.39-3.54). CONCLUSIONS In China, obesity is an important risk factor for IGT and IFG, and the risk of IGT increases during the overweight stage.
Collapse
Affiliation(s)
- Xin Zhang
- grid.508400.9National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Diseases Control and Prevention, Beijing, 100050 China
| | - Yankun Yue
- grid.24696.3f0000 0004 0369 153XFu Xing Hospital, Capital Medical University, Beijing, 100045 China
| | - Shaobo Liu
- grid.508400.9National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Diseases Control and Prevention, Beijing, 100050 China
| | - Xiangfeng Cong
- grid.508400.9National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Diseases Control and Prevention, Beijing, 100050 China
| | - Wenjuan Wang
- grid.508400.9National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Diseases Control and Prevention, Beijing, 100050 China
| | - Jianhong Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Diseases Control and Prevention, Beijing, 100050, China.
| |
Collapse
|
39
|
McAuley E, Fleck O, Cassidy L, Kemp BJ, Cupples G, Kelly B, Creighton RM, Graham U, Wallace H, Patterson CC, McCance DR. A pragmatic lifestyle intervention for overweight and obese women with gestational diabetes mellitus (PAIGE2): A parallel arm, multicenter randomized controlled trial study protocol. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1118509. [PMID: 37034478 PMCID: PMC10080069 DOI: 10.3389/fcdhc.2023.1118509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023]
Abstract
Background The global epidemic of type 2 diabetes (T2D) and obesity has been translated into pregnancy, with approximately 18% of women being diagnosed worldwide with Gestational Diabetes Mellitus (GDM). Whilst preventive strategies have proven effective in the non-pregnant context, attrition rates are high and there is an urgent need to develop a customized, pragmatic lifestyle intervention for women both during and after pregnancy. Diet and exercise modification, behavioral support, and Commercial Weight Management Organizations have been strongly recommended to aid postpartum weight reduction for mothers with previous GDM, subsequently reducing their risk of developing obesity and T2D. This study, informed by a previous pilot study, aims to determine the effectiveness of a pragmatic pregnancy and postpartum lifestyle modification program for overweight women with previous GDM (PAIGE2) to reduce body weight at 12 months postpartum. Methods/design This paper summarizes the protocol for the PAIGE2 study, which has been developed based on results from a pilot study (PAIGE). A six center, two parallel arm, 12-month, randomized controlled trial will be conducted across Northern Ireland and the Republic of Ireland (3 centers each), involving 340 women with GDM and body mass index ≥25 kg/m2 recruited during pregnancy. The lifestyle intervention involves a one-hour virtual educational program (to take place at 32-36 weeks gestation). Postpartum, the intervention will include monthly phone calls, weekly motivational text messages, weekly step counts, and referral for three months to a Commercial Weight Management Organization (Slimming World). The control arm will receive usual care as offered by the local maternity hospital. The primary outcome is weight loss at 12 months postpartum. Study visits for anthropometric and clinical measurements, fasting blood samples, questionnaires pertaining to health, wellbeing and physical activity will take place at 6 weeks, 6- and 12-months postpartum. Focus groups will be conducted with intervention mothers' post-intervention to determine the acceptability of the study design including utility of a Commercial Weight Management Organization, feasibility of remote patient contact, family involvement and patient satisfaction. Discussion The PAIGE2 study will address the gaps in previously conducted research and, if positive, has the potential to have major public health implications for the prevention of future GDM and subsequent T2D. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04579016?term=NCT04579016&draw=2&rank=1, identifier NCT04579016.
Collapse
Affiliation(s)
- Emma McAuley
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Olwen Fleck
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Laura Cassidy
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Bridie J. Kemp
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Gina Cupples
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Bronagh Kelly
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Rachel M. Creighton
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Helen Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Chris C. Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - David R. McCance
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
- *Correspondence: David R. McCance,
| |
Collapse
|
40
|
Zhang YB, Pan XF, Lu Q, Wang YX, Geng TT, Zhou YF, Liao LM, Tu ZZ, Chen JX, Xia PF, Wang Y, Wan ZZ, Guo KQ, Yang K, Yang HD, Chen SH, Wang GD, Han X, Wang YX, Yu D, He MA, Zhang XM, Liu LG, Wu T, Wu SL, Liu G, Pan A. Association of Combined Healthy Lifestyles With Cardiovascular Disease and Mortality of Patients With Diabetes: An International Multicohort Study. Mayo Clin Proc 2023; 98:60-74. [PMID: 36603958 PMCID: PMC9830550 DOI: 10.1016/j.mayocp.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To prospectively examine the associations of combined lifestyle factors with incident cardiovascular disease (CVD) and mortality in patients with diabetes. PATIENTS AND METHODS Patients with prevalent diabetes were included from 5 prospective, population-based cohorts in China (Dongfeng-Tongji cohort and Kailuan study), the United Kingdom (UK Biobank study), and the United States (National Health and Nutrition Examination Survey and National Institutes of Health-AARP Diet and Health Study). Healthy lifestyle scores were constructed according to non-current smoking, low to moderate alcohol drinking, regular physical activity, healthy diet, and optimal body weight; the healthy level of each lifestyle factor was assigned 1 point, or 0 for otherwise, and the range of the score was 0 to 5. Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CVD mortality, and all-cause mortality adjusting for sociodemographic, medical, and diabetes-related factors, and outcomes were obtained by linkage to medical records and death registries. Data were collected from October 18, 1988, to September 30, 2020. RESULTS A total of 6945 incident CVD cases were documented in 41,350 participants without CVD at baseline from the 2 Chinese cohorts and the UK Biobank during 389,330 person-years of follow-up, and 40,353 deaths were documented in 101,219 participants from all 5 cohorts during 1,238,391 person-years of follow-up. Adjusted hazard ratios (95% CIs) comparing patients with 4 or 5 vs 0 or 1 healthy lifestyle factors were 0.67 (0.60 to 0.74) for incident CVD, 0.58 (0.50 to 0.68) for CVD mortality, and 0.60 (0.53 to 0.68) for all-cause mortality. Findings remained consistent across different cohorts, subgroups, and sensitivity analyses. CONCLUSION The international analyses document that adherence to multicomponent healthy lifestyles is associated with lower risk of CVD and premature death of patients with diabetes.
Collapse
Affiliation(s)
- Yan-Bo Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong-Fei Pan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China; Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Qi Lu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Xiu Wang
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Ting-Ting Geng
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Feng Zhou
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linda M Liao
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Zhou-Zheng Tu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Xiang Chen
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng-Fei Xia
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen-Zhen Wan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun-Quan Guo
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Kun Yang
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Han-Dong Yang
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Shuo-Hua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Guo-Dong Wang
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Xu Han
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yi-Xin Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Mei-An He
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Min Zhang
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lie-Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tangchun Wu
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shou-Ling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
41
|
Curtain JP, Lee MMY, McMurray JJ, Gardner RS, Petrie MC, Jhund PS. Efficacy of implantable haemodynamic monitoring in heart failure across ranges of ejection fraction: a systematic review and meta-analysis. Heart 2022; 109:823-831. [PMID: 36522146 DOI: 10.1136/heartjnl-2022-321885] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
AimsWe conducted a meta-analysis of randomised controlled trials (RCTs) of implantable haemodynamic monitoring (IHM)-guided care.MethodsPubMed and Ovid MEDLINE were searched for RCTs of IHM in patients with heart failure (HF). Outcomes were examined in total (first and recurrent) event analyses.ResultsFive trials comparing IHM-guided care with standard care alone were identified and included 2710 patients across ejection fraction (EF) ranges. Data were available for 628 patients (23.2%) with heart failure with preserved ejection fraction (HFpEF) (EF ≥50%) and 2023 patients (74.6%) with heart failure with a reduced ejection fraction (HFrEF) (EF <50%). Chronicle, CardioMEMS and HeartPOD IHMs were used. In all patients, regardless of EF, IHM-guided care reduced total HF hospitalisations (HR 0.74, 95% CI 0.66 to 0.82) and total worsening HF events (HR 0.74, 95% CI 0.66 to 0.84). In patients with HFrEF, IHM-guided care reduced total worsening HF events (HR 0.75, 95% CI 0.66 to 0.86). The effect of IHM-guided care on total worsening HF events in patients with HFpEF was uncertain (fixed-effect model: HR 0.72, 95% CI 0.59 to 0.88; random-effects model: HR 0.60, 95% CI 0.32 to 1.14). IHM-guided care did not reduce mortality (HR 0.92, 95% CI 0.71 to 1.20). IHM-guided care reduced all-cause mortality and total worsening HF events (HR 0.80, 95% CI 0.72 to 0.88).ConclusionsIn patients with HF across all EFs, IHM-guided care reduced total HF hospitalisations and worsening HF events. This benefit was consistent in patients with HFrEF but not consistent in HFpEF. Further trials with pre-specified analyses of patients with an EF of ≥50% are required.PROSPERO registration numberCRD42021253905.
Collapse
Affiliation(s)
- James P Curtain
- BHF Cardiovascular Research Centre, University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Matthew M Y Lee
- BHF Cardiovascular Research Centre, University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - John Jv McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Roy S Gardner
- BHF Cardiovascular Research Centre, University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| |
Collapse
|
42
|
Kowall B. Lower body muscle strength, dynapenic obesity and risk of type 2 diabetes -longitudinal results on the chair-stand test from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 2022; 22:924. [PMID: 36456934 PMCID: PMC9713985 DOI: 10.1186/s12877-022-03647-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The chair-stand test is a measure of lower body muscle strength. In a longitudinal study with older adults, we investigated whether results of the five-repetition chair-stand test (CST-5) are associated with incident type 2 diabetes, and whether diabetes risk in obese persons is modified by dynapenia (age-related loss of muscle strength) in the lower limbs. METHODS We used data of the Survey of Health, Ageing and Retirement in Europe (SHARE), a panel study with eight waves carried out between 2004 and 2020 in 28 European countries and Israel mainly in persons aged 50 years or older. Forty-six thousand one hundred nineteen persons (mean age 63.5 years, 44.1% men) with CST-5 data and follow-up data for diabetes were included from wave 2 and waves 4 to 7. The mean follow-up time was 5.3 years (standard deviation 2.9 years). Relative risks with 95% confidence intervals (CI) were estimated from log-linear models with a Poisson working likelihood and robust standard errors. RESULTS In the crude model, increased risks of diabetes were found for persons who considered the CST-5 as not safe, or whose times for the test were in the highest or second highest quartiles (relative risks 2.18 (95% CI: 1.95-2.43), 1.71 (1.54-1.91), 1.44 (95% CI: 1.29-1.61), reference: lowest quartile). These associations were attenuated in the fully adjusted regression model (relative risks 1.32 (95% CI: 1.17-1.48), 1.23 (1.10-1.37), 1.19 (1.06-1.33)). Furthermore, in fully adjusted models, the risk of diabetes in obese persons did not depend on whether they had low muscle strength or not. In obese persons with times for 5 sits and stands > 15 seconds, the adjusted risk of diabetes was 2.56 (95% CI: 2.22-2.95) times higher than in non-obese persons with times ≤15 seconds. The corresponding relative risk in obese persons with times ≤15 seconds was 2.45 (2.25-2.67). CONCLUSIONS Poor results in the CST-5 were associated with an increased risk of diabetes. Among obese persons, the risk of diabetes was not modified by results of the CST-5.
Collapse
Affiliation(s)
- Bernd Kowall
- grid.410718.b0000 0001 0262 7331Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| |
Collapse
|
43
|
Cadario F. Vitamin D and ω-3 Polyunsaturated Fatty Acids towards a Personalized Nutrition of Youth Diabetes: A Narrative Lecture. Nutrients 2022; 14:nu14224887. [PMID: 36432570 PMCID: PMC9699239 DOI: 10.3390/nu14224887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
After the discovery of insulin, nutrition has become central in the management of diabetes in order to limit glycemic rise after meals, optimize metabolic control, and prevent complications. Over the past one hundred years, international scientific societies have consecutively refined nutritional needs and optimized food intake for the treatment of diabetes. In particular, over the past century, nutrition applied with pumps for the administration of insulin and continuous glucose monitoring have allowed substantial advancement in the treatment of type 1 diabetes mellitus. The role of some substances, such as vitamin D and n-3 polyunsaturated fatty acids, have been proposed without univocal conclusions, individually or in combination, or in the diet, to improve the nutrition of type 1 and type 2 diabetes. This second condition, which is highly associated with overweight, should be prevented from childhood onwards. Personalized nutrition could bypass the problem, reaching a scientific conclusion on the individual subject. This article focuses on childhood and adolescent diabetes, aims to provide a narrative summary of nutrition over the past century, and promotes the concept of personalized nutrition to pediatricians and pediatric diabetologists as a possible tool for the treatment of type 1 diabetes and the prevention of type 2 diabetes.
Collapse
Affiliation(s)
- Francesco Cadario
- Division of Pediatrics, University of Piemonte Orientale, 28100 Novara, Italy;
- Diabetes Research Institute Federation, Miami, FL 33163, USA
| |
Collapse
|
44
|
Almulhim AN, Goyder E, Caton SJ. Assessing the Feasibility and Acceptability of Health Coaching as a New Diabetes Management Approach for the People with Type 2 Diabetes in Saudi Arabia: A Protocol for a Mixed Methods Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15089. [PMID: 36429807 PMCID: PMC9690217 DOI: 10.3390/ijerph192215089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Over recent years, the Middle East, and especially Saudi Arabia, has faced multiple changes, including structural-demographic and economic shifts. This has led to massive changes in the population's lifestyle, including more unhealthy diets and increases in physical inactivity. As a result, accelerating rates of chronic diseases, including type 2 diabetes mellitus (T2DM) are a major public health concern. Current diabetes care in Saudi Arabia focuses on increasing the awareness of patients through various approaches, mainly based on health education, which is found to be suboptimal and ineffective for improving long-term outcomes. This study aims to assess the feasibility and acceptability of using a client-centred approach called health coaching that supports, enables, and engages T2DM patients to take the central role of controlling their own conditions by developing new crucial skills. METHODS A mixed methods randomised controlled feasibility study of health coaching will be used. Participants (n = 30) are adults with T2DM with poorly controlled diabetes (A1C ≥7) who can read and write in Arabic. Eligible participants are randomly allocated to either an intervention or control group for 12 weeks. COM-B model and Behaviour Change Technique Taxonomy version 1 (BCTTv1) guide the intervention curriculum. Predetermined progression criteria will be used to determine whether to proceed to a larger trial or not. Outcomes will be measured at baseline and 3 months. The study's primary aim is to assess the process of eligibility, recruitment, retention and completion rates, acceptability and suitability of intervention and the time to complete each procedure. The preliminary efficacy of health coaching is the secondary outcome that includes different measurements, such as HbA1c, blood pressure, body mass index (BMI), waist circumference, weight, patients' self-efficacy, and diabetes self-management. DISCUSSION This is the first study to explore the feasibility, acceptability, and preliminary efficacy of health coaching that used the Capability, Opportunity, Motivation, Behaviour (COM-B) model and BCTTv1 as guidance to develop the intervention for adults with T2DM in Saudi Arabia. The findings of this study will be used to inform the larger RCT trial if it is shown to be feasible and acceptable.
Collapse
Affiliation(s)
- Abdullah N. Almulhim
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh 13316, Saudi Arabia
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK
| | - Samantha J. Caton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK
| |
Collapse
|
45
|
Liu L, Wang Z, Zhao L, Chen X, He S. External validation of non-invasive diabetes score in a 15-year prospective study. Am J Med Sci 2022; 364:624-630. [PMID: 35640678 DOI: 10.1016/j.amjms.2022.05.023] [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: 10/11/2020] [Revised: 04/29/2021] [Accepted: 05/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND A novel scoring system called Non-invasive Diabetes Score (NDS) was developed. The model showed prominent discrimination and calibration in the original study population. However, before a new model could be adopted in clinical practice and acquire widespread use, it is necessary to confirm that it also performs well in external validations in different settings of people. The aim of this study was to investigate whether the novel user-friendly score predicting diabetes mellitus (DM) could have satisfying performance in predicting DM in Southwest China in a 15-year prospective cohort study. METHODS This prospective cohort study was carried out based on a general Chinese population of 711 individuals from 1992 to 2007. We excluded 24 of them at baseline because they were diabetics. The end point was DM, and the risk was calculated using the model formula. RESULTS During a follow-up of 15 years, 74 (10.77%) patients reached the end point. Evaluation of this model in our cohort, with Harrell's C-index of 0.662 (95% CI: 0.600-0.723) for the whole cohort and 0.695 (95% CI: 0.635-0.756) in sensitivity analysis, indicated the possibly helpful discrimination. The calibration capability in our cohort was useful that the observed incidence of diabetes mellitus was near the predicted. CONCLUSIONS Our external validation suggested NDS had possibly helpful discrimination and satisfying calibration for predicting DM during 15-year follow-up.
Collapse
Affiliation(s)
- Lu Liu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
| | - Ziqiong Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
| | - Liming Zhao
- Department of Cardiovascular Medicine, Hospital of Chengdu Office of People's Government of Tibet Autonomous Region, Chengdu, China.
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
| |
Collapse
|
46
|
Abstract
It is well established from clinical trials that behavioural interventions can halve the risk of progression from prediabetes to type 2 diabetes but translating this evidence of efficacy into effective real-world interventions at scale is an ongoing challenge. A common suggestion is that future preventive interventions need to be more personalised in order to enhance effectiveness. This review evaluates the degree to which existing interventions are already personalised and outlines how greater personalisation could be achieved through better identification of those at high risk, division of type 2 diabetes into specific subgroups and, above all, more individualisation of the behavioural targets for preventive action. Approaches using more dynamic real-time data are in their scientific infancy. Although these approaches are promising they need longer-term evaluation against clinical outcomes. Whatever personalised preventive approaches for type 2 diabetes are developed in the future, they will need to be complementary to existing individual-level interventions that are being rolled out and that are demonstrably effective. They will also need to ideally synergise with, and at the very least not detract attention from, efforts to develop and implement strategies that impact on type 2 diabetes risk at the societal level.
Collapse
Affiliation(s)
- Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge Clinical School, Cambridge, UK.
| |
Collapse
|
47
|
Merino J. Precision nutrition in diabetes: when population-based dietary advice gets personal. Diabetologia 2022; 65:1839-1848. [PMID: 35593923 DOI: 10.1007/s00125-022-05721-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
Abstract
Diet plays a fundamental role in maintaining long-term health, with healthful diets being endorsed by current dietary guidelines for the prevention and management of type 2 diabetes. However, the response to dietary interventions varies widely, highlighting the need for refinement and personalisation beyond population-based 'one size fits all'. This article reviews the clinical evidence supporting precision nutrition as a fundamental approach for dietary advice in diabetes. Further, it proposes a framework for the eventual implementation of precision nutrition and discusses key challenges for the application of this approach in the prevention of diabetes. One implication of this approach is that precision nutrition would not exclude the parallel goal of population-based healthy dietary advice. Nevertheless, the shift in prioritising precision nutrition is needed to reflect the dynamic nature of responses to dietary interventions that vary among individuals and change over the life course.
Collapse
Affiliation(s)
- Jordi Merino
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
48
|
Selvaraj MS, Paruchuri K, Haidermota S, Bernardo R, Rich SS, Peloso GM, Natarajan P. Genome-wide discovery for diabetes-dependent triglycerides-associated loci. PLoS One 2022; 17:e0275934. [PMID: 36269708 PMCID: PMC9586367 DOI: 10.1371/journal.pone.0275934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We aimed to discover loci associated with triglyceride (TG) levels in the context of type 2 diabetes (T2D). We conducted a genome-wide association study (GWAS) in 424,120 genotyped participants of the UK Biobank (UKB) with T2D status and TG levels. METHODS We stratified the cohort based on T2D status and conducted association analyses of TG levels for genetic variants with minor allele count (MAC) at least 20 in each stratum. Effect differences of genetic variants by T2D status were determined by Cochran's Q-test and we validated the significantly associated variants in the Mass General Brigham Biobank (MGBB). RESULTS Among 21,176 T2D and 402,944 non-T2D samples from UKB, stratified GWAS identified 19 and 315 genomic risk loci significantly associated with TG levels, respectively. Only chr6p21.32 exhibited genome-wide significant heterogeneity (I2 = 98.4%; pheterogeneity = 2.1x10-15), with log(TG) effect estimates of -0.066 (95%CI: -0.082, -0.050) and 0.002 (95%CI: -0.002, 0.006) for T2D and non-T2D, respectively. The lead variant rs9274619:A (allele frequency 0.095) is located 2Kb upstream of the HLA-DQB1 gene, between HLA-DQB1 and HLA-DQA2 genes. We replicated this finding among 25,137 participants (6,951 T2D cases) of MGBB (pheterogeneity = 9.5x10-3). Phenome-wide interaction association analyses showed that the lead variant was strongly associated with a concomitant diagnosis of type 1 diabetes (T1D) as well as diabetes-associated complications. CONCLUSION In conclusion, we identified an intergenic variant near HLA-DQB1/DQA2 significantly associates with decreased triglycerides only among those with T2D and highlights an immune overlap with T1D.
Collapse
Affiliation(s)
- Margaret Sunitha Selvaraj
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Kaavya Paruchuri
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
| | - Sara Haidermota
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
| | - Rachel Bernardo
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, United States of America
| | - Gina M. Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail: (PN); (GMP)
| | - Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- * E-mail: (PN); (GMP)
| |
Collapse
|
49
|
Teshome AA, Baih SZ, Wolie AK, Mengstie MA, Muche ZT, Amare SN, seid MA, Yitbark GY, Molla YM, Baye ND, Ayehu GW. Magnitude of impaired fasting glucose and undiagnosed diabetic mellitus and associated risk factors among adults living in Woreta town, northwest Ethiopia: a community-based cross-sectional study, 2021. BMC Endocr Disord 2022; 22:243. [PMID: 36199073 PMCID: PMC9533517 DOI: 10.1186/s12902-022-01156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Impaired fasting glucose (IFG) is an early warning system that provides prior information to prevent the future development of DM and diabetes-related problems, but early detection of DM is not practically applicable in Ethiopia. This study was aimed to assess the magnitude of impaired fasting glucose and undiagnosed diabetes mellitus (DM) and associated factors. METHODS A community-based, cross-sectional study was conducted from May to June 30, 2021. A structured interviewer-administered questionnaire was used to collect data. Anthropometric measurements were also recorded. A fasting blood sugar (FBS) test was assessed by samples taken early in the morning. Epi-Info 7.2.5.0 was used to enter data, which was then exported to SPSS 25 for analysis. To identify factors associated with IFG, logistics regression was used. The level of statistical significance was declared at p 0.05. RESULT Three hundred and twenty-four (324) participants with a mean age of 43.76 ± 17.29 years were enrolled. The overall magnitude of impaired fasting glucose (IFG) and undiagnosed diabetes mellitus (DM) were 43.2% and 10.0%, respectively. Waist circumference (AOR: 1.72, 95% CI 1.23-3.14), hypertension (AOR: 3.48, 95% CI 1.35-8.89), family history of Diabetic mellitus (AOR: 2.34, 95% CI 1.37-5.79) and hypertriglyceridemia (AOR: 2.35, 95% CI 1.41-5.43) were found to be independently associated with impaired fasting glucose. CONCLUSION Individuals who are overweight, hypertriglyceridemia, and are hypertensive should have regular checkups and community-based screening.
Collapse
Affiliation(s)
- Assefa Agegnehu Teshome
- Department of biomedical science, college of health science, Debre Tabor University, Debre Tabor, P.O. Box 272, Ethiopia
| | - Shegaw Zeleke Baih
- Department of adult health nursing, college of health science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw Wolie
- Department of pediatrics and child health nursing, college of health science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of biomedical science, college of health science, Debre Tabor University, Debre Tabor, P.O. Box 272, Ethiopia
| | - Zelalem Tilahun Muche
- Department of biomedical science, college of health science, Debre Tabor University, Debre Tabor, P.O. Box 272, Ethiopia
| | - Shambel Nigussie Amare
- Department of clinical pharmacy, school of pharmacy, college of health and medical science, Haramaya University, Harar, Ethiopia
| | - Mohammed Abdu seid
- Department of biomedical science, college of health science, Debre Tabor University, Debre Tabor, P.O. Box 272, Ethiopia
| | - Getachew Yideg Yitbark
- Department of biomedical science, college of health science, Debre Tabor University, Debre Tabor, P.O. Box 272, Ethiopia
| | - Yalew Melkamu Molla
- Department of pediatrics and child health, college of medicine and health science, university of Gondar, Gondar, Ethiopia
| | - Nega Dagnaw Baye
- Department of biomedical science, college of health science, Debre Tabor University, Debre Tabor, P.O. Box 272, Ethiopia
| | - Gashaw walle Ayehu
- Department of biomedical science, college of health science, Debre Tabor University, Debre Tabor, P.O. Box 272, Ethiopia
| |
Collapse
|
50
|
Identifying Glucose Metabolism Status in Nondiabetic Japanese Adults Using Machine Learning Model with Simple Questionnaire. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1026121. [PMID: 36118835 PMCID: PMC9481387 DOI: 10.1155/2022/1026121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
We aimed to identify the glucose metabolism statuses of nondiabetic Japanese adults using a machine learning model with a questionnaire. In this cross-sectional study, Japanese adults (aged 20–64 years) from Tokyo and surrounding areas were recruited. Participants underwent an oral glucose tolerance test (OGTT) and completed a questionnaire regarding lifestyle and physical characteristics. They were classified into four glycometabolic categories based on the OGTT results: category 1: best glucose metabolism, category 2: low insulin sensitivity, category 3: low insulin secretion, and category 4: combined characteristics of categories 2 and 3. A total of 977 individuals were included; the ratios of participants in categories 1, 2, 3, and 4 were 46%, 21%, 14%, and 19%, respectively. Machine learning models (decision tree, support vector machine, random forest, and XGBoost) were developed for identifying the glycometabolic category using questionnaire responses. Then, the top 10 most important variables in the random forest model were selected, and another random forest model was developed using these variables. Its areas under the receiver operating characteristic curve (AUCs) to classify category 1 and the others, category 2 and the others, category 3 and the others, and category 4 and the others were 0.68 (95% confidence intervals: 0.62–0.75), 0.66 (0.58–0.73), 0.61 (0.51–0.70), and 0.70 (0.62–0.77). For external validation of the model, the same dataset of 452 Japanese adults in Hokkaido was obtained. The AUCs to classify categories 1, 2, 3, and 4 and the others were 0.66 (0.61–0.71), 0.57 (0.51–0.62), 0.60 (0.50–0.69), and 0.64 (0.57–0.71). In conclusion, our model could identify the glucose metabolism status using only 10 factors of lifestyle and physical characteristics. This model may help the larger general population without diabetes to understand their glucose metabolism status and encourage lifestyle improvement to prevent diabetes.
Collapse
|