Effects of diet and exercise interventions on diabetes risk factors in adults without diabetes: meta-analyses of controlled trials

Lifestyle and clinical risk factors in relation with the prevalence of diabetes in the Indonesian urban and rural populations: The 2018 Indonesian Basic Health Survey

Aims

To investigate the differences between Indonesian urban and rural populations in the association of lifestyle and clinical factors with diabetes prevalence.

Methods

Using database of the 2018 Indonesian Basic Health Survey, which was conducted in April-May 2018, non-pregnant respondents aged ≥15 years old with available blood glucose data (n urban = 17,129, n rural = 16,585) were included in this study. The diagnosis of diabetes was based on the combination of known diabetes, i.e., a previous history of diabetes or use of anti-diabetes medication, and unknown diabetes based on blood glucose criteria. We performed logistic regression analyses separately for the urban and rural populations to examine the association of lifestyle and clinical factors with prevalent diabetes.

Results

Indonesian urban population was less physically active, had a lower proportion of adequate fruit and vegetable intake, and had higher individuals with obesity than rural population. Although there were no differences in the total prevalence of diabetes between the two populations (10.9 % vs. 11.0 %, for urban and rural, respectively), the prevalence of known diabetes was twice higher in urban than in rural population (3.8 % vs. 1.9 %). Physical activity was associated with lower risk of diabetes, especially in the urban population [prevalence OR (95 %CI): 0.91 (0.85; 0.98) for urban and 0.94 (0.89; 1.00) for rural). Obesity, hypertension, and dyslipidemia were risk factors for prevalent diabetes in both populations.

Conclusions

Indonesian rural population showed relatively better lifestyle and clinical profiles compared to their urban counterparts. However, no differences were observed between the two populations in the relation between risk factors and diabetes. Special attention needs to be addressed to the high prevalence of undiagnosed and untreated diabetes in Indonesia.

Diabetic complications and prospective immunotherapy

The incidence of Diabetes Mellitus is increasing globally. Individuals who have been burdened with diabetes for many years often develop complications as a result of hyperglycemia. More and more research is being conducted highlighting inflammation as an important factor in disease progression. In all kinds of diabetes, hyperglycemia leads to activation of alternative glucose metabolic pathways, resulting in problematic by-products including reactive oxygen species and advanced glycation end products. This review takes a look into the pathogenesis of three specific diabetic complications; retinopathy, nephropathy and neuropathy as well as their current treatment options. By considering recent research papers investigating the effects of immunotherapy on relevant conditions in animal models, multiple strategies are suggested for future treatment and prevention of diabetic complications with an emphasis on molecular targets associated with the inflammation.

Lipidome Alterations with Exercise Among People With and Without HIV: An Exploratory Study

Age-related comorbidities and physical function impairments in aging people with HIV (PWH) can be improved through exercise interventions. The mechanisms underlying these improvements, including lipidomic changes, are unknown. Sedentary adults (50-75 years old) with or without HIV participated in supervised endurance/resistance exercise for 24 weeks. Plasma lipid concentrations (∼1,200 lipid species from 13 lipid classes) at baseline and week 24 were measured by mass spectrometry. Given multiple comparisons, unadjusted and Benjamini-Hochberg corrected p values are reported. Analyses are considered exploratory. Twenty-five PWH and 24 controls had paired samples at baseline and week 24. The change in total triacylglycerol (TAG) concentrations after exercise intervention differed between groups (unadj-p = 0.006, adj-p = 0.078) with concentrations increasing among controls, but not among PWH. Changes in concentrations of TAG species composed of long-chain fatty acids differed between groups (unadj-p < 0.04) with increases among controls, but not among PWH. Changes in total diacylglycerol (DAG) concentration from baseline to week 24 differed between groups (unadj-p = 0.03, adj-p = 0.2) with an increase in PWH and a nonsignificant decrease in controls. Baseline to week 24 changes in DAGs composed of palmitic acid (16:0), palmitoleic acid (16:1), and stearic acid (18:0) differed by serostatus (unadj-p = 0.009-0.03; adj-p 0.10-0.12), with nonsignificant increases and decreases in concentrations in PWH and controls, respectively. Concentrations of individual lysophosphatidylcholine (LPC) and ceramide (CER) species also differed by HIV serostatus (unadj-p < = 0.05). Although exploratory, the effects of exercise on the lipidome may differ among people with and without HIV, potentially due to underlying alterations in lipid processing and fatty acid oxidation in PWH. Clinical Trials NCT02404792.

Effectiveness of a Singaporean Community-Based Physical Activity and Nutrition Intervention: A Cluster Randomized Controlled Trial

This study examined the effectiveness of a 6-month intervention to improve the health behaviors and outcomes among women aged 50 years and older. A sample of 580 (intervention n = 295; control n = 285) women was recruited from 26 recreational centers. Only the intervention group participated in the Singapore Physical Activity (PA) and Nutrition Study (SPANS), received health resources (calendar, recipe, and booklets) and motivational support from program ambassadors. The intervention group showed significant improvements in moderate-intensity PA, vigorous-intensity PA, and total PA (P < .001), increased intake frequency of fruit and vegetables (P = .049), a reduction in salt and sugary beverage intake (P ≤ .042), and reductions in systolic blood pressure (BP; -3.68 mm Hg), diastolic BP (-3.54 mm Hg), and percentage body fat (-2.13%; P ≤ .020) when compared with the control group. The SPANS appeared to be efficacious in improving PA and dietary behaviors, reducing BP and percentage body fat among Singaporean women.

Reducing risk of Type 2 diabetes in HIV: a mixed-methods investigation of the STOP-Diabetes diet and physical activity intervention

AIM

To conduct a mixed-methods feasibility study of the effectiveness and acceptability of an individualized diet and physical activity intervention designed to reduce the risk of Type 2 diabetes experienced by people living with HIV.

METHODS

Participants with impaired fasting glucose and HIV were invited to take part in a 6-month diet and physical activity intervention. Individualized advice to achieve 10 lifestyle goals was delivered monthly. Diabetes risk was assessed pre- and post-intervention by measurement of the glucose and insulin response to a 3-h meal tolerance test. Six-month change was analysed using paired t-tests. Research interviews exploring the acceptability of the intervention and factors influencing behaviour change were conducted with those who participated in the intervention, and those who declined participation.

RESULTS

The intervention (n=28) significantly reduced the following: glucose and insulin, both fasting and postprandial incremental area under the curve (glucose 7.9% and 17.6%; insulin 22.7% and 31.4%, respectively); weight (4.6%); waist circumference (6.2%); systolic blood pressure (7.4%); and triglycerides (36.7%). Interview data demonstrated the acceptability of the intervention. However, participants expressed concern that deliberate weight loss might lead to disclosure of HIV status or association with AIDS-related illness. The belief that antiretroviral medications drove diabetes risk was associated with declining study participation or achieving fewer goals.

CONCLUSIONS

We have demonstrated the beneficial effects of a lifestyle intervention in mitigating the increased risk of Type 2 diabetes associated with HIV. Future interventions should be designed to further reduce the unique barriers that prevent successful outcomes in this cohort.

Non-nutritive Sweeteners and Their Associations with Obesity and Type 2 Diabetes

Evidence linking the excessive consumption of nutritive sweeteners (NS) to adverse metabolic health outcomes has led to an increase in consumption of non-nutritive sweeteners (NNS), particularly among the obese and individuals with diabetes. NNS are characterized by having zero-to-negligible caloric load, while also having a sweet taste. They are utilized as a replacement for traditional NS to reduce energy intake and to limit carbohydrate-related negative health outcomes. However, recent studies have suggested that NNS may actually contribute to the development or worsening of metabolic diseases, including metabolic syndrome, obesity, type

2 diabetes, and cardiovascular disease. Thus, it is imperative to understand the NNS efficacy and the relationship between NNS and metabolic diseases.

Type 2 Diabetes Risk Among University Students in Malaysia

BACKGROUND

Type 2 diabetes (T2D) is a preventable condition. Targeting those who are at risk of getting this disease is essential.

OBJECTIVE

To examine T2D risk among university students in Malaysia and determine its relationship with socio-demographic characteristics and physical activity.

METHODS

The study was conducted cross-sectionally on 390 students selected using quota sampling method from 13 faculties in Universiti Kebangsaan Malaysia. A short form of the International Physical Activity Questionnaire and Finnish Diabetes Risk Score were used to measure the physical activity and T2D risk.

RESULTS

The T2D risk was found to be low (M = 5.23, SD = 3.32) with more than two-third of the student population at the low risk level while a significant proportion of 23.8%, 5.6% and 0.3% having slightly elevated, moderate and high risk respectively. The T2D risk was significantly related to their age (rho = 0.197, p < 0.000), gender (U = 12641, p = 0.011), ethnic group (Χ2 = 18.86, p < 0.000), marital status (Χ2 = 6.597, p = 0.037), residence (U = 10345, p = 0.008), academic year (Χ2 = 14.24, p = 0.007) and physical activity (rho = -0.205, p < 0.000 and Χ2 = 13.515, p = 0.001). Of these, only age (β=0.130) and physical activity (β=-0.159) remained significant in the regression analysis.

CONCLUSION

The findings call for a radical change in the nursing practice to target the amendable factors that are significant in order to prevent the progression of the risk towards type 2 diabetes.

Type 2 diabetes prevalence and its risk factors in HIV: A cross-sectional study

BACKGROUND

Type 2 diabetes (T2D) has a reported greater prevalence and poorer treatment outcomes in people living with HIV (PLWH) than comparable HIV-uninfected cohorts. We conducted a cross-sectional study to delineate the factors driving T2D in PLWH in an ethnically diverse cohort, and additionally observed how these have changed over time.

SETTING

We studied a diverse HIV cohort in London to determine the prevalence and risk factors for T2D, and compared them to a cohort studied 10 years previously.

METHODS

Patients were classified as normoglycaemic (fasting glucose <6.0 mmol/l) or dysglycaemic (≥6.0 mmol/l). The relative contribution to dysglycaemia of modifiable and fixed factors, including demographics, anthropometrics, comorbidities, immune status, and HIV therapy, were analysed using univariate and logistic regression analyses.

RESULTS

T2D prevalence was 15.1% in 2015 with a relative risk of 2.4 compared to the general population. The prevalence compared to 6.8% ten years earlier. The 2015 versus the 2005 cohort was significantly older (median age 49 (42-57) years versus 41 (IQR 35-47), p<0.001), had a higher BMI (27.4 (23.3-29.9) versus 24.9 (22.4-28.0) kg/m2 respectively, p = 0.019) and hypertensive (37.9% versus 19.6 respectively, p<0.001). The strongest predictors of dysglycaemia in the 2015 cohort were hepatic steatosis and hypertension, odds ratios (OR) and 95% confidence intervals (CI) 6.74 (3.48-13.03) and 2.92 (1.66-5.16) respectively, and also HIV-related factors of weight gain following antiretroviral initiation and longer known duration of HIV infection (OR 1.07 (1.04-1.11) and 1.06 (1.02-1.10) respectively).

CONCLUSIONS

The alarmingly high prevalence of T2D in HIV requires improved screening, targeted to older patients and those with a longer duration of exposure to antiretrovirals. Effective diabetes prevention and management strategies are needed urgently to reduce this risk; such interventions should target both conventional risk factors, such as abdominal obesity, and HIV-specific risk factors such as weight gain following initiation of antiretrovirals.

Promotion of healthy nutrition in clinical practice: A cross-sectional survey of practices and barriers among physiotherapists in southeast Nigeria

Background:

Healthy diet counselling is an important concept in health promotion. Physiotherapists are well positioned to initiate or support healthy nutrition in addition to physical activity counselling, in routine patient consultation.

Objective:

To determine the practices about and barriers to diet counselling practices among physiotherapists in Southeast Nigeria.

Methods:

In this cross-sectional survey, a total of 140 questionnaires were distributed among physiotherapists.

Results:

Overall, 103 physiotherapists responded. Physiotherapists are confident and consider the incorporation of dietary counselling very important and of high priority in their daily clinical work. They, however, assessed and counselled on dietary status opportunistically in patients. Notwithstanding, physiotherapists believed that the diet counselling they give could be effective in helping patients change their unhealthy dieting practices. Patients were also amenable to physiotherapists advocating on diet issues as part of their consultation. Several barriers to incorporating diet counselling into physiotherapy practice were identified, including lack of access to a dietician/health promotion staff/counsellors, lack of proper patient education materials, lack of expertise in relation to dietary risk factors’ assessment and management, and uncertainty about what dietary services to provide.

Conclusion:

Although physiotherapists consider it important to incorporate diet counselling in their daily clinical practice, development and implementation of strategies to improve physiotherapists’ diet counselling knowledge, competence, skills, and practice are warranted.

Ethnic differences in prediabetes and diabetes in the Suriname Health Study

BACKGROUND

Diabetes is increasing worldwide, and information on risk factors to develop targeted interventions is limited. Therefore, we analyzed data of the Suriname Health Study to estimate the prevalence of prediabetes and diabetes. We also explored whether ethnic differences in prediabetes or diabetes risk could be explained by biological, demographic, lifestyle, anthropometric, and metabolic risk factors.

METHOD

The study was designed according to the WHO Steps guidelines. Fasting blood glucose levels were measured in 3393 respondents, aged 15-65 years, from an Amerindian, Creole, Hindustani, Javanese, Maroon or Mixed ethnic background. Prediabetes was defined by fasting blood glucose levels between 6.1 and 7.0 mmol/L and diabetes by fasting blood glucose levels ≥7.0 mmol/L or 'self-reported diabetes medication use.' For all ethnicities, we analyzed sex, age, marital status, educational level, income status, employment, smoking status, residence, physical activity, body mass index, waist circumference, hypertension, and the levels of triglyceride, total cholesterol, high-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol.

RESULTS

The prevalence of prediabetes was 7.4%, while that of diabetes was 13 0%. From these diabetes cases, 39.6% were not diagnosed previously. No ethnic differences were observed in the prevalence of prediabetes. For diabetes, Hindustanis (23.3%) had twice the prevalence compared to other ethnic groups (4.7-14.2%). The associations of the risk factors with prediabetes or diabetes varied among the ethnic groups. The differences in the associations of ethnic groups with prediabetes or diabetes were partly explained by these risk factors.

CONCLUSIONS

The prevalence of diabetes in Suriname is high and most elevated in Hindustanis. The observed variations in risk factors among ethnic groups might explain the ethnic differences between these groups, but follow-up studies are needed to explore this in more depth.