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Mahe J, Xu A, Liu L, Hua L, Tu H, Huo Y, Huang W, Liu X, Wang J, Tang J, Zhao Y, Liu Z, Hong Q, Ye R, Hu P, Jia P, Huang J, Kong X, Ge Z, Xu A, Wu L, Du C, Shi F, Cui H, Wang S, Li Z, Wang L, Zhang L, Zhang L. Association between weekend warrior physical activity pattern and all-cause mortality among adults living with type 2 diabetes: a prospective cohort study from NHANES 2007 to 2018. Diabetol Metab Syndr 2024; 16:226. [PMID: 39267148 PMCID: PMC11391736 DOI: 10.1186/s13098-024-01455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/22/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND It is uncertain whether the weekend warrior pattern is associated with all-cause mortality among adults living with type 2 diabetes. This study explored how the 'weekend warrior' physical activity (PA) pattern was associated with all-cause mortality among adults living with type 2 diabetes. METHODS This prospective cohort study investigated US adults living with type 2 diabetes in the National Health and Nutrition Examination Survey (NHANES). Mortality data was linked to the National Death Index. Based on self-reported leisure-time and occupational moderate-to-vigorous PA (MVPA), participants were categorized into 3 groups: physically inactive (< 150 min/week of MVPA), weekend warrior (≥ 150 min/week of MVPA in 1 or 2 sessions), and physically active (≥ 150 min/week of MVPA in 3 or more sessions). RESULTS A total of 6067 participants living with type 2 diabetes [mean (SD) age, 61.4 (13.5) years; 48.0% females] were followed for a median of 6.1 years, during which 1206 deaths were recorded. Of leisure-time and occupational activity, compared with inactive individuals, hazard ratios (HRs) for all-cause mortality were 0.49 (95% CI 0.26-0.91) and 0.57 (95% CI 0.38-0.85) for weekend warrior individuals, and 0.55 (95% CI 0.45-0.67) and 0.64 (95% CI 0.53-0.76) for regularly active individuals, respectively. However, when compared leisure-time and occupational weekend warrior with regularly active participants, the HRs were 0.82 (95% CI 0.42-1.61) and 1.00 (95% CI 0.64-1.56) for all-cause mortality, respectively. CONCLUSIONS Weekend warrior PA pattern may have similar effects on lowering all-cause mortality as regularly active pattern among adults living with type 2 diabetes, regardless of leisure-time or occupational activity. Therefore, weekend warrior PA pattern may be sufficient to reduce all-cause mortality for adults living with type 2 diabetes.
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Affiliation(s)
- Jinli Mahe
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Ao Xu
- Monash University-Southeast University Joint Research Institute (Suzhou), Southeast University, Suzhou, China
| | - Li Liu
- Data Centre, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Lei Hua
- Data Centre, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Huiming Tu
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yujia Huo
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
- Monash University-Southeast University Joint Research Institute (Suzhou), Southeast University, Suzhou, China
| | - Weiyuan Huang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Xinru Liu
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Jian Wang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Jinhao Tang
- International College, Krirk University, Bangkok, Thailand
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Beijing, China
| | - Zhining Liu
- Anhui Medical University Affiliated Hospital, Hefei, China
| | - Qiaojun Hong
- Anhui No.2 Provincial People's Hospital, Hefei, China
| | - Rong Ye
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Canter of Neuropsychiatric Disorders and Mental Health, Hefei, China
| | - Panpan Hu
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Canter of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- Hubei Luojia Laboratory, Wuhan, China
- School of Public Health, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hongkong, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zongyuan Ge
- Faculty of Engineering, Monash University, Melbourne, Australia
| | - Aimin Xu
- College of Big Data and Software Engineering, Zhejiang Wanli University, Ningbo, China
| | - Longfei Wu
- Centre for Genetic Epidemiology and Genomics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, China
| | - Chaopin Du
- Department of Neurology, Nantong Third Hospital Affiliated to Nantong University, Nantong, China
| | - Feng Shi
- Department of Surgery, Civil Aviation General Hospital, Shanghai, China
| | - Hanbin Cui
- Department of Cardiovascular Medicine, First Affiliated Hospital, Ningbo University, Ningbo, China
| | - Shengfeng Wang
- School of Public Health, Peking University, Beijing, China
| | - Zhihui Li
- Tsinghua Vanke School of Public Health, Beijing, China
| | - Liang Wang
- Department of Public Health, Marshall University, Huntington, WV, USA
| | - Lei Zhang
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
- Clinical Medical Research Centre, Children's Hospital of Nanjing Medical University, Nanjing, China.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
| | - Lin Zhang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China.
- Monash University-Southeast University Joint Research Institute (Suzhou), Southeast University, Suzhou, China.
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Li M, Zhang B, Guo L, Zhang Y, Du X, Wang B, Xu Z, Sun N, Chen R, Han W, Chen L, Song Z. Portrait for Type 2 Diabetes with Goal-Achieved HbA1c Using Digital Diabetes Care Model: A Real-World 12-Month Study from China. Patient Prefer Adherence 2023; 17:2227-2235. [PMID: 37701426 PMCID: PMC10494920 DOI: 10.2147/ppa.s416121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
Background Our previous study demonstrated that digital diabetes care model (DDCM) created by multidisciplinary care team (MDCT) can improve glycemic control for patients with diabetes than usual care. Therefore, we aimed to explore long-term glycemic control with DDCM and influencing factors in type 2 diabetic cohort, in order to make a portrait for diabetes with goal-achieved HbA1c in clinics. Methods A total of 1198 outpatients with type 2 diabetes using DDCM for at least 12 months were recruited as a cohort. Medical records and specific DDCM indexes were collected. The influencing factors for glycemic control were explored by multivariate logistic regression analysis, followed by an internal and external validation. Results A total of 887 patients were finally included. HbA1c target-achieving rate was increased from 39.83% at baseline to 71.79% after 3-month follow-up. A shorter duration of diabetes, more frequent self-monitoring of blood glucose, lower HbA1c level at baseline, and less frequent emergency out-of-hospital follow-ups were influencing factors for HbA1c <7% at 12-month follow-up. AUC of the prediction model was 0.790, with a sensitivity of 69.7% and specificity of 76.1%. Internal and external validation in patients using the DDCM monitored by MDCT indicated that the DDCM was robust (AUC =0.783 and 0.723, respectively). Conclusion Our findings made a portrait for T2DM with goal-achieved HbA1c in our DDCM. It is important to recognize associated factors for health providers to make personalized intervention in clinical practice.
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Affiliation(s)
- Mingzhen Li
- Department of Endocrinology, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Bing Zhang
- Department of Information Management, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Lichuan Guo
- Department of Information Management, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Yuan Zhang
- Department of Information Management, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Xiaoyan Du
- Department of Medical, Happy Life Technology Co Ltd, Beijing, People’s Republic of China
| | - Bingyi Wang
- Department of Medical, Happy Life Technology Co Ltd, Beijing, People’s Republic of China
| | - Zheng Xu
- Department of Yutang, Andon Health Co., Ltd, Tianjin, People’s Republic of China
| | - Ning Sun
- Department of Yutang, Andon Health Co., Ltd, Tianjin, People’s Republic of China
| | - Ruibin Chen
- Department of Yutang, Andon Health Co., Ltd, Tianjin, People’s Republic of China
| | - Wanwen Han
- Department of Yutang, Andon Health Co., Ltd, Tianjin, People’s Republic of China
| | - Liming Chen
- Department of Endocrinology, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Zhenqiang Song
- Department of Endocrinology, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
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3
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Khoo CL, Chimoriya R, Simmons D, Piya MK. Partial meal replacement for people with type 2 diabetes: 2-year outcomes from an Australian general practice. Aust J Prim Health 2023; 29:74-80. [PMID: 36318919 DOI: 10.1071/py22180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to determine weight loss and improvement in glycaemia at 12 and 24months in patients with type 2 diabetes mellitus (T2DM), following a 3-month partial meal replacement and subsequent reduced calorie diet. METHODS This was a retrospective cohort study of patients with T2DM attending a solo general practice in Sydney, New South Wales, Australia. Participants were advised to follow a 3-month partial meal replacement plan comprising of two meal replacement shakes plus a healthy meal. Over the subsequent 21months, patients were encouraged to follow a reduced calorie diet with a particular emphasis on lowering carbohydrate intake. RESULTS Of the 153 patients with T2DM, 51 (33.3%) agreed to follow a 3-month partial meal replacement plan, which was completed by 66.7% (n =34/51). Compared to baseline, the average weight loss at 12 and 24months was 7.1±7.0kg (102.2±20.9kg vs 95.1±18.7kg, P <0.001) and 4.2±7.7kg (102.2±20.9kg vs 98.0±18.2kg, P =0.003), respectively. Haemoglobin A1c (HbA1c) was significantly reduced at 12months (6.9±1.5% vs 6.3±0.9%, P =0.003), but not at 24months. The proportion of participants that met the criteria for diabetes remission was similar at baseline (8.8%) and 12months (11.8%), but increased to 32.4% at 24months (P =0.016). CONCLUSIONS Patients with T2DM who were able to follow a partial meal replacement plan for 3months with advice from a general practitioner achieved significant weight loss over 24months. A multicentre randomised controlled trial to confirm these findings is required as this could significantly change the management of T2DM in primary care.
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Affiliation(s)
- Chee L Khoo
- Healthfocus Family Practice, Ingleburn, NSW 2565, Australia; and School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; and Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; and Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
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4
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Aliyev SA, Mamedova SY, Aliyev ES. [Endoscopic intragastric injection of botulinum toxin in the treatment of patients with morbid obesity: opportunities and prospects]. Khirurgiia (Mosk) 2023:81-88. [PMID: 36583498 DOI: 10.17116/hirurgia202301181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The authors consider modern epidemiological and demographic data on morbid obesity. Literature review is devoted to non-surgical treatment of patients with morbid obesity. The authors analyze the results of experimental and clinical studies on endoscopic intragastric injection of botulinum toxin and bariatric efficacy of this approach. The indications for endoscopic intragastric injection of botulinum toxin and advantages of this technique are clearly formulated. The authors identified the most significant criteria for objective assessment of clinical effectiveness of endoscopic intragastral injection of botulinum toxin, as well as scientific and methodological principles necessary for this technique. Clinical efficacy of intragastric injection of botulinum toxin including overweight loss, anorexigenic and gastroparetic effects indicates inconsistent results and certain unresolved problems. Thus, large-scale multiple-center randomized controlled trials and multivariate analysis are required to determine the role of endoscopic intragastric injection of botulinum toxin in complex treatment of patients with morbid obesity.
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Affiliation(s)
- S A Aliyev
- Azerbaijan Medical University, Baku, Azerbaijan
| | | | - E S Aliyev
- Azerbaijan Medical University, Baku, Azerbaijan
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5
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Mehran L, Honarvar M, Masoumi S, Khalili D, Amouzegar A, Azizi F. Weight fluctuation, mortality, and cardiovascular disease in adults in 18 years of follow-up: Tehran Lipid and Glucose Study. J Endocrinol Invest 2023; 46:37-49. [PMID: 35921037 DOI: 10.1007/s40618-022-01881-9] [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: 05/28/2022] [Accepted: 07/21/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Controversies exist in the effect of body weight loss and fluctuation on cardiovascular disease (CVD) and mortality. This study aims to assess the effect of weight variability on CVD and all-cause and cardiovascular mortality in the Tehran Lipid and Glucose Study (TLGS) cohort. METHOD Participants aged ≥ 40 year at the baseline period with at least 3 BMI measurements were included in this study. After excluding individuals with cancer, CVD, end-stage renal disease, systemic use of glucocorticoids, pregnancy, and missing covariates at the baseline, a total of 3461 participants were enrolled and followed for 18 years. BMI variability was defined using root mean squared error (RMSE) and average successive variability (ASV). In the RMSE method, BMI variability was calculated using the best-fitting model for BMI trend of each subject. Multivariate Cox proportional hazard models were applied to assess BMI variability's effect on CVD and mortality. RESULTS Among the 3461 participants in this study, the group with the highest weight variability had an increased risk of death for all-cause (HR 1.65; 95% CI 1.21-2.25), non-cardiovascular (HR 1.77; 95% CI 1.24-2.53), and non-cancer (HR 1.77; 95% CI 1.25-2.50) mortality. However, BMI variability showed to be protective against CVD (HR 0.76; 95% CI 0.6-0.97). These findings were significant in males, non-smokers, participants with age ≤ 60 year, BMI < 30, negative BMI slope, and both diabetic and non-diabetic subjects. CONCLUSION High BMI variability is associated with increased risk of all-cause, non-CVD, and non-cancer mortality, although protective for the CVD event. Appropriate strategies for body weight maintenance after weight loss could be adopted to avoid weight variability, particularly in non-obese subjects.
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Affiliation(s)
- L Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran
| | - M Honarvar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran
| | - S Masoumi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - D Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - A Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran.
| | - F Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Islamic Republic of Iran
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Lin C, Yeong TJJM, Lim WH, Ng CH, Yau CE, Chin YH, Muthiah MD, Loh PH, Foo RSY, Mok SF, Shabbir A, Dimitriadis GK, Khoo CM, Chew NWS. Comparison of mechanistic pathways of bariatric surgery in patients with diabetes mellitus: A Bayesian network meta-analysis. Obesity (Silver Spring) 2022; 30:1380-1390. [PMID: 35715979 DOI: 10.1002/oby.23453] [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] [Received: 01/28/2022] [Revised: 03/09/2022] [Accepted: 03/25/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Metabolic bariatric procedures are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). Previous meta-analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. This updated network meta-analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of metabolic surgery against restrictive procedures and standard first-line treatment for patients with T2DM. METHODS Embase, MEDLINE, and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM on September 3, 2021. A Bayesian network meta-analysis was conducted. The primary outcome was T2DM remission. Secondary outcomes included changes in BMI, lipoprotein levels, and blood pressure. RESULTS Thirty-two articles were included. Metabolic surgery was statistically superior to restrictive procedures (risk ratio [RR]: 2.57, 95% credibility intervals [CrI]: 1.36-5.43), medical therapy (RR: 35.29, 95% Crl: 10.56-183.23), and lifestyle intervention (RR: 40.51, 95% Crl: 5.32-402.59) in T2DM remission. Metabolic surgery significantly lowered BMI and blood pressure compared with other interventions. Restrictive procedures significantly increased high-density lipoprotein compared with metabolic surgery. Lifestyle intervention and metabolic surgery were statistically superior to restrictive procedures in reducing low-density lipoprotein. CONCLUSIONS The superiority in diabetes remission and favorable metabolic profile support the choice of metabolic surgery over restrictive bariatric procedures.
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Affiliation(s)
- Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Roger S Y Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Shao Feng Mok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore
| | - Georgios K Dimitriadis
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
- Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London, UK
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
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Prendergast H, Tyo C, Colbert C, Kelley M, Pobee R. Medical complications of obesity: heightened importance in a COVID era. Int J Emerg Med 2022; 15:29. [PMID: 35739488 PMCID: PMC9219148 DOI: 10.1186/s12245-022-00431-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Obesity is a major public health problem associated with significant medical complications. Main body This review examines 8 primary diseases: type 2 diabetes, hypertension, dementia, non-alcoholic fatty liver disease, polycystic ovarian syndrome, dyslipidemia, cancer, and their manifestations in obese patients. A total of 39 articles were used for this review. The authors conducted limited review, searching PubMed and Google Scholar databases using a combination of key words “COVID-19” or “SARS-COV2”, “type 2 diabetes”, “hypertension”, “dementia”, “non-alcoholic fatty liver disease”, “polycystic ovarian syndrome”, “dyslipidemia”, “cancer”, and “obesity”. No specific date limitation was used. Obesity exacerbates many medical conditions and has recently been identified as an independent risk factor for COVID-19 severity. This sets obesity at the pinnacle of all disease complications. The long-term impact of obesity ranges from financial burden on the health system, lower life expectancy, and reduced survival rates. Conclusion Obesity is an important modifiable risk factor. There is the need for healthcare providers to understand the medical complications associated with obesity to optimize patient care.
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Affiliation(s)
- Heather Prendergast
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Carissa Tyo
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher Colbert
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Morgan Kelley
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ruth Pobee
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
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8
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Delestre F, Lehéricey G, Estellat C, Diallo MH, Hansel B, Giral P. Hypnosis reduces food impulsivity in patients with obesity and high levels of disinhibition: HYPNODIET randomized controlled clinical trial. Am J Clin Nutr 2022; 115:1637-1645. [PMID: 35170724 DOI: 10.1093/ajcn/nqac046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The obesogenic environment of Western countries raises questions about its current management. Some clinical studies have explored hypnosis, although the current state of knowledge does not lead to definitive conclusions about its efficacy. OBJECTIVES We assessed the impact of Ericksonian hypnosis and self-hypnosis on disinhibition of eating in adults with obesity and high food impulsivity levels, compared with standard nutritional education. METHODS From September 2014 to July 2015, adults with BMI (in kg/m2) of 30-40 and a high disinhibition score [>8 on the Three Factor Eating Questionnaire (TFEQ-51)] were included in a randomized controlled trial. The control and hypnosis groups received the same standard nutrition education in 8 workshops. In the hypnosis group, subjects had 8 sessions of hypnosis combined with training in self-hypnosis. Disinhibition (primary outcome) and other scores from the TFEQ-51 as well as anthropometric, food intake, cardiometabolic, and physical activity variables were collected at inclusion and at 8 mo. RESULTS Of 82 randomly assigned adults, 70 participated in all sessions; 80 participated in ≥1 session and were included in the main analysis (hypnosis group, n = 41; control group, n = 39). After 8 mo of follow-up, disinhibition scores adjusted for baseline values were lower in the hypnosis group, with a mean between-group difference of 4.2 (95% CI: 2.8, 5.5; P < 0.001); 67.7% of adults in the hypnosis group had normalized their disinhibition (compared with 11.1% in control; P < 0.0001). Differences for weight (1.8 kg; 95% CI: -0.1, 3.7 kg; P = 0.052), BMI (0.8; 95% CI: 0.1, 1.4; P = 0.028), susceptibility to hunger score (2.2; 95% CI: 1.0, 3.3; P < 0.001), and its 2 subscales also favored the hypnosis group. CONCLUSIONS In the management of adults with obesity and a high disinhibition score, hypnosis and self-hypnosis can significantly improve the deep mechanisms of eating behaviors and seem to have a beneficial effect on weight loss.This trial was registered at clinicaltrials.gov as NCT02292108.
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Affiliation(s)
- Fabienne Delestre
- Dietetics Department, Pitié Salpêtrière University Hospital, AP-HP, Paris, France
| | - Guillaume Lehéricey
- Dietetics Department, Pitié Salpêtrière University Hospital, AP-HP, Paris, France
| | - Candice Estellat
- PEPITES team, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, INSERM, Paris, France.,Clinical Research Unit (URC), Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Pharmacoepidemiology Center (Cephepi), Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Hassimiou Diallo
- Clinical Research Unit (URC), Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Boris Hansel
- INSERM U1148, University of Paris, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Giral
- Endocrinology-Metabolism Department, Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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9
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Abduljabbar MH, Nafea OE, Alahmari WM, Alharthi AA, Alorabi AS, Alharthi SJ, Alosami NA, Larbi N, Alshareef K. Glycemic control after sleeve gastrectomy in Taif Hospitals, Kingdom of Saudi Arabia. ALL LIFE 2022. [DOI: 10.1080/26895293.2022.2078895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Maram H. Abduljabbar
- Department of Pharmacology and Toxicology, Collage of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Ola E. Nafea
- Department of Clinical Pharmacy, Collage of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Wafa M. Alahmari
- Pharm D, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | | | | | | | - Norah A. Alosami
- Pharm D, College of Pharmacy, Taif University, Taif, Saudi Arabia
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10
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Moravcová K, Karbanová M, Bretschneider MP, Sovová M, Ožana J, Sovová E. Comparing Digital Therapeutic Intervention with an Intensive Obesity Management Program: Randomized Controlled Trial. Nutrients 2022; 14:nu14102005. [PMID: 35631145 PMCID: PMC9143861 DOI: 10.3390/nu14102005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 01/21/2023] Open
Abstract
In this study, we evaluated whether the digital program Vitadio achieves comparable results to those of an intensive in-person lifestyle intervention in obesity management. This is a 12-month prospective, randomized controlled trial. Obese patients with insulin resistance, prediabetes or type 2 diabetes were included. The intervention group (IG) used Vitadio. The control group (CG) received a series of in-person consultations. Body weight and various metabolic parameters were observed and analyzed with ANOVA. The trial is ongoing and the presented findings are preliminary. Among 100 participants (29% men; mean age, 43 years; mean BMI, 40.1 kg/m2), 78 completed 3-month follow-up, and 51 have completed the 6-month follow-up so far. Participants significantly (p < 0.01) reduced body weight at 3 months (IG: −5.9 ± 5.0%; CG: −4.2 ± 5.0%) and 6 months (IG: −6.6±6.1%; CG: −7.1 ± 7.1%), and the difference between groups was not significant. The IG achieved favorable change in body composition; significant improvement in TAG (−0.6 ± 0.9 mmol/l, p < 0.01), HDL (0.1 ± 0.1%, p < 0.05), HbA1c (−0.2 ± 0.5%, p < 0.05) and FG (−0.5 ± 1.5 mmol/l, p < 0.05); and a superior (p = 0.02) HOMA-IR reduction (−2.5 ± 5.2, p < 0.01). The digital intervention achieved comparable results to those of the intensive obesity management program. The results suggest that Vitadio is an effective tool for supporting patients in obesity management and diabetes prevention.
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Affiliation(s)
- Katarína Moravcová
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (M.S.); (J.O.); (E.S.)
- Correspondence:
| | - Martina Karbanová
- Department of Health, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
- First Faculty of Medicine, Charles University in Prague, Kateřinská 32, 121 08 Prague, Czech Republic
| | - Maxi Pia Bretschneider
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Markéta Sovová
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (M.S.); (J.O.); (E.S.)
| | - Jaromír Ožana
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (M.S.); (J.O.); (E.S.)
| | - Eliška Sovová
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (M.S.); (J.O.); (E.S.)
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11
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Goit RK, Taylor AW, Yin Lo AC. The central melanocortin system as a treatment target for obesity and diabetes: A brief overview. Eur J Pharmacol 2022; 924:174956. [DOI: 10.1016/j.ejphar.2022.174956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 12/12/2022]
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12
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Mazin I, Chernomordik F, Fefer P, Matetzky S, Beigel R. The Impact of Novel Anti-Diabetic Medications on CV Outcomes: A New Therapeutic Horizon for Diabetic and Non-Diabetic Cardiac Patients. J Clin Med 2022; 11:1904. [PMID: 35407513 PMCID: PMC9000034 DOI: 10.3390/jcm11071904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/17/2022] [Accepted: 03/27/2022] [Indexed: 01/27/2023] Open
Abstract
It is estimated that in the past two decades the number of patients diagnosed with diabetes mellites (DM) has doubled. Despite significant progress in the treatment of cardiovascular disease (CVD), including novel anti-platelet agents, effective lipid-lowering medications, and advanced revascularization techniques, patients with DM still are least twice as likely to die of cardiovascular causes compared with their non-diabetic counterparts, and current guidelines define patients with DM at the highest risk for atherosclerotic cardiovascular disease and major adverse cardiovascular events (MACE). Over the last few years, there has been a breakthrough in anti-diabetic therapeutics, as two novel anti-diabetic classes have demonstrated cardiovascular benefit with consistently reduced MACE, and for some agents, also improvement in heart failure status as well as reduced cardiovascular and all-cause mortality. These include the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists. The benefits of these medications are thought to be derived not only from their anti-diabetic effect but also from additional mechanisms. The purpose of this review is to provide the everyday clinician a detailed review of the various agents within each class with regard to their specific characteristics and the effects on MACE and cardiovascular outcomes.
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Affiliation(s)
- Israel Mazin
- Department of Cardiology, The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 5265601, Israel; (F.C.); (P.F.); (S.M.); (R.B.)
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13
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Cheong AJY, Teo YN, Teo YH, Syn NL, Ong HT, Ting AZH, Chia AZQ, Chong EY, Chan MY, Lee CH, Lim AYL, Kong WKF, Wong RCC, Chai P, Sia CH. SGLT inhibitors on weight and body mass: A meta-analysis of 116 randomized-controlled trials. Obesity (Silver Spring) 2022; 30:117-128. [PMID: 34932882 DOI: 10.1002/oby.23331] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Multiple trials have demonstrated the metabolic effects of sodium/glucose cotransporter 2 (SGLT2) inhibitors in patients regardless of diabetes status, and recent trials have been conducted on the combined sodium/glucose cotransporter 1 and sodium/glucose cotransporter 2 (SGLT1/SGLT2) inhibitors. Therefore, a meta-analysis was conducted to investigate the weight reduction effects and dose-response relationship of SGLT inhibitors and to assess the relative efficacy of SGLT1/SGLT2 inhibitors. METHODS Four electronic databases (PubMed, Embase, Cochrane, and Scopus) were searched on November 21, 2020, for articles published from January 1, 2000, up to November 21, 2020. RESULTS In total, 116 randomized-controlled trials were included, with a combined cohort of 98,497 patients. Overall, patients had a mean weight reduction of -1.79 kg (95% CI: -1.93 to -1.66, p < 0.001) compared with placebo. This effect was observed across diabetes status, duration of follow-up, various comorbidities, and all SGLT drug types. Mean BMI changes were -0.71 kg/m2 (95% CI: -0.94 to -0.47, p < 0.001) compared with placebo. Canagliflozin, empagliflozin, sotagliflozin, and licogliflozin showed a dose-response relationship for mean weight change. Compared with SGLT2 inhibitors, SGLT1/SGLT2 inhibitors had a significantly larger reduction in weight. CONCLUSIONS SGLT inhibitors demonstrated weight reduction benefits in this meta-analysis. Further studies are needed to clarify their role in weight management.
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Affiliation(s)
- Alex Jia Yang Cheong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas L Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - How Ting Ong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adriel Z H Ting
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alys Z Q Chia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elliot Yeung Chong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Amanda Yuan Ling Lim
- Division of Endocrinology, University Medicine Cluster, National University Health System (NUHS), Singapore
| | - William K F Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Raymond C C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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14
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Alkhalidy H, Orabi A, Alnaser K, Al-Shami I, Alzboun T, Obeidat MD, Liu D. Obesity Measures as Predictors of Type 2 Diabetes and Cardiovascular Diseases among the Jordanian Population: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12187. [PMID: 34831943 PMCID: PMC8618033 DOI: 10.3390/ijerph182212187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 12/23/2022]
Abstract
Obesity is strongly associated with cardiovascular diseases (CVD) and type 2 diabetes (T2D). This study aimed to use obesity measures, body mass index (BMI) and waist circumference (WC) to predict the CVD and T2D risk and to determine the best predictor of these diseases among Jordanian adults. A cross-sectional study was conducted at the governmental and military hospitals across Jordan. The study participants were healthy or previously diagnosed with CVD or T2D. The continuous variables were compared using ANOVA, and the categorical variables were compared using the X2 test. The multivariate logistic regression was used to predict CVD and T2D risk through their association with BMI and WC. The final sample consisted of 6000 Jordanian adults with a mean age of 41.5 ± 14.7 years, 73.6% females. The BMI (OR = 1.7, CI: 1.30-2.30, p < 0.001) was associated with a higher risk of T2D compared to WC (OR = 1.3, CI: 1.04-1.52, p = 0.016). However, our results showed that BMI was not associated with CVD risk, while the WC was significantly and positively associated with CVD risk (OR = 1.9, CI: 1.47-2.47, p < 0.001). In conclusion, an elevated BMI predicts a higher risk of T2D, while WC is more efficient in predicting CVD risk. Our results can be used to construct a population-specific intervention to reduce the risk of CVD and T2D among adults in Jordan and other countries with similar backgrounds.
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Affiliation(s)
- Hana Alkhalidy
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan; (A.O.); (K.A.); (T.A.)
| | - Aliaa Orabi
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan; (A.O.); (K.A.); (T.A.)
| | - Khadeejah Alnaser
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan; (A.O.); (K.A.); (T.A.)
| | - Islam Al-Shami
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan;
| | - Tamara Alzboun
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan; (A.O.); (K.A.); (T.A.)
| | - Mohammad D. Obeidat
- Department of Animal Production, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Dongmin Liu
- Department of Human Nutrition, Foods and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA 24061, USA;
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15
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Xie S, Wang M, Zhang B, Weng S. Hypoglycemic mechanism of intestinal bypass surgery in type 2 diabetic rats. Sci Rep 2021; 11:21596. [PMID: 34732821 PMCID: PMC8566479 DOI: 10.1038/s41598-021-98714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the effect of duodenal-jejunal bypass (DJB) surgery on postoperative blood glucose in type 2 diabetic rats, and further explore possible mechanisms for the effect of surgical treatment of type 2 diabetes. Forty rats with type 2 diabetes were randomly assigned to 4 groups (n = 10 rats per group), which subsequently underwent DJB, new biliopancreatic diversion (NBPD) or duodenal-jejunal exclusion (DJE) surgery or a sham operation (SHAM). Fasting glucose, 2-h postprandial glucose and blood lipids were measured, and the mRNA in liver and intestinal tissue for bile acid receptor (FXR), as well as the FXR protein expression in the liver tissues were determined. Postprandial blood glucose and fasting TG and FFA in the DJB and NBPD groups were significantly lower than those in the SHAM group and preoperative (p < 0.05) at 8 weeks postoperation. Liver FXR protein was expressed at significantly higher in the DJB and NBPD groups than in the other two (p < 0.05), and the intestinal FXR mRNA in the DJE group were highest. DJB up-regulates the expression of bile acid receptors in the liver and down-regulates those receptors in the intestinal tract via biliopancreatic diversion. This process reduces TG levels, and subsequently any lipotoxicity to islet cells to produce a hypoglycemic effect.
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Affiliation(s)
- Siqi Xie
- Hepatopancreatobiliary Surgery Department, The First Affiliated Hospital of Fujian Medical University, National Abdominal Surgery Institute of Fujian, No 20 Chazhong Road, Fuzhou City, Fujian, People's Republic of China
| | - MingChang Wang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Fujian Medical University, No. 34, North Zhongshan Road, Licheng District, Quanzhou City, Fujian, People's Republic of China
| | - Bin Zhang
- Hepatopancreatobiliary Surgery Department, The First Affiliated Hospital of Fujian Medical University, National Abdominal Surgery Institute of Fujian, No 20 Chazhong Road, Fuzhou City, Fujian, People's Republic of China
| | - ShanGeng Weng
- Hepatopancreatobiliary Surgery Department, The First Affiliated Hospital of Fujian Medical University, National Abdominal Surgery Institute of Fujian, No 20 Chazhong Road, Fuzhou City, Fujian, People's Republic of China.
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16
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National trends in the prevalence of glycemic control among patients with type 2 diabetes receiving continuous care in Thailand from 2011 to 2018. Sci Rep 2021; 11:14260. [PMID: 34253809 PMCID: PMC8275592 DOI: 10.1038/s41598-021-93733-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022] Open
Abstract
Diabetes is one of the largest global health problems and exhibits a constantly increasing trend. A series of nationwide hospital-based cross-sectional surveys of clinical outcomes was performed annually from 2011 to 2015 and 2018 among patients with type 2 diabetes aged ≥ 20 years receiving medical care for at least 12 months. A two-stage stratified cluster that was proportional to the size sampling technique was used to select a nationally and provincially representative sample of patients with type 2 diabetes in Thailand. A total of 186,010 patients with type 2 diabetes were enrolled in the study from 2011 to 2018. The prevalence of adequate glycemic control (hemoglobinA1c level < 7.0%) among patients with type 2 diabetes were estimated to be 34.5% (95%CI 33.8–35.2%) in 2011, 33.0% (95%CI 32.4–33.6%) in 2012, 34.7% (95%CI 34.1–35.4%) in 2013, 35.5 (95%CI 34.9–36.1%) in 2014, 35.6 (95%CI 35.0–36.2%) in 2015, and 35.6% (95%CI 35.0–36.2%) in 2018, respectively (p for trend < 0.001). Independent factors related to poor glycemic control (hemoglobinA1c ≥ 7%) were being female, younger aged, living in the northeastern region, received care form hospitals lower than regional level, under universal health coverage scheme, greater duration of diabetes, higher body mass index level and absence of hypertension comorbidity.
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17
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Chen M, Surbhi S, Bailey JE. Association of Weight Loss With Type 2 Diabetes Remission Among Adults in Medically Underserved Areas: A Retrospective Cohort Study. Am J Health Promot 2021; 36:29-37. [PMID: 34128392 DOI: 10.1177/08901171211024426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the association between weight loss and type 2 diabetes remission among vulnerable populations living in medically underserved areas of the Mid-Southern United States. DESIGN Quantitative, retrospective cohort study. SETTING 114 ambulatory sites and 5 adults' hospitals in the Mid-South participating in a regional diabetes registry. PARTICIPANTS 9,900 adult patients with type 2 diabetes, stratified by remission status, with 1 year of baseline electronic medical record data, and 1 year of follow-up data for the 2015-2018 study period. MEASURES The outcomes were diabetes remissions, categorized as any remission, partial remission, and complete remission based on the guidelines of the American Diabetes Association. The exposure was weight loss, calculated by the change in the Body Mass Index (BMI) as a proxy measure. ANALYSIS χ2 tests, Fisher's exact tests, and the Mann-Whitney U-test were used to examine the differences in patient characteristics by remission status across the 3 remission categories, as appropriate. Multiple multivariable logistic regressions adjusting for confounders were performed to estimate the adjusted odds ratios (aORs) for the associations between weight loss and diabetes remission. RESULTS Among 9,900 patients identified, a reduction of 0.3 kg/m2 (standard deviation: 2.5) in the average BMI from the baseline to the follow-up was observed. 10.8% achieved any type of remission, with 9.8% for partial and 1.0% for complete remissions. Greater weight loss was significantly associated with an increased likelihood of any (aOR = 1.07, 95% confidence interval (CI), 1.06-1.08), partial (aOR 1.06, 95% CI, 1.04-1.07), and complete diabetes remission (aOR 1.10, 95% CI, 1.07-1.13). CONCLUSIONS Weight loss is significantly associated with diabetes remission among patients living in medically underserved areas, but complete remission is rare.
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Affiliation(s)
- Ming Chen
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satya Surbhi
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine-General Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James E Bailey
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institute of Health Outcome and Policy, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine-General Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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18
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Liu B, Du Y, Wu Y, Snetselaar LG, Wallace RB, Bao W. Trends in obesity and adiposity measures by race or ethnicity among adults in the United States 2011-18: population based study. BMJ 2021; 372:n365. [PMID: 33727242 PMCID: PMC7961695 DOI: 10.1136/bmj.n365] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the trends in obesity and adiposity measures, including body mass index, waist circumference, body fat percentage, and lean mass, by race or ethnicity among adults in the United States from 2011 to 2018. DESIGN Population based study. SETTING National Health and Nutrition Examination Survey (NHANES), 2011-18. PARTICIPANTS A nationally representative sample of US adults aged 20 years or older. MAIN OUTCOME MEASURES Weight, height, and waist circumference among adults aged 20 years or older were measured by trained technicians using standardized protocols. Obesity was defined as body mass index of 30 or higher for non-Asians and 27.5 or higher for Asians. Abdominal obesity was defined as a waist circumference of 102 cm or larger for men and 88 cm or larger for women. Body fat percentage and lean mass were measured among adults aged 20-59 years by using dual energy x ray absorptiometry. RESULTS This study included 21 399 adults from NHANES 2011-18. Body mass index was measured for 21 093 adults, waist circumference for 20 080 adults, and body fat percentage for 10 864 adults. For the overall population, age adjusted prevalence of general obesity increased from 35.4% (95% confidence interval 32.5% to 38.3%) in 2011-12 to 43.4% (39.8% to 47.0%) in 2017-18 (P for trend<0.001), and age adjusted prevalence of abdominal obesity increased from 54.5% (51.2% to 57.8%) in 2011-12 to 59.1% (55.6% to 62.7%) in 2017-18 (P for trend=0.02). Age adjusted mean body mass index increased from 28.7 (28.2 to 29.1) in 2011-12 to 29.8 (29.2 to 30.4) in 2017-18 (P for trend=0.001), and age adjusted mean waist circumference increased from 98.4 cm (97.4 to 99.5 cm) in 2011-12 to 100.5 cm (98.9 to 102.1 cm) in 2017-18 (P for trend=0.01). Significant increases were observed in body mass index and waist circumference among the Hispanic, non-Hispanic white, and non-Hispanic Asian groups (all P for trend<0.05), but not for the non-Hispanic black group. For body fat percentage, a significant increase was observed among non-Hispanic Asians (30.6%, 29.8% to 31.4% in 2011-12; 32.7%, 32.0% to 33.4% in 2017-18; P for trend=0.001), but not among other racial or ethnic groups. The age adjusted mean lean mass decreased in the non-Hispanic black group and increased in the non-Hispanic Asian group, but no statistically significant changes were found in other racial or ethnic groups. CONCLUSIONS Among US adults, an increasing trend was found in obesity and adiposity measures from 2011 to 2018, although disparities exist among racial or ethnic groups.
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Affiliation(s)
- Buyun Liu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Yang Du
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Yuxiao Wu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
- Obesity Research and Education Initiative, University of Iowa, Iowa City, IA, USA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA
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Michaud TL, Ern J, Scoggins D, Su D. Assessing the Impact of Telemonitoring-Facilitated Lifestyle Modifications on Diabetes Outcomes: A Systematic Review and Meta-Analysis. Telemed J E Health 2021; 27:124-136. [DOI: 10.1089/tmj.2019.0319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Tzeyu L. Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jessica Ern
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dylan Scoggins
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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20
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MacDonald CS, Nielsen SM, Bjørner J, Johansen MY, Christensen R, Vaag A, Lieberman DE, Pedersen BK, Langberg H, Ried-Larsen M, Midtgaard J. One-year intensive lifestyle intervention and improvements in health-related quality of life and mental health in persons with type 2 diabetes: a secondary analysis of the U-TURN randomized controlled trial. BMJ Open Diabetes Res Care 2021; 9:9/1/e001840. [PMID: 33441418 PMCID: PMC7812095 DOI: 10.1136/bmjdrc-2020-001840] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/21/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The effects of lifestyle interventions in persons with type 2 diabetes (T2D) on health-related quality of life (HRQoL) and subjective well-being are ambiguous, and no studies have explored the effect of exercise interventions that meet or exceed current recommended exercise levels. We investigated whether a 1-year intensive lifestyle intervention is superior in improving HRQoL compared with standard care in T2D persons. RESEARCH DESIGN AND METHODS We performed secondary analyses of a previously conducted randomized controlled trial (April 2015 to August 2016). Persons with non-insulin-dependent T2D (duration ≤10 years) were randomized to 1-year supervised exercise and individualized dietary counseling (ie, 'U-TURN'), or standard care. The primary HRQoL outcome was change in the 36-item Short Form Health Survey (SF-36) physical component score (PCS) from baseline to 12 months of follow-up, and a key secondary outcome was changes in the SF-36 mental component score (MCS). RESULTS We included 98 participants (U-TURN group=64, standard care group=34) with a mean age of 54.6 years (SD 8.9). Between-group analyses at 12-month follow-up showed SF-36 PCS change of 0.8 (95% CI -0.7 to 2.3) in the U-TURN group and deterioration of 2.4 (95% CI -4.6 to -0.1) in the standard care group (difference of 3.2, 95% CI 0.5 to 5.9, p=0.02) while no changes were detected in SF-36 MCS. At 12 months, 19 participants (30%) in the U-TURN group and 6 participants (18%) in the standard care group achieved clinically significant improvement in SF-36 PCS score (adjusted risk ratio 2.6, 95% CI 1.0 to 4.5 corresponding to number needed to treat of 4, 95% CI 1.6 to infinite). CONCLUSION In persons with T2D diagnosed for less than 10 years, intensive lifestyle intervention improved the physical component of HRQoL, but not the mental component of HRQoL after 1 year, compared with standard care. TRIAL REGISTRATION NUMBER NCT02417012.
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Affiliation(s)
- Christopher Scott MacDonald
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina M Nielsen
- Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jakob Bjørner
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Optum Patient Insights, Lincoln, Rhode Island, USA
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette Y Johansen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Allan Vaag
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Langberg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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21
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Lohner S, Kuellenberg de Gaudry D, Toews I, Ferenci T, Meerpohl JJ. Non-nutritive sweeteners for diabetes mellitus. Cochrane Database Syst Rev 2020; 5:CD012885. [PMID: 32449201 PMCID: PMC7387865 DOI: 10.1002/14651858.cd012885.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Products sweetened with non-nutritive sweeteners (NNS) are widely available. Many people with type 1 or type 2 diabetes use NNS as a replacement for nutritive sweeteners to control their carbohydrate and energy intake. Health outcomes associated with NNS use in diabetes are unknown. OBJECTIVES To assess the effects of non-nutritive sweeteners in people with diabetes mellitus. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Scopus, the WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases (except for Scopus) was May 2019. We last searched Scopus in January 2019. We did not apply any language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with a duration of four weeks or more comparing any type of NNS with usual diet, no intervention, placebo, water, a different NNS, or a nutritive sweetener in individuals with type 1 or type 2 diabetes. Trials with concomitant behaviour-changing interventions, such as diet, exercise, or both, were eligible for inclusion, given that the concomitant interventions were the same in the intervention and comparator groups. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, full texts, and records retrieved from trials registries, assessed the certainty of the evidence, and extracted data. We used a random-effects model to perform meta-analysis, and calculated effect estimates as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs). We assessed risk of bias using the Cochrane 'Risk of bias' tool and the certainty of evidence using the GRADE approach. MAIN RESULTS We included nine RCTs that randomised a total of 979 people with type 1 or type 2 diabetes. The intervention duration ranged from 4 to 10 months. We judged none of these trials as at low risk of bias for all 'Risk of bias' domains; most of the included trials did not report the method of randomisation. Three trials compared the effects of a dietary supplement containing NNS with sugar: glycosylated haemoglobin A1c (HbA1c) was 0.4% higher in the NNS group (95% CI -0.5 to 1.2; P = 0.44; 3 trials; 72 participants; very low-certainty evidence). The MD in weight change was -0.1 kg (95% CI -2.7 to 2.6; P = 0.96; 3 trials; 72 participants; very low-certainty evidence). None of the trials with sugar as comparator reported on adverse events. Five trials compared NNS with placebo. The MD for HbA1c was 0%, 95% CI -0.1 to 0.1; P = 0.99; 4 trials; 360 participants; very low-certainty evidence. The 95% prediction interval ranged between -0.3% and 0.3%. The comparison of NNS versus placebo showed a MD in body weight of -0.2 kg, 95% CI -1 to 0.6; P = 0.64; 2 trials; 184 participants; very low-certainty evidence. Three trials reported the numbers of participants experiencing at least one non-serious adverse event: 36/113 participants (31.9%) in the NNS group versus 42/118 participants (35.6%) in the placebo group (RR 0.78, 95% CI 0.39 to 1.56; P = 0.48; 3 trials; 231 participants; very low-certainty evidence). One trial compared NNS with a nutritive low-calorie sweetener (tagatose). HbA1c was 0.3% higher in the NNS group (95% CI 0.1 to 0.4; P = 0.01; 1 trial; 354 participants; very low-certainty evidence). This trial did not report body weight data and adverse events. The included trials did not report data on health-related quality of life, diabetes complications, all-cause mortality, or socioeconomic effects. AUTHORS' CONCLUSIONS There is inconclusive evidence of very low certainty regarding the effects of NNS consumption compared with either sugar, placebo, or nutritive low-calorie sweetener consumption on clinically relevant benefit or harm for HbA1c, body weight, and adverse events in people with type 1 or type 2 diabetes. Data on health-related quality of life, diabetes complications, all-cause mortality, and socioeconomic effects are lacking.
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Affiliation(s)
- Szimonetta Lohner
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Daniela Kuellenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tamas Ferenci
- Physiological Controls Research Center, Obuda University, Budapest, Hungary
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane France, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes University, Paris, France
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22
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Michaud TL, Siahpush M, Estabrooks P, Schwab RJ, LeVan TD, Grimm B, Ramos AK, Johansson P, Scoggins D, Su D. Association Between Weight Loss and Glycemic Outcomes: A Post Hoc Analysis of a Remote Patient Monitoring Program for Diabetes Management. Telemed J E Health 2020; 26:621-628. [DOI: 10.1089/tmj.2019.0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Tzeyu L. Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paul Estabrooks
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robert J. Schwab
- Division of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tricia D. LeVan
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Internal Medicine and Veterans Nebraska Western Iowa Healthcare System, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Brandon Grimm
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Athena K. Ramos
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Patrik Johansson
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dylan Scoggins
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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23
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Yang X, Li Z, Sun J. Effects of Cognitive Behavioral Therapy-Based Intervention on Improving Glycaemic, Psychological, and Physiological Outcomes in Adult Patients With Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials. Front Psychiatry 2020; 11:711. [PMID: 32848906 PMCID: PMC7399630 DOI: 10.3389/fpsyt.2020.00711] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with diabetes mellitus (DM) have a high risk of secondary physiological and psychological complications. Some interventions based on cognitive behavioral therapy (CBT) have been used to control glucose levels and improve negative emotions of patients with DM. This study was undertaken to provide an overview of the effectiveness of CBT-based interventions for improving glycaemic control, psychological, and physiological outcomes in adult patients with DM. METHODS Randomized controlled trials (RCTs) published in English and Chinese during 2007 and April 2019 were searched through various electronic databases including PubMed, Cochrane Library, Scopus, Embase, ProQuest Dissertations and Theses, and the Chinese databases (WanFang data and China National Knowledge Infrastructure). The primary outcome variables included glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), depression, and anxiety symptoms. The secondary outcomes were weight and cholesterol. Effect sizes were pooled by random-effects modelling using Comprehensive Meta-Analysis software. Physiotherapy Evidence Database tool was used to assess the quality of all included studies. RESULTS Twenty-three RCTs comprising 2,619 patients with DM (type 1 and type 2) were included in at least one meta-analysis. The results of the main analysis showed that CBT-based interventions had a better effect on reduced HbA1c (-0.275%, 95% CI: -0.443 to -0.107; p < 0.01) with Hedge's g of 0.466 (95% CI: 0.710 - 0.189), reduced depression symptoms with average reduction of -2.788 (95% CI: -4.450 to -1.207; p < 0.01) and Hedge's g of 0.966 (95% CI: 1.507 - 0.426). Twenty-three RCTs comprising 2,619 patients with DM (type 1 and type 2) were included in this meta-analysis. Several mediators of the effect were found through subgroup analysis for HbA1c and depression symptoms. The interventions emphasising completion homework assignments, stress management, and that used an interpersonal strategy delivered via a group had a better effect on both HbA1c and depression symptoms. In addition, behavioral strategies had a better effect on glycaemic control, and cognitive strategies had a better effect on depression symptoms. There was no difference in the change of FPG, anxiety symptoms, weight, and high-density lipoprotein cholesterol (HDL-C) between CBT-based interventions and the control conditions. CONCLUSIONS The findings indicate that CBT-based interventions are effective for improving glycaemic control and depression symptoms in adult patients with type 1 DM (T1DM) or type 2 DM (T2DM) with moderate to large effect size. The results of the subgroup analysis suggest that it is necessary to adopt different types and technical components of CBT according to the population and purpose of the treatment in clinical practice. Due to the high heterogeneity of included studies and other limitations, further study including large number of studies is needed to confirm these results.
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Affiliation(s)
- Xiangyun Yang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhanjiang Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jing Sun
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
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24
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Chan CB, Ahuja P, Ye K. Developing Insulin and BDNF Mimetics for Diabetes Therapy. Curr Top Med Chem 2019; 19:2188-2204. [PMID: 31660832 DOI: 10.2174/1568026619666191010160643] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/29/2019] [Accepted: 09/05/2019] [Indexed: 01/06/2023]
Abstract
Diabetes is a global public health concern nowadays. The majority of diabetes mellitus (DM) patients belong to type 2 diabetes mellitus (T2DM), which is highly associated with obesity. The general principle of current therapeutic strategies for patients with T2DM mainly focuses on restoring cellular insulin response by potentiating the insulin-induced signaling pathway. In late-stage T2DM, impaired insulin production requires the patients to receive insulin replacement therapy for maintaining their glucose homeostasis. T2DM patients also demonstrate a drop of brain-derived neurotrophic factor (BDNF) in their circulation, which suggests that replenishing BDNF or enhancing its downstream signaling pathway may be beneficial. Because of their protein nature, recombinant insulin or BDNF possess several limitations that hinder their clinical application in T2DM treatment. Thus, developing orally active "insulin pill" or "BDNF pill" is essential to provide a more convenient and effective therapy. This article reviews the current development of non-peptidyl chemicals that mimic insulin or BDNF and their potential as anti-diabetic agents.
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Affiliation(s)
- Chi Bun Chan
- School of Biological Sciences, The University of Hong Kong, Hong Kong
| | - Palak Ahuja
- School of Biological Sciences, The University of Hong Kong, Hong Kong
| | - Keqiang Ye
- Department of Pathology and Laboratory Medicine, Emory University of School of Medicine, Atlanta, GA, United States
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25
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Almeda-Valdes P, Herrera-Mercadillo RJ, Aguilar-Salinas CA, Uribe M, Méndez-Sánchez N. The Role of Diet in Patients with Metabolic Syndrome. Curr Med Chem 2019; 26:3613-3619. [PMID: 28521684 DOI: 10.2174/0929867324666170518095316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 01/22/2023]
Abstract
Metabolic syndrome is a frequent metabolic disorder characterized by obesity and insulin resistance seems to be the main pathophysiological alteration. The goal of treating metabolic syndrome is to reduce the risk of coronary heart disease and the development of type 2 diabetes. The lifestyle modification therapy combines specific recommendations on diet alone or combined with other strategies. In this review, we address the following topics: 1) the importance of the high prevalence of metabolic syndrome and obesity, and 2) the role of lifestyle modification focusing on dietary fat intake in the management of MS.
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Affiliation(s)
- Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Roberto J Herrera-Mercadillo
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation. Mexico City, Mexico
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26
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Jin X, Wang J, Li X, An P, Wang H, Mao W, Zhou Q, Chen Y, Wang J, Chen K, Mu Y. Quality Assessment of Systematic Review of the Bariatric Surgery for Diabetes Mellitus. J Diabetes Res 2019; 2019:9541638. [PMID: 31871951 PMCID: PMC6906849 DOI: 10.1155/2019/9541638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/08/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Using the AMSTAR tool, this study evaluated the quality of systematic reviews (SRs) that assessed the efficacy of bariatric surgery in diabetic patients. We aimed to identify studies that can be used as clinical references. METHODS Medline (via PubMed), EMBASE, Epistemonikos, Web of Science, Cochrane Library, CBM, CNKI, and Wanfang Data were systematically searched from inception to December 31, 2017. Two reviewers independently selected SRs and extracted data. Disagreements were solved by discussions or through consultation with a third reviewer. Reviewers extracted data (characteristics of included SRs, e.g., publication year, language, and number of authors) into the predefined tables in the Microsoft Excel 2013 sheet. Data were visualized using the forest plot in RevMan 5.3 software. RESULTS A total of 64 SRs were included. The average AMSTAR score was 7.4 ± 1.7. AMSTAR scores of 7 (n = 21, 32.8%) and 8 (n = 14, 28.1%) were most common. The AMSTAR scores of SRs published before 2016 (n = 46, 71.9%) were compared with SRs published after 2016 (n = 18, 28.1%), and no significant differences were observed (MD = -0.79, 95% confidence interval (CI) -1.65-0.07, P = 0.07). For SRs published in Chinese (n = 17, 26.6%) compared to those published in English (n = 47, 73.4%), the AMSTAR scores significantly differed (MD = 0.21, 95% CI (-0.55, 0.97), P = 0.59). For SRs published in China (n = 33, 51.6%) compared to those published outside of China (n = 31, 48.4%), significant differences in the AMSTAR scores were observed (MD = 1.10, 95% CI (0.29, 1.91), P = 0.008). For SRs with an author number ≤ 6 (n = 31, 48.4%) compared to SRs with authors ≥ 6 (n = 33, 51.6%), no significant differences were observed (MD = -0.36, 95% CI (-1.22, 0.50), P = 0.41). For high-quality SRs published after 2016 (n = 11, 17.2%) compared to other SRs (n = 53, 82.8%), statistically significant differences were noted (MD = 1.75, 95% CI (1.01, 2.49), P < 0.00001). CONCLUSIONS The number of SRs assessing the efficacy of bariatric surgery in diabetic patients is increasing by year, but only a small number meet the criteria to support guideline recommendations. Study protocols not being registered, grey literature not retrieved, incorporation of grey literature as exclusion criteria, and failure to evaluate publication bias and report a conflict of interest were the main causes of low AMSTAR scores.
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Affiliation(s)
- Xinye Jin
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
- Department of Endocrinology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Jinjing Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
- Department of Endocrinology, Fifth Medical Center of Chinese PLA General Hospital, East Avenue, Beijing 100071, China
| | - Xueqiong Li
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
- Department of Gerontology, First Affiliated Hospital of Kunming Medical University, Kunming 650031, China
| | - Ping An
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Haibin Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Wenfeng Mao
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
- Medicine School of Nankai University, Tianjin, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Chinese GRADE Center, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Chinese GRADE Center, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Jie Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
- Medicine School of Nankai University, Tianjin, China
| | - Kang Chen
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yiming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
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Tavares RS, Escada-Rebelo S, Sousa MI, Silva A, Ramalho-Santos J, Amaral S. Can Antidiabetic Drugs Improve Male Reproductive (Dys)Function Associated with Diabetes? Curr Med Chem 2019; 26:4191-4222. [PMID: 30381064 DOI: 10.2174/0929867325666181101111404] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 07/25/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022]
Abstract
The alarming increase in the number of diabetic patients worldwide raises concerns regarding the impact of the disease on global health, not to mention on social and economic aspects. Furthermore, the association of this complex metabolic disorder with male reproductive impairment is worrying, mainly due to the increasing chances that young individuals, at the apex of their reproductive window, could be affected by the disease, further contributing to the disturbing decline in male fertility worldwide. The cornerstone of diabetes management is glycemic control, proven to be effective in avoiding, minimizing or preventing the appearance or development of disease-related complications. Nonetheless, the possible impact of these therapeutic interventions on male reproductive function is essentially unexplored. To address this issue, we have made a critical assessment of the literature on the effects of several antidiabetic drugs on male reproductive function. While the crucial role of insulin is clear, as shown by the recovery of reproductive impairments in insulin-deficient individuals after treatment, the same clearly does not apply to other antidiabetic strategies. In fact, there is an abundance of controversial reports, possibly related to the various study designs, experimental models and compounds used, which include biguanides, sulfonylureas, meglitinides, thiazolidinediones/glitazones, bile acid sequestrants, amylin mimetics, as well as sodiumglucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP1), α-glucosidase inhibitors and dipeptidyl peptidase 4 (DPP4) inhibitors. These aspects constitute the focus of the current review.
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Affiliation(s)
- R S Tavares
- Biology of Reproduction and Stem Cell Group, CNC- Center for Neuroscience and Cell Biology, University of Coimbra 3004-504 Coimbra, Portugal.,Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - S Escada-Rebelo
- Biology of Reproduction and Stem Cell Group, CNC- Center for Neuroscience and Cell Biology, University of Coimbra 3004-504 Coimbra, Portugal.,Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - M I Sousa
- Biology of Reproduction and Stem Cell Group, CNC- Center for Neuroscience and Cell Biology, University of Coimbra 3004-504 Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
| | - A Silva
- Biology of Reproduction and Stem Cell Group, CNC- Center for Neuroscience and Cell Biology, University of Coimbra 3004-504 Coimbra, Portugal.,Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - J Ramalho-Santos
- Biology of Reproduction and Stem Cell Group, CNC- Center for Neuroscience and Cell Biology, University of Coimbra 3004-504 Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
| | - S Amaral
- Biology of Reproduction and Stem Cell Group, CNC- Center for Neuroscience and Cell Biology, University of Coimbra 3004-504 Coimbra, Portugal.,Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
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28
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Bangalore S, Fayyad R, DeMicco DA, Colhoun HM, Waters DD. Body Weight Variability and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus. Circ Cardiovasc Qual Outcomes 2019; 11:e004724. [PMID: 30571333 DOI: 10.1161/circoutcomes.118.004724] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some studies have shown that body weight variability is a risk factor for cardiovascular events, but this has not been studied in subjects with diabetes mellitus. METHODS AND RESULTS We measured intraindividual variations in body weight from baseline and follow-up visits in 6408 subjects with type 2 diabetes mellitus from 3 clinical trials. The primary end point, any coronary event, was a composite of coronary heart disease death, myocardial infarction, resuscitated cardiac arrest, coronary revascularization, and unstable or new-onset angina. After adjustment for risk factors, baseline lipid levels, mean body weight, and weight change, each increase of 1 SD in body weight variability, measured as average successive variability and used as a time-dependent covariate, was associated with an increase in the risk of any coronary event (hazard ratio, 1.08; 95% CI, 1.01-1.14; P=0.017), major coronary event (hazard ratio, 1.12; 95% CI, 1.04-1.20; P=0.002), any cardiovascular event (hazard ratio, 1.08; 95% CI, 1.03-1.14; P=0.0015), and death (hazard ratio, 1.16; 95% CI, 1.10-1.22; P<0.0001). Among patients in the quintile with the highest variation in body weight compared with the lowest, the risk of any coronary event was 59% higher; the risk of a major coronary event, 82% higher; any cardiovascular event, 75% higher; death, 82% higher; myocardial infarction, 99% higher; and stroke, 92% higher in adjusted models. The results were consistent in a number of sensitivity analyses. CONCLUSIONS Among subjects with type 2 diabetes mellitus, fluctuation in body weight was associated with higher mortality and a higher rate of cardiovascular events, independent of traditional cardiovascular risk factors. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov . Unique identifier: NCT00327691 and NCT00327418.
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Affiliation(s)
- Sripal Bangalore
- Department of Cardiology, New York University School of Medicine (S.B.)
| | | | | | | | - David D Waters
- Department of Cardiology, Zuckerberg San Francisco General Hospital, CA (D.D.W.)
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Ahuja A, Tantia O, Chaudhuri T, Khanna S, Seetharamaiah S, Majumdar K, Goyal G. Predicting remission of diabetes post metabolic surgery: a comparison of ABCD, diarem, and DRS scores. Obes Surg 2019; 28:2025-2031. [PMID: 29435812 DOI: 10.1007/s11695-018-3136-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is one of the major causes for development of T2DM. Metabolic surgery has been proved to be a successful and cost-effective treatment modality for managing the patients with obesity and T2DM. Many scoring systems and models have been described in literature to predict the outcome of T2DM after metabolic surgery. The aim of this study is to compare the efficacy of Diarem, DRS, and ABCD score in predicting the T2DM remission. METHODS A total number of 102 diabetic patients, who underwent LMGB/LOAGB, were selected for this study. A retrospective analysis of the three scoring systems when applied to these patients and their predictive abilities were analyzed. RESULTS At 1 year after surgery, 72 (70.59%) patients achieved remission of T2DM. Though the pairwise comparisons between AUC on ROC analysis of ABCD, Diarem, and DRS scores does not show statistically significant difference between them, Diarem score has the maximum relative area under ROC curves. By multivariate analysis, it was found that factors significantly associated with T2DM remission were duration of T2DM, C-peptide, and Pre-Op HbA1c. CONCLUSIONS Among the three scoring systems, though DiaRem score has the best sensitivity and specificity and maximum AUC, no statistically significant difference was found in their diabetes remission predicting abilities. A shorter duration of T2DM, a lower HbA1C, and higher levels of C-peptide were significantly associated with a higher chance of T2DM remission.
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Affiliation(s)
- Anmol Ahuja
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Om Tantia
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India.
| | - Tamonas Chaudhuri
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Shashi Khanna
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Shivakumar Seetharamaiah
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Kajari Majumdar
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
| | - Ghanshyam Goyal
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, West Bengal, 700064, India
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Harvey KL, Holcomb LE, Kolwicz SC. Ketogenic Diets and Exercise Performance. Nutrients 2019; 11:nu11102296. [PMID: 31561520 PMCID: PMC6835497 DOI: 10.3390/nu11102296] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
The ketogenic diet (KD) has gained a resurgence in popularity due to its purported reputation for fighting obesity. The KD has also acquired attention as an alternative and/or supplemental method for producing energy in the form of ketone bodies. Recent scientific evidence highlights the KD as a promising strategy to treat obesity, diabetes, and cardiac dysfunction. In addition, studies support ketone body supplements as a potential method to induce ketosis and supply sustainable fuel sources to promote exercise performance. Despite the acceptance in the mainstream media, the KD remains controversial in the medical and scientific communities. Research suggests that the KD or ketone body supplementation may result in unexpected side effects, including altered blood lipid profiles, abnormal glucose homeostasis, increased adiposity, fatigue, and gastrointestinal distress. The purpose of this review article is to provide an overview of ketone body metabolism and a background on the KD and ketone body supplements in the context of obesity and exercise performance. The effectiveness of these dietary or supplementation strategies as a therapy for weight loss or as an ergogenic aid will be discussed. In addition, the recent evidence that indicates ketone body metabolism is a potential target for cardiac dysfunction will be reviewed.
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Affiliation(s)
- Kristin L Harvey
- Heart and Muscle Metabolism Laboratory, Health and Exercise Physiology, Ursinus College, Collegeville, PA 19426, USA.
| | - Lola E Holcomb
- Heart and Muscle Metabolism Laboratory, Health and Exercise Physiology, Ursinus College, Collegeville, PA 19426, USA.
| | - Stephen C Kolwicz
- Heart and Muscle Metabolism Laboratory, Health and Exercise Physiology, Ursinus College, Collegeville, PA 19426, USA.
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Abu Kishk N, Shahin Y, Mitri J, Turki Y, Zeidan W, Seita A. Model to improve cardiometabolic risk factors in Palestine refugees with diabetes mellitus attending UNRWA health centers. BMJ Open Diabetes Res Care 2019; 7:e000624. [PMID: 31497303 PMCID: PMC6708257 DOI: 10.1136/bmjdrc-2018-000624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/21/2019] [Accepted: 06/18/2019] [Indexed: 01/27/2023] Open
Abstract
Introduction The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the main primary healthcare provider and provides assistance and protection to around 5 million Palestine refugees in Jordan, Lebanon, Syria, West Bank and Gaza. Diabetes mellitus (DM) is a common problem among Palestine refugees, with a prevalence of 11.0%. In 2014, UNRWA embarked on a diabetes campaign to assist both patients with DM and staff in improving diabetes care management, by building the capacity of UNRWA's health staff and improving the knowledge and lifestyle behaviors among Palestine refugees with DM. Method Using a quasiexperimental study, we randomly selected 50 patients with diabetes from the 32 largest UNRWA health centers (HC); a total of 1600 participants were enrolled. Each HC conducted weekly group sessions for 6 months, including education, healthy cooking, and physical exercise. Body measurements, 2-hour postprandial glucose test, blood pressure and session attendance were collected on a weekly basis. Demographical data, pre/postquestionnaires and cholesterol levels were collected before and after the campaign. Paired t-test in SPSS V.21 was used. Results Out of 1600 patients, 1598 (1186 (74.0%) females and 412 (26.0%) males) completed the campaign; 576 (36.0%) patients had diabetes type 2 (DMII), 960 (60.0%) had DMII and hypertension and 62 (4.0%) had diabetes type 1 (DMI). After the campaign, the average weight loss was 2.6 kg (95% CI 2.4 to 2.7). In addition, 22% lost ≥5%, 25% lost 3%-5%, and 30% lost 1%-3% of their weight. Significant improvements were seen in blood glucose, cholesterol and waist circumference (WC) (p≤0.001 for all). The session attendance rate was 70.6% in total. Conclusions This campaign focused on raising healthy lifestyle awareness and practices among Palestine refugees with DM. It was associated with reduction cardiometabolic risk factors. Similar campaigns need to be sustained and expanded. Local community and non-governmental organization partnerships observed during the campaign should be strengthened and sustained.
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Affiliation(s)
| | | | - Joanna Mitri
- Joslin Center, Harvard Medical School, Boston, Massachusetts, USA
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Jarvie JL, Pandey A, Ayers CR, McGavock JM, Sénéchal M, Berry JD, Patel KV, McGuire DK. Aerobic Fitness and Adherence to Guideline-Recommended Minimum Physical Activity Among Ambulatory Patients With Type 2 Diabetes Mellitus. Diabetes Care 2019; 42:1333-1339. [PMID: 31221698 PMCID: PMC6609956 DOI: 10.2337/dc18-2634] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/19/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Lifestyle intervention remains the cornerstone of management of type 2 diabetes mellitus (T2DM). However, adherence to physical activity (PA) recommendations and the impact of that adherence on cardiorespiratory fitness in this population have been poorly described. We sought to investigate adherence to PA recommendations and its association with cardiorespiratory fitness in a population of patients with T2DM. RESEARCH DESIGN AND METHODS A cross-sectional analysis of baseline data from a randomized clinical trial (NCT00424762) was performed. A total of 150 individuals with medically treated T2DM and atherosclerotic cardiovascular disease (ASCVD) or risk factors for ASCVD were recruited from outpatient clinics at a single academic medical center. All individuals underwent a graded maximal exercise treadmill test to exhaustion with breath-by-breath gas exchange analysis to determine VO2peak. PA was estimated using a structured 7-Day Physical Activity Recall interview. RESULTS Participants had a mean ± SD age of 54.9 ± 9.0 years; 41% were women, 40% were black, and 21% were Hispanic. The mean HbA1c was 7.7 ± 1.8% and the mean BMI, 34.5 ± 7.2 kg/m2. A total of 72% had hypertension, 73% had hyperlipidemia, and 35% had prevalent ASCVD. The mean ± SD reported daily PA was 34.3 ± 4 kcal/kg, only 7% above a sedentary state; 47% of the cohort failed to achieve the minimum recommended PA. Mean ± SD VO2peak was 27.4 ± 6.5 mL/kg fat-free mass/min (18.8 ± 5.0 mL/kg/min). CONCLUSIONS On average, patients with T2DM who have or are at risk for ASCVD report low levels of PA and have low measured cardiopulmonary fitness. This underscores the importance of continued efforts to close this therapeutic gap.
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Affiliation(s)
- Jennifer L Jarvie
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Martin Sénéchal
- Cardio-Metabolic Exercise and Lifestyle Laboratory, Fredericton, New Brunswick, Canada.,Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Jarett D Berry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kershaw V Patel
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX .,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
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Jasmin, Jaitak V. A Review on Molecular Mechanism of Flavonoids as Antidiabetic Agents. Mini Rev Med Chem 2019; 19:762-786. [DOI: 10.2174/1389557519666181227153428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023]
Abstract
The development of drugs possessing anti-diabetic activities is a long pursued goal in drug
discovery. It has been shown that deregulated insulin mediated signaling, oxidative stress, obesity, and
β-cell dysfunction are the main factors responsible for the disease. With the advent of new and more
powerful screening assays and prediction tools, the idea of a drug that can effectively treat diabetes by
targeting different pathways has re-bloomed. Current anti-diabetic therapy is based on synthetic drugs
that very often have side effects. For this reason, there is an instantaneous need to develop or search
new alternatives. Recently, more attention is being paid to the study of natural products. Their huge
advantage is that they can be ingested in everyday diet. Here, we discuss various causes, putative targets,
and treatment strategies, mechanistic aspects as well as structural features with a particular focus
on naturally occurring flavonoids as promising starting points for anti-diabetic led development.
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Affiliation(s)
- Jasmin
- Laboratory of Natural Products, Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda (Pb.) 151001, India
| | - Vikas Jaitak
- Laboratory of Natural Products, Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda (Pb.) 151001, India
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Abu-Qamar MZ. Use of nutrition therapy in the management of diabetes mellitus. Nurs Stand 2019; 34:61-66. [PMID: 31468927 DOI: 10.7748/ns.2019.e11253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 01/28/2023]
Abstract
Effective management of diabetes mellitus requires lifelong adherence to a plan that incorporates lifestyle changes, exercise and diet. Following a dietary plan is a fundamental component of diabetes management because this can regulate the body's supply of glucose and lipids, resulting in weight reduction, an improved response to pharmacotherapies, and optimal control of the patient's glycaemic status and lipid profile. This article examines the components of nutrition therapy recommended for people with diabetes. Initially, the patient's daily calorie requirements should be determined, and therapeutic objectives should be decided that take into account the individual's clinical profile and personal preferences. Subsequently, a dietary plan should be negotiated with the patient that considers the carbohydrate, protein, fat and fibre content of each food item.
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Korsmo-Haugen HK, Brurberg KG, Mann J, Aas AM. Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2019; 21:15-27. [PMID: 30098129 DOI: 10.1111/dom.13499] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 02/06/2023]
Abstract
AIMS This systematic review and meta-analysis (registration number: CRD42013005825) compares the effects of low carbohydrate diets (LCDs) on body weight, glycaemic control, lipid profile and blood pressure with the effects of higher carbohydrate diets (HCDs) in adults with type 2 diabetes. METHODS MEDLINE, EMBASE, CENTRAL, CINAHL, Food Science Source and SweMed+ databases were systematically searched to identify randomized controlled trials (duration ≥3 months) investigating the effects of an LCD compared to an HCD in the management of type 2 diabetes. Data were extracted and pooled using a random effects model and were expressed as mean differences and risk ratio. Subgroup analyses were undertaken to examine the effects of duration of intervention, extent of carbohydrate restriction and risk of bias. The certainty of evidence was assessed using GRADE. RESULTS Of the 1589 studies identified, 23, including 2178 participants, met inclusion criteria. Reductions were slightly greater with LCDs than with HCDs for HbA1c (-1.0 mmol/mol; CI, -1.9, -0.1 [-0.09%; CI, -0.17, -0.01]) and for triglycerides (-0.13 mmol/L; CI, -0.24, -0.02). Changes in weight, HDL- and LDL-cholesterol, total cholesterol and blood pressure did not differ significantly between groups. Subgroup analyses suggested that the difference in HbA1c was evident only in studies with a duration of ≤6 months and with a high risk of bias. CONCLUSIONS The proportion of daily energy provided by carbohydrate intake is not an important determinant of response to dietary management, especially when considering longer term trials. A range of dietary patterns, including those traditional in Mediterranean countries, seems suitable for translating nutritional recommendations for individuals with diabetes into practical advice.
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Affiliation(s)
- Henny-Kristine Korsmo-Haugen
- Faculty of Health Sciences, Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Kjetil G Brurberg
- Division for Health Services, Norwegian Institute of Public Health, Oslo/Western Norway University of Applied Sciences, Centre for Evidence Based Practice, Bergen, Norway
| | - Jim Mann
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Anne-Marie Aas
- Oslo University Hospital, Division of Medicine, Department of Clinical Services, Section of Nutrition and Dietetics/Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Kang ZQ, Huo JL, Zhai XJ. Effects of perioperative tight glycemic control on postoperative outcomes: a meta-analysis. Endocr Connect 2018; 7:R316-R327. [PMID: 30120204 PMCID: PMC6240152 DOI: 10.1530/ec-18-0231] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/15/2018] [Indexed: 01/04/2023]
Abstract
Background The optimal glycemic target during the perioperative period is still controversial. We aimed to explore the effects of tight glycemic control (TGC) on surgical mortality and morbidity. Methods PubMed, EMBASE and CENTRAL were searched from January 1, 1946 to February 28, 2018. Appropriate trails comparing the postoperative outcomes (mortality, hypoglycemic events, acute kidney injury, etc.) between different levels of TGC and liberal glycemic control were identified. Quality assessments were performed with the Jadad scale combined with the allocation concealment evaluation. Pooled relative risk (RR) and 95% CI were calculated using random effects models. Heterogeneity was detected by the I2 test. Results Twenty-six trials involving a total of 9315 patients were included in the final analysis. The overall mortality did not differ between tight and liberal glycemic control (RR, 0.92; 95% CI, 0.78-1.07; I 2 = 20.1%). Among subgroup analyses, obvious decreased risks of mortality were found in the short-term mortality, non-diabetic conditions, cardiac surgery conditions and compared to the very liberal glycemic target. Furthermore, TGC was associated with decreased risks for acute kidney injury, sepsis, surgical site infection, atrial fibrillation and increased risks of hypoglycemia and severe hypoglycemia. Conclusions Compared to liberal control, perioperative TGC (the upper level of glucose goal ≤150 mg/dL) was associated with significant reduction of short-term mortality, cardic surgery mortality, non-diabetic patients mortality and some postoperative complications. In spite of increased risks of hypoglycemic events, perioperative TGC will benefits patients when it is done carefully.
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Affiliation(s)
- Zhou-Qing Kang
- Department of Nursing, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China
- Correspondence should be addressed to Z-Q Kang:
| | - Jia-Ling Huo
- Department of Respiratory Medicine, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China
| | - Xiao-Jie Zhai
- Department of Nursing, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China
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Channanath AM, AlWotayan R, Alkandari H, Davidsson L, Tuomilehto J, Thanaraj TA. Glycaemic control in native Kuwaiti Arab patients with type 2 diabetes. Prim Care Diabetes 2018; 12:526-532. [PMID: 30115526 DOI: 10.1016/j.pcd.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate the influence of age at diabetes diagnosis, diabetes duration, BMI, comorbidity with hypertension and medication regimen on glycaemic control in native Kuwaiti Arab patients with T2D. METHODS This cross-sectional study considered 7657 patients from Kuwait Diabetes Registry and analysed data from their laboratory and hospital records. RESULTS HbA1c and prevalence of hypertension increased significantly with diabetes duration. Duration of diabetes (β=0.034; P<0.001) and age at diagnosis (β=-0.03; P<0.001) were independently associated with HbA1c. Inadequate glycaemic control was more likely in patients diagnosed at <60 than in those ≥60 years of age (OR:1.80, 95%-CI:1.39-2.31). Increasing duration of diabetes witnessed decrease in metformin prescription and increase in sulfonylureas prescription; proportion of patients treated with insulin increased from 5.6% to 44.4% in 9 years of diagnosis. Patients with 9-years duration of diabetes or with combination therapy of insulin-metformin-sulfonylureas differed in mean BMI for adequate or inadequate glycaemic control (29.5 versus 31.2kg/m2; P<0.001 and 29.8 versus 33.2; P<0.01, respectively). CONCLUSIONS Only 25.6% of the T2D patients in this ethnic cohort exhibited adequate glycaemic control. The delineated relationship of inadequate glycaemic control with diabetes duration, onset age, obesity and hypertension prevalence has a bearing on diabetes management programs for Arabs.
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Affiliation(s)
- Arshad M Channanath
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
| | - Rihab AlWotayan
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Department of Primary Health Care, Ministry of Health, Kuwait
| | - Hessa Alkandari
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Department of Pediatrics, Farwaniya Hospital, Farwaniya, Kuwait
| | - Lena Davidsson
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
| | - Jaakko Tuomilehto
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
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Abstract
INTRODUCTION Prevention of type 2 diabetes (T2D) is important to reduce suffering and health care costs. A precursor to T2D is impaired glucose regulation (IGR), a condition of elevated plasma glucose that is associated with insulin resistance and increased risk of cardiovascular disease. Prevention of T2D is determined by preservation of pancreatic β cell function which can be achieved by the use of anti-hyperglycemic medications or intensive lifestyle interventions (ILIs) to modify dietary and physical activity habits that induce modest weight loss (≥5%). Both interventions have beneficial effects on normal glucose regulation (NGR), but ILI is preferred due to its safety, efficacy, and cost. AREAS COVERED Traditional approaches to the prevention of T2D have used a variety of screening methods to identify those who are at high risk for developing T2D (prediabetes). People designated with prediabetes are then treated with ILI. An alternative approach for preventing T2D is to offer ILI to all overweight/obese adults who volunteer for weight loss treatment. EXPERT COMMENTARY This new alternative has several potential advantages: more rapid recruitment of participants with lower burden of care and early, aggressive treatment of potential β cell dysfunction. Cost-effectiveness studies of this alternative approach are needed.
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Affiliation(s)
- Donald A Williamson
- a Health Psychology Laboratory , Pennington Biomedical Research Center , Landrum , SC , USA
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Akehurst H, Pesantes MA, Cornejo SDP, Manrique K, Lazo-Porras M, Portocarrero J, Diez-Canseco F, Bernabe-Ortiz A, Trujillo AJ, Miranda JJ. A descriptive study of potential participant preferences for the design of an incentivised weight loss programme for people with type 2 diabetes mellitus attending a public hospital in Lima, Peru. Wellcome Open Res 2018; 3:53. [PMID: 30740534 PMCID: PMC6348435 DOI: 10.12688/wellcomeopenres.14552.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Weight loss is important for the control of type 2 diabetes mellitus but is difficult to achieve and sustain. Programmes employing financial incentives have been successful in areas such as smoking cessation. However, the optimum design for an incentivised programme for weight loss is undetermined, and may depend on social, cultural and demographic factors. Methods: An original questionnaire was designed whose items addressed respondent personal and health characteristics, and preferences for a hypothetical incentivised weight loss programme. One hundred people with type 2 diabetes mellitus were recruited to complete the questionnaire from the endocrinology clinic of a public hospital in Lima, Peru. A descriptive analysis of responses was performed. Results: Ninety-five percent of subjects who had previously attempted to lose weight had found this either 'difficult' or 'very difficult'. Eighty-five percent of subjects would participate in an incentivised weight loss programme. Median suggested incentive for 1 kg weight loss every 2 weeks over 9 months was PEN 100 (~USD $30). Cash was preferred by 70% as payment method. Only 56% of subjects would participate in a deposit-contract scheme, and the median suggested deposit amount was PEN 20 (~USD $6). Eighty percent of subjects would share the incentive with a helper, and family members were the most common choice of helper. Conclusions: The challenge of achieving and sustaining weight loss is confirmed in this setting. Direct cash payments of PEN 100 were generally preferred, with substantial scope for involving a co-participant with whom the incentive could be shared. Employing direct financial incentives in future weight loss programmes appears to be widely acceptable among people with type 2 diabetes mellitus.
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Affiliation(s)
- Harold Akehurst
- Great Western Hospitals NHS Trust, Swindon, UK
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M. Amalia Pesantes
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Katty Manrique
- Department of Endocrinology, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Maria Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- CONEVID Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jill Portocarrero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio J. Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Cash JG, Konaniah E, Hegde N, Kuhel DG, Watanabe M, Romick-Rosendale L, Hui DY. Therapeutic reduction of lysophospholipids in the digestive tract recapitulates the metabolic benefits of bariatric surgery and promotes diabetes remission. Mol Metab 2018; 16:55-64. [PMID: 30087032 PMCID: PMC6158127 DOI: 10.1016/j.molmet.2018.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Obesity and obesity-related metabolic disorders are major health problems worldwide. The most effective obesity intervention is bariatric surgery. This study tested the hypothesis that bariatric surgery alters phospholipid metabolism in the gastrointestinal tract to favor a metabolically healthy gut microbiota profile and therapeutic intervention of phospholipid metabolism in the gastrointestinal may have similar metabolic benefits. METHODS The first study compared plasma levels of the bioactive lipid metabolites lysophospholipid and trimethylamine N-oxide (TMAO) as well as gut microbiota profile in high fat/carbohydrate (HFHC) diet-fed C57BL/6 mice with or without vertical sleeve gastrectomy (VSG) and in Pla2g1b-/- mice with group 1B phospholipase A2 gene inactivation. The second study examined the effectiveness of the non-absorbable secretory phospholipase A2 inhibitor methyl indoxam to reverse hyperglycemia and hyperlipidemia in HFHC diet-fed C57BL/6 mice after diabetes onset. RESULTS Both bariatric surgery and PLA2G1B inactivation were shown to reduce lysophospholipid content in the gastrointestinal tract, resulting in resistance to HFHC diet-induced alterations of the gut microbiota, reduction of the cardiovascular risk factors hyperlipidemia and TMAO, decreased adiposity, and prevention of HFHC diet-induced diabetes. Importantly, treatment of wild type mice with methyl indoxam after HFHC diet-induced onset of hyperlipidemia and hyperglycemia effectively restored normal plasma lipid and glucose levels and replicated the metabolic benefits of VSG surgery with diabetes remission and TMAO reduction. CONCLUSION These results provided pre-clinical evidence that PLA2G1B inhibition in the digestive tract may be a viable alternative option to bariatric surgery for obesity and obesity-related cardiometabolic disorder intervention.
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Affiliation(s)
- James G Cash
- Department of Pathology and Laboratory Medicine, Metabolic Diseases Research Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45237, USA
| | - Eddy Konaniah
- Department of Pathology and Laboratory Medicine, Metabolic Diseases Research Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45237, USA
| | - Narasimha Hegde
- Department of Pathology and Laboratory Medicine, Metabolic Diseases Research Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45237, USA
| | - David G Kuhel
- Department of Pathology and Laboratory Medicine, Metabolic Diseases Research Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45237, USA
| | - Miki Watanabe
- Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Lindsey Romick-Rosendale
- Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - David Y Hui
- Department of Pathology and Laboratory Medicine, Metabolic Diseases Research Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45237, USA.
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Ahuja A, Tantia O, Goyal G, Chaudhuri T, Khanna S, Poddar A, Gupta S, Majumdar K. MGB-OAGB: Effect of Biliopancreatic Limb Length on Nutritional Deficiency, Weight Loss, and Comorbidity Resolution. Obes Surg 2018; 28:3439-3445. [DOI: 10.1007/s11695-018-3405-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Akehurst H, Pesantes MA, Cornejo SDP, Manrique K, Lazo-Porras M, Portocarrero J, Diez-Canseco F, Bernabe-Ortiz A, Trujillo AJ, Miranda JJ. A descriptive study of potential participant preferences for the design of an incentivised weight loss programme for people with type 2 diabetes mellitus attending a public hospital in Lima, Peru. Wellcome Open Res 2018; 3:53. [PMID: 30740534 PMCID: PMC6348435 DOI: 10.12688/wellcomeopenres.14552.1] [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: 04/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Weight loss is important for the control of type 2 diabetes mellitus but is difficult to achieve and sustain. Programmes employing financial incentives have been successful in areas such as smoking cessation. However, the optimum design for an incentivised programme for weight loss is undetermined, and may depend on social, cultural and demographic factors. Methods: An original questionnaire was designed whose items addressed respondent personal and health characteristics, and preferences for a hypothetical incentivised weight loss programme. One hundred people with type 2 diabetes mellitus were recruited to complete the questionnaire from the endocrinology clinic of a public hospital in Lima, Peru. A descriptive analysis of responses was performed. Results: Ninety-five percent of subjects who had previously attempted to lose weight had found this either 'difficult' or 'very difficult'. Eighty-five percent of subjects would participate in an incentivised weight loss programme. Median suggested incentive for 1 kg weight loss every 2 weeks over 9 months was PEN 100 (~USD $30). Cash was preferred by 70% as payment method. Only 56% of subjects would participate in a deposit-contract scheme, and the median suggested deposit amount was PEN 20 (~USD $6). Eighty percent of subjects would share the incentive with a helper, and family members were the most common choice of helper. Conclusions: The challenge of achieving and sustaining weight loss is confirmed in this setting. Direct cash payments of PEN 100 were generally preferred, with substantial scope for involving a co-participant with whom the incentive could be shared. Employing direct financial incentives in future weight loss programmes appears to be widely acceptable among people with type 2 diabetes mellitus.
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Affiliation(s)
- Harold Akehurst
- Great Western Hospitals NHS Trust, Swindon, UK
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M. Amalia Pesantes
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Katty Manrique
- Department of Endocrinology, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Maria Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- CONEVID Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jill Portocarrero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio J. Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Chan JKW, Bittner S, Bittner A, Atwal S, Shen WJ, Inayathullah M, Rajada J, Nicolls MR, Kraemer FB, Azhar S. Nordihydroguaiaretic Acid, a Lignan from Larrea tridentata (Creosote Bush), Protects Against American Lifestyle-Induced Obesity Syndrome Diet-Induced Metabolic Dysfunction in Mice. J Pharmacol Exp Ther 2018; 365:281-290. [PMID: 29472517 PMCID: PMC5878670 DOI: 10.1124/jpet.117.243733] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/16/2018] [Indexed: 12/30/2022] Open
Abstract
To determine the effects of nordihydroguaiaretic acid (NDGA) on metabolic and molecular changes in response to feeding a typical American fast food or Western diet, mice were fed an American lifestyle-induced obesity syndrome (ALIOS) diet and subjected to metabolic analysis. Male C57BL/6J mice were randomly assigned to the ALIOS diet, the ALIOS diet supplemented with NDGA (NDGA+ALIOS), or a control diet and were maintained on the specific diet for 8 weeks. Mice fed the ALIOS diet showed increased body, liver, and epididymal fat pad weight as well as increased plasma alanine transaminase (ALT) and aspartate aminotransferase (AST) levels (a measure of liver injury) and liver triglyceride content. Coadministration of NDGA normalized body and epididymal fat pad weight, ALT and AST levels, and liver triglycerides. NDGA treatment also improved insulin sensitivity but not glucose intolerance in mice fed the ALIOS diet. In mice fed the NDGA+ALIOS diet, NDGA supplementation induced peroxisome proliferator-activated receptor α (PPARα; the master regulator of fatty acid oxidation) and mRNA levels of carnitine palmitoyltransferases Cpt1c and Cpt2, key genes involved in fatty acid oxidation, compared with the ALIOS diet. NDGA significantly reduced liver endoplasmic reticulum (ER) stress response C/EBP homologous protein, compared with chow or the ALIOS diet, and also ameliorated ALIOS diet-induced elevation of apoptosis signaling protein, caspase 3. Likewise, NDGA downregulated the ALIOS diet-induced mRNA levels of Pparg, fatty acid synthase Fasn, and diacylglycerol acyltransferase Dgat2 NDGA treatment of ALIOS-fed mice upregulated the hepatic expression of antioxidant enzymes, glutathione peroxidase 4, and peroxiredoxin 3 proteins. In conclusion, we provide evidence that NDGA improves metabolic dysregulation by simultaneously modulating the PPARα transcription factor and key genes involved in fatty acid oxidation, key antioxidant and lipogenic enzymes, and apoptosis and ER stress signaling pathways.
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Affiliation(s)
- Jackie K W Chan
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Stefanie Bittner
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Alex Bittner
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Suman Atwal
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Wen-Jun Shen
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Mohammed Inayathullah
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Jayakumar Rajada
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Mark R Nicolls
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Fredric B Kraemer
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
| | - Salman Azhar
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.); and Division of Endocrinology, Gerontology, and Metabolism (J.K.W.C., S.B., A.B., S.At., W.-J.S., F.B.K., S.Az.), BioADD Laboratory, and Divisions of Cardiovascular Pharmacology CVI (M.I., J.R.) and Pulmonary and Critical Care Medicine (M.R.N.), Stanford University, Stanford, California
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Higgins KA, Considine RV, Mattes RD. Aspartame Consumption for 12 Weeks Does Not Affect Glycemia, Appetite, or Body Weight of Healthy, Lean Adults in a Randomized Controlled Trial. J Nutr 2018; 148:650-657. [PMID: 29659969 DOI: 10.1093/jn/nxy021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/23/2018] [Indexed: 12/16/2022] Open
Abstract
Background Low-calorie sweeteners are often used to moderate energy intake and postprandial glycemia, but some evidence indicates that they may exacerbate these aims. Objective The trial's primary aim was to assess the effect of daily aspartame ingestion for 12 wk on glycemia. Effects on appetite and body weight were secondary aims. Methods One hundred lean [body mass index (kg/m2): 18-25] adults aged 18-60 y were randomly assigned to consume 0, 350, or 1050 mg aspartame/d (ASP groups) in a beverage for 12 wk in a parallel-arm design. At baseline, body weight and composition were determined, a 240-min oral-glucose-tolerance test (OGTT) was administered, and measurements were made of appetite and selected hormones. Participants also collected a 24-h urine sample. During the intervention, the 0-mg/d ASP group consumed capsules containing 680 mg dextrose and 80 mg para-amino benzoic acid. For the 350-mg/d ASP group, the beverage contained 350 mg aspartame and the 1050-mg/d ASP group consumed the same beverage plus capsules containing 680 mg dextrose and 700 mg aspartame. Body weight, blood pressure, heart rate, and waist circumference were measured weekly. At weeks 4, 8, and 12, participants collected 24-h urine samples and kept appetite logs. Baseline measurements were repeated at week 12. Results With the exception of the baseline OGTT glucose concentration at 60 min (and resulting area under the curve value), there were no group differences for glucose, insulin, resting leptin, glucagon-like peptide 1, or gastric inhibitory peptide at baseline or week 12. There also were no effects of aspartame ingestion on appetite, body weight, or body composition. Compliance with the beverage intervention was ∼95%. Conclusions Aspartame ingested at 2 doses for 12 wk had no effect on glycemia, appetite, or body weight among healthy, lean adults. These data do not support the view that aspartame is problematic for the management of glycemia, appetite, or body weight. This trial was registered at www.clinicaltrials.gov as NCT02999321.
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Affiliation(s)
- Kelly A Higgins
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Robert V Considine
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Richard D Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, IN
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Carranza-Leon BG, Puzziferri N, Adams-Huet B, Jabbour I, Lingvay I. Metabolic response 4 years after gastric bypass in a complete cohort with type 2 diabetes mellitus. Diabetes Res Clin Pract 2018; 137:224-230. [PMID: 29355650 DOI: 10.1016/j.diabres.2017.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 10/24/2017] [Accepted: 11/16/2017] [Indexed: 01/04/2023]
Abstract
AIMS To evaluate the long-term remission rates of type 2 diabetes mellitus and associated comorbidities after gastric bypass surgery in a complete cohort, in a real-life clinic setting. METHODS A retrospective study of all consecutive patients with type 2 diabetes mellitus who underwent gastric bypass at a Veterans Affairs Medical Center from 2003 to 2010. The main outcome was remission of type 2 diabetes mellitus defined as HbA1c <6.5% (49 mmol/mol) without diabetic medication usage. Secondary outcomes were remission of hypertension and hyperlipidemia, weight loss, and long-term complications four years post-gastric bypass. RESULTS Eighty-four patients with type 2 diabetes mellitus underwent gastric bypass. Four-year follow-up data were available for 92% (77/84) of patients. The patients (73% male; mean age 54 years) had a mean body mass index of 49 kg/m2 ± 8.3. Hypertension and hyperlipidemia prevalence were 92% and 85%, respectively. The mean total body weight decrease over four years was 35 kg ± 21. Remission of type 2 diabetes mellitus occurred in 15% at 6 months and 49% four years after surgery. Diabetes remission was more likely (OR 3.2; 95% confidence interval 1.2-9.7) in patients not using insulin at baseline. Remission rates were 12% (9/74) for hypertension and 16% (11/68) for hyperlipidemia. Long-term surgical complications included reoperation (11%), incisional hernia (10%) and anastomotic ulcer (10%). Forty-four percent of patients had one or more nutritional complications. CONCLUSIONS The metabolic effects of gastric bypass are significant and durable for at least four years, even in a predominantly male cohort and real-life clinical setting.
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Affiliation(s)
- B Gisella Carranza-Leon
- Department of Internal Medicine, Division of Endocrinology, Vanderbilt University, Nashville, TN, USA
| | - Nancy Puzziferri
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Surgery, Veterans Affairs North Texas Health Care System, Dallas, TX, USA.
| | - Beverley Adams-Huet
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ibrahim Jabbour
- Department of Surgery, Maricopa Integrated Health System, Phoenix, AZ, USA
| | - Ildiko Lingvay
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Smith ED, Layden BT, Hassan C, Sanchez-Johnsen L. Surgical Treatment of Obesity in Latinos and African Americans: Future Directions and Recommendations to Reduce Disparities in Bariatric Surgery. Bariatr Surg Pract Patient Care 2018; 13:2-11. [PMID: 32612896 PMCID: PMC7325708 DOI: 10.1089/bari.2017.0037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Obesity and metabolic syndrome are increasingly prevalent in the United States, particularly among African Americans and Latinos. Bariatric surgery has become one of the primary treatment modalities for obesity and type 2 diabetes. However, fewer Latinos and African Americans are undergoing bariatric surgery than whites. The aim of this article is to describe the disparities in seeking and accessing bariatric surgery, describe the outcomes following bariatric procedures in Latinos and African Americans, and offer recommendations and future research directions that may assist in addressing these disparities. Methods: Original research and review articles published in English were reviewed. Results: Potential reasons why Latinos and African Americans have low rates of seeking bariatric surgery are described. Disparities in access to care and financial coverage, low rates of referral by primary care providers, and cultural attitudes toward obesity in conjunction with mistrust of the healthcare system are discussed as potential contributors to the low rate of bariatric surgery in Latinos and African Americans. Finally, disparities in bariatric surgery outcomes, comorbidities, and complications are reviewed. Conclusions: Additional research studies in bariatric surgical disparities are needed. Recommendations and future directions that may help to reduce disparities in bariatric surgery are discussed.
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Affiliation(s)
- Emily Daviau Smith
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.,Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | - Brian T Layden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.,Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | - Chandra Hassan
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa Sanchez-Johnsen
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.,Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
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Hecker M, Wagner AH. Role of protein carbonylation in diabetes. J Inherit Metab Dis 2018; 41:29-38. [PMID: 29110177 DOI: 10.1007/s10545-017-0104-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 01/17/2023]
Abstract
Diabetes mellitus is a metabolic disease characterized by, among others, elevated blood glucose levels. Hyperglycaemia as well as enhanced levels of glucose-derived reactive metabolites contribute to the development of diabetic complications partly via increased generation of reactive oxygen species (ROS). ROS are not only part of signaling pathways themselves but also lead to carbonylation of particular amino acid side chains by direct metal-catalyzed oxidation. In addition, carbonyl groups can be introduced into proteins indirectly by non-oxidative covalent adduction of reactive carbonyl species generated by the oxidation of lipids or carbohydrates. Both direct and indirect carbonylation mechanisms may affect protein conformation, activity, and function. Herein we introduce the different mechanisms of the carbonylation reaction, discuss degradation mechanisms, and the fate of proteins modified this way and how the overall degree of carbonylation affects protein homeostasis and function differently. The role of protein carbonylation in metabolic control systems and cell signaling are also summarized. Finally, current diagnostic and antioxidant therapeutic options in diabetes are discussed.
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Affiliation(s)
- Markus Hecker
- Department of Cardiovascular Physiology, Heidelberg University, Im Neuenheimer Feld 326, 69120, Heidelberg, Germany
| | - Andreas H Wagner
- Department of Cardiovascular Physiology, Heidelberg University, Im Neuenheimer Feld 326, 69120, Heidelberg, Germany.
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Davidson J, Kalra S, Singh V, Fegade M, Singh G, Mane A. Resolving the KgA1c paradox in the management of type 2 diabetes mellitus. Diabetes Metab Syndr 2017; 11 Suppl 1:S159-S168. [PMID: 28063802 DOI: 10.1016/j.dsx.2016.12.026] [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: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 11/27/2022]
Abstract
Excess body weight is a leading cause of metabolic complications such as hypertension and dyslipidemia in T2DM patients. Available antihyperglycemic agents have minimal or no impact on these complications and a majority are known to trigger weight gain, thereby exerting a paradoxical effect on overall metabolic status. This review introduces the concept of 'KgA1c paradox' and underscores the significance of resolving this paradox for comprehensive T2DM management. It provides a therapeutic rationale for inclusion of sodium glucose cotransporter 2 inhibitors in the T2DM treatment algorithm as these agents have demonstrated favorable glycemic effects along with reduction in body weight.
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Affiliation(s)
- Jaime Davidson
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology (BRIDE), Karnal, Haryana, India.
| | - Vikram Singh
- Janssen, Pharmaceutical Companies of Johnson & Johnson, Mumbai, Maharashtra, India
| | - Mayuresh Fegade
- Janssen, Pharmaceutical Companies of Johnson & Johnson, Mumbai, Maharashtra, India
| | - Gursimran Singh
- Janssen, Pharmaceutical Companies of Johnson & Johnson, Mumbai, Maharashtra, India
| | - Amey Mane
- Janssen, Pharmaceutical Companies of Johnson & Johnson, Mumbai, Maharashtra, India
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Abstract
The liver is crucial for the maintenance of normal glucose homeostasis - it produces glucose during fasting and stores glucose postprandially. However, these hepatic processes are dysregulated in type 1 and type 2 diabetes mellitus, and this imbalance contributes to hyperglycaemia in the fasted and postprandial states. Net hepatic glucose production is the summation of glucose fluxes from gluconeogenesis, glycogenolysis, glycogen synthesis, glycolysis and other pathways. In this Review, we discuss the in vivo regulation of these hepatic glucose fluxes. In particular, we highlight the importance of indirect (extrahepatic) control of hepatic gluconeogenesis and direct (hepatic) control of hepatic glycogen metabolism. We also propose a mechanism for the progression of subclinical hepatic insulin resistance to overt fasting hyperglycaemia in type 2 diabetes mellitus. Insights into the control of hepatic gluconeogenesis by metformin and insulin and into the role of lipid-induced hepatic insulin resistance in modifying gluconeogenic and net hepatic glycogen synthetic flux are also discussed. Finally, we consider the therapeutic potential of strategies that target hepatosteatosis, hyperglucagonaemia and adipose lipolysis.
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Affiliation(s)
- Max C Petersen
- Department of Internal Medicine, Yale School of Medicine
- Department of Cellular &Molecular Physiology, Yale School of Medicine
| | | | - Gerald I Shulman
- Department of Internal Medicine, Yale School of Medicine
- Department of Cellular &Molecular Physiology, Yale School of Medicine
- Howard Hughes Medical Institute, Yale School of Medicine, New Haven, Connecticut 06520, USA
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Johansen MY, MacDonald CS, Hansen KB, Karstoft K, Christensen R, Pedersen M, Hansen LS, Zacho M, Wedell-Neergaard AS, Nielsen ST, Iepsen UW, Langberg H, Vaag AA, Pedersen BK, Ried-Larsen M. Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA 2017; 318:637-646. [PMID: 28810024 PMCID: PMC5817591 DOI: 10.1001/jama.2017.10169] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/10/2017] [Indexed: 11/14/2022]
Abstract
Importance It is unclear whether a lifestyle intervention can maintain glycemic control in patients with type 2 diabetes. Objective To test whether an intensive lifestyle intervention results in equivalent glycemic control compared with standard care and, secondarily, leads to a reduction in glucose-lowering medication in participants with type 2 diabetes. Design, Setting, and Participants Randomized, assessor-blinded, single-center study within Region Zealand and the Capital Region of Denmark (April 2015-August 2016). Ninety-eight adult participants with non-insulin-dependent type 2 diabetes who were diagnosed for less than 10 years were included. Participants were randomly assigned (2:1; stratified by sex) to the lifestyle group (n = 64) or the standard care group (n = 34). Interventions All participants received standard care with individual counseling and standardized, blinded, target-driven medical therapy. Additionally, the lifestyle intervention included 5 to 6 weekly aerobic training sessions (duration 30-60 minutes), of which 2 to 3 sessions were combined with resistance training. The lifestyle participants received dietary plans aiming for a body mass index of 25 or less. Participants were followed up for 12 months. Main Outcomes and Measures Primary outcome was change in hemoglobin A1c (HbA1c) from baseline to 12-month follow-up, and equivalence was prespecified by a CI margin of ±0.4% based on the intention-to-treat population. Superiority analysis was performed on the secondary outcome reductions in glucose-lowering medication. Results Among 98 randomized participants (mean age, 54.6 years [SD, 8.9]; women, 47 [48%]; mean baseline HbA1c, 6.7%), 93 participants completed the trial. From baseline to 12-month follow-up, the mean HbA1c level changed from 6.65% to 6.34% in the lifestyle group and from 6.74% to 6.66% in the standard care group (mean between-group difference in change of -0.26% [95% CI, -0.52% to -0.01%]), not meeting the criteria for equivalence (P = .15). Reduction in glucose-lowering medications occurred in 47 participants (73.5%) in the lifestyle group and 9 participants (26.4%) in the standard care group (difference, 47.1 percentage points [95% CI, 28.6-65.3]). There were 32 adverse events (most commonly musculoskeletal pain or discomfort and mild hypoglycemia) in the lifestyle group and 5 in the standard care group. Conclusions and Relevance Among adults with type 2 diabetes diagnosed for less than 10 years, a lifestyle intervention compared with standard care resulted in a change in glycemic control that did not reach the criterion for equivalence, but was in a direction consistent with benefit. Further research is needed to assess superiority, as well as generalizability and durability of findings. Trial Registration clinicaltrials.gov Identifier: NCT02417012.
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Affiliation(s)
- Mette Yun Johansen
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christopher Scott MacDonald
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- CopenRehab, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Bagge Hansen
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Karstoft
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Parker Institute, Copenhagen, Denmark
- Frederiksberg Hospital, Copenhagen, Denmark
| | - Maria Pedersen
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev, Denmark
| | - Louise Seier Hansen
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Zacho
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Sophie Wedell-Neergaard
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Signe Tellerup Nielsen
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Wining Iepsen
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Langberg
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- CopenRehab, University of Copenhagen, Copenhagen, Denmark
| | - Allan Arthur Vaag
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Translational Research and Early Clinical Development, Cardiovascular and Metabolic Research, AstraZeneca, Mölndal, Sweden
| | - Bente Klarlund Pedersen
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
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