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Feng C, Jiang Y, Wu G, Shi Y, Ge Y, Li B, Cheng X, Tang X, Zhu J, Le G. Dietary Methionine Restriction Improves Gastrocnemius Muscle Glucose Metabolism through Improved Insulin Secretion and H19/IRS-1/Akt Pathway in Middle-Aged Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:5655-5666. [PMID: 36995760 DOI: 10.1021/acs.jafc.2c08373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Methionine restriction (MR) improves glucose metabolism. In skeletal muscle, H19 is a key regulator of insulin sensitivity and glucose metabolism. Therefore, this study aims to reveal the underlying mechanism of H19 upon MR on glucose metabolism in skeletal muscle. Middle-aged mice were fed MR diet for 25 weeks. Mouse islets β cell line β-TC6 cells and mouse myoblast cell line C2C12 cells were used to establish the apoptosis or insulin resistance model. Our findings showed that MR increased B-cell lymphoma-2 (Bcl-2) expression, deceased Bcl-2 associated X protein (Bax), cleaved cysteinyl aspartate-specific proteinase-3 (Caspase-3) expression in pancreas, and promoted insulin secretion of β-TC6 cells. Meanwhile, MR increased H19 expression, insulin Receptor Substrate-1/insulin Receptor Substrate-2 (IRS-1/IRS-2) value, protein Kinase B (Akt) phosphorylation, glycogen synthase kinase-3β (GSK3β) phosphorylation, and hexokinase 2 (HK2) expression in gastrocnemius muscle and promoted glucose uptake in C2C12 cells. But these results were reversed after H19 knockdown in C2C12 cells. In conclusion, MR alleviates pancreatic apoptosis and promotes insulin secretion. And MR enhances gastrocnemius muscle insulin-dependent glucose uptake and utilization via the H19/IRS-1/Akt pathway, thereby ameliorating blood glucose disorders and insulin resistance in high-fat-diet (HFD) middle-aged mice.
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Affiliation(s)
- Chuanxing Feng
- Center for Food Nutrition and Functional Food Engineering, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Yuge Jiang
- Center for Food Nutrition and Functional Food Engineering, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Guoqing Wu
- School of Public Health, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Yonghui Shi
- Center for Food Nutrition and Functional Food Engineering, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Yueting Ge
- College of Life Science, Xinyang Normal University, Xinyang 464000, China
| | - Bowen Li
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Xiangrong Cheng
- Center for Food Nutrition and Functional Food Engineering, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Xue Tang
- Center for Food Nutrition and Functional Food Engineering, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Jianjin Zhu
- Center for Food Nutrition and Functional Food Engineering, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Guowei Le
- Center for Food Nutrition and Functional Food Engineering, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
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Simpson EJ, Mendis B, Dunlop M, Schroeter H, Kwik-Uribe C, Macdonald IA. Cocoa Flavanol Supplementation and the Effect on Insulin Resistance in Females Who Are Overweight or Obese: A Randomized, Placebo-Controlled Trial. Nutrients 2023; 15:nu15030565. [PMID: 36771271 PMCID: PMC9921219 DOI: 10.3390/nu15030565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 01/24/2023] Open
Abstract
There is interest in the impact that dietary interventions can have on preventing the transition from insulin resistance to type 2 diabetes, including a suggestion that the bioactive components of cocoa may enhance fasting insulin sensitivity. However, a role for cocoa flavanols (CF) in reducing insulin resistance in the insulin-stimulated state, an important risk factor for cardiovascular disease, is unresolved. This study investigated whether CF consumption improved whole-body insulin-mediated glucose uptake ('M') in females with overweight/obesity, using a randomized, double-blinded, placebo-controlled, parallel-group design. Thirty-two premenopausal females (19-49 years; 27-35 kg·m-2) with elevated HOMA-IR (HOMA-IR >1.5) supplemented their habitual diet with two servings/day of a high-flavanol cocoa drink (HFC; 609 mg CF/serving; n = 16) or low-flavanol cocoa drink (LFC; 13 mg CF/serving; n = 16) for 4 weeks. Assessment of HOMA-IR and 'M' during a 3-h, 60 mIU insulin·m-2·min-1 euglycemic clamp was performed before and after the intervention. Data are the mean (SD). Changes to HOMA-IR (HFC -0.003 (0.57); LFC -0.0402 (0.86)) and 'M' (HFC 0.99 (7.62); LFC -1.32 (4.88) µmol·kg-1·min-1) after the intervention were not different between groups. Four weeks' consumption of ~1.2 g CF/day did not improve indices of fasting insulin sensitivity or insulin-mediated glucose uptake. A recommendation for dietary supplementation with cocoa flavanols to improve glycemic control is therefore not established.
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Affiliation(s)
- Elizabeth J. Simpson
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
- Correspondence: ; Tel.: +44-115-8230128
| | - Buddhike Mendis
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Mandy Dunlop
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Hagen Schroeter
- Department of Nutrition, University of California, One Shields Avenue, 3150E Meyer Hall, Davis, CA 95616, USA
| | | | - Ian A. Macdonald
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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3
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Dietary iron intake and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective cohort studies. Eur J Nutr 2022; 61:2279-2296. [PMID: 35107626 DOI: 10.1007/s00394-022-02813-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 01/19/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE We aimed to assess the long-term association of total, heme, non-heme, and supplemental iron intake and risk of type 2 diabetes (T2D). METHODS PubMed, Scopus, and Web of Science were searched to October 2021. Two researchers extracted data in duplicate and rated the certainty in the estimates using the GRADE approach. Random-effects models were applied to estimate the relative risks (RRs) and 95% CIs. Dose-response associations were modeled by a one-stage weighted mixed-effects meta-analysis. RESULTS Eleven prospective cohort studies 323,788 participants and 28,837 incident cases of T2D were included. High versus low category meta-analysis indicated that higher heme iron intake was associated with a 20% higher risk of T2D (95% CI 1.07, 1.35; I2 = 77%, n = 11; GRADE = moderate). Dose-response analysis indicated a positive monotonic association, wherein each 1 mg/day increment in heme iron intake was related to a 16% higher risk (95% CI 1.03, 1.30). No significant relationship was detected between dietary intakes of total, non-heme, and supplemental iron and risk of T2D (GRADE = very low). CONCLUSIONS In summary, higher heme iron intake was associated with a higher risk of T2D. Our results are in line with existing evidence indicating that adopting a Western-style dietary pattern, rich in dietary sources of heme iron, was associated with a higher risk of T2D. REGISTRY AND REGISTRY NUMBER The protocol of this systematic review was registered at PROSPERO (registration number: CRD42021226835).
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Empagliflozin therapy and insulin resistance-associated disorders: effects and promises beyond a diabetic state. ACTA ACUST UNITED AC 2021; 6:e57-e78. [PMID: 34027215 PMCID: PMC8117073 DOI: 10.5114/amsad.2021.105314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/21/2021] [Indexed: 12/21/2022]
Abstract
Empagliflozin is a SGLT2 inhibitor that has shown remarkable cardiovascular and renal activities in patients with type 2 diabetes (T2D). Preclinical and clinical studies of empagliflozin in T2D population have demonstrated significant improvements in body weight, waist circumference, insulin sensitivity, and blood pressure – effects beyond its antihyperglycaemic control. Moreover, several studies suggested that this drug possesses significant anti-inflammatory and antioxidative stress properties. This paper explores extensively the main preclinical and clinical evidence of empagliflozin administration in insulin resistance-related disorders beyond a diabetic state. It also discusses its future perspectives, as a therapeutic approach, in this high cardiovascular-risk population.
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Abusaib M, Ahmed M, Nwayyir HA, Alidrisi HA, Al-Abbood M, Al-Bayati A, Al-Ibrahimi S, Al-Kharasani A, Al-Rubaye H, Mahwi T, Ashor A, Howlett H, Shakir M, Al-Naqshbandi M, Mansour A. Iraqi Experts Consensus on the Management of Type 2 Diabetes/Prediabetes in Adults. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2020; 13:1179551420942232. [PMID: 32884389 PMCID: PMC7440731 DOI: 10.1177/1179551420942232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022]
Abstract
Type 2 diabetes mellitus (T2DM) management differs dramatically between Iraqi public and private sectors; this variability is due to treatment access discrepancy. The aim of this consensus is to put for the first-time uniform recommendation on how to manage patients with T2DM taking in consideration the local obstacles in Iraq. These consensuses were approved by a group of Iraqi Internist and diabetologist from all over the country. Up-to-date and latest level of evidence was used throughout the recommendation.
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Affiliation(s)
- Mohammed Abusaib
- Department of Medicine, College of Medicine, Najaf Health Directorate, University of Kufa, Kufa, Iraq
| | - Mazyar Ahmed
- Department of Medicine, Erbil Health Directorate, Erbil, Iraq
| | - Hussein Ali Nwayyir
- Department of Medicine, Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Haider Ayad Alidrisi
- Department of Medicine, Basrah Health Directorate, University of Basrah, Basrah, Iraq.,Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah, Iraq.,Endocrine and Metabolism Division, Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq
| | - Majid Al-Abbood
- Department of Medicine, Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ali Al-Bayati
- Department of Medicine, College of Medicine, Babylon Health Directorate, University of Babylon, Hillah, Iraq
| | | | | | - Haidar Al-Rubaye
- National Center for Diabetes, University of Mustansiriya, Baghdad, Iraq
| | - Taha Mahwi
- Department of Medicine, University of Sulaimani, Sulaymaniyah, Iraq
| | - Ammar Ashor
- National Center for Diabetes, University of Mustansiriya, Baghdad, Iraq
| | | | - Mahmood Shakir
- Department of Medicine, Nahrain University, Baghdad, Iraq
| | | | - Abbas Mansour
- Department of Medicine, Basrah Health Directorate, University of Basrah, Basrah, Iraq.,Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah, Iraq.,Endocrine and Metabolism Division, Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq
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6
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Mansourian M, Yazdani A, Faghihimani E, Aminorraya A, Amini M, Jafari-Koshki T. Factors associated with progression to pre-diabetes: a recurrent events analysis. Eat Weight Disord 2020; 25:135-141. [PMID: 29931448 DOI: 10.1007/s40519-018-0529-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/13/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS Pre-diabetes is a strong risk factor for type 2diabetes (T2D). The aim of this study was to explore factors associated with normal glucose maintenance and pre-diabetes prevention or delay. METHODS Data of 1016 first-degree relatives of T2D patients were retrieved from the Isfahan Diabetes Prevention Study (IDPS). Association of various variables including nutrients, serum tests and physical activity with the risk of pre-diabetes was assessed using recurrent events approach. RESULTS Cumulative incidence of diabetes was 8.17, 9.44, and 4.91% for total sample and individuals with and without pre-diabetes experience in the follow-up. Risk of progression to pre-diabetes was higher in women and older people (p < 0.01). Additionally, BMI and blood pressure had significant association with the risk (p < 0.01) and individuals with higher intake of fat were at higher risk (HR = 2.26; 95% CI 1.66-3.07 for high-intake and HR = 1.52; 95% CI 1.27-1.83 for medium-intake compared to low-intake group). Carbohydrates and protein intake were positively associated with the risk of pre-diabetes with HR = 8.63 per 49 g extra carbohydrates per day and HR = 1.32 per 6 g extra protein per day (p < 0.01). The association was also significant for triglyceride (TG) with 7% risk increase per 1 SD = 1.14 increase in TG level. CONCLUSION Despite frequent studies on lifestyle modification for pre-diabetes prevention, less information is available about the role of nutritional components. We observed direct effects for intake of macronutrients including fat, carbohydrates, and protein in first-degree relatives. Further research is warranted to assess these associations in general populations. LEVEL OF EVIDENCE Level III: Evidence obtained from a single-center cohort study.
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Affiliation(s)
- Marjan Mansourian
- Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akram Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Faghihimani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorraya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tohid Jafari-Koshki
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. .,Road Traffic Injury research Center, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Attar-Neyshabouri St., Tabriz, Iran.
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7
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Wang W, Lee ET, Howard BV, Devereux R, Zhang Y, Stoner JA. Large Cohort Data Based Cost-Effective Disease Prevention Design Strategy: Strong Heart Study. ACTA ACUST UNITED AC 2019; 8:588-601. [PMID: 30687583 PMCID: PMC6343848 DOI: 10.4236/wjcd.2018.812058] [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] [Indexed: 11/25/2022]
Abstract
Background and Objective: A multitude of large cohort studies have collected data on incidence and covariates/risk factors of various chronic diseases. However, approaches for utilization of these large data and translation of the valuable results to inform and guide clinical disease prevention practice are not well developed. In this paper, we proposed, based on large cohort study data, a novel conceptual cost-effective disease prevention design strategy for a target group when it is not affordable to include everyone in the target group for intervention. Methods and Results: Data from American Indian participants (n = 3516; 2056 women) aged 45 – 74 years in the Strong Heart Study, the diabetes risk prediction model from the study, a utility function, and regression models were used. A conceptual cost-effective disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for diabetes prevention was illustrated. Discussion: The strategy may provide reasonable solutions to address cost-effective prevention design issues. These issues include complex associations of a disease with its significant risk factors, cost-effectively selecting individuals at high risk of developing disease to undergo intervention, individual differences in health conditions, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. Conclusions: The strategy and methods shown in the illustrative example can also be analogously adopted and applied to other diseases preventions. The proposed strategy provides a way to translate and apply epidemiological study results to clinical disease prevention practice.
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Affiliation(s)
- Wenyu Wang
- Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elisa T Lee
- Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Ying Zhang
- Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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8
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Barletta V, Profili F, Gini R, Grilli L, Rampichini C, Matarrese D, Francesconi P. Impact of Chronic Care Model on diabetes care in Tuscany: a controlled before-after study. Eur J Public Health 2018; 27:8-13. [PMID: 28177456 DOI: 10.1093/eurpub/ckw189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Rosa Gini
- Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Leonardo Grilli
- Department of Statistics, Informatics, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Carla Rampichini
- Department of Statistics, Informatics, Applications "G. Parenti", University of Florence, Florence, Italy
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9
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Unnikrishnan R, Mohan V. Diabetes in the tropics: prevalent, increasing and a major public health problem. Trans R Soc Trop Med Hyg 2018; 110:263-4. [PMID: 27198208 DOI: 10.1093/trstmh/trw021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, 4 Conran Smith Road, Gopalapuram, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, 4 Conran Smith Road, Gopalapuram, Chennai, India
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10
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Wang W, Lee ET, Howard BV, Devereux R, Zhang Y, Stoner JA. Large Cohort Data Based Group or Community Disease Prevention Design Strategy: Strong Heart Study. WORLD JOURNAL OF CARDIOVASCULAR DISEASES 2018; 8:196-207. [PMID: 30283726 PMCID: PMC6167019 DOI: 10.4236/wjcd.2018.83019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE A multitude of large cohort studies have data on incidence rates and predictors of various chronic diseases. However, approaches for utilization of these costly collected data and translation of these valuable results to inform and guide clinical disease prevention practice are not well developed. In this paper we proposed a novel conceptual group/community disease prevention design strategy based on large cohort study data. METHODS AND RESULTS The data from participants (n = 3516; 2056 women) aged 45 to 74 years and the diabetes risk prediction model from Strong Heart Study were used. The Strong Heart Study is a population-based cohort study of cardiovascular disease and its risk factors in American Indians. A conceptual group/community disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for group diabetes prevention was illustrated. DISCUSSION The strategy may provide reasonable solutions to the prevention design issues. These issues include complex associations of a disease with its combined and correlated risk factors, individual differences, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. CONCLUSIONS The strategy and methods shown in the illustration example can be analogously adopted and applied for other diseases preventions. The proposed strategy for a target group/community in a population provides a way to translate and apply epidemiological study results to clinical disease prevention practice.
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Affiliation(s)
- Wenyu Wang
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elisa T Lee
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Ying Zhang
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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11
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Sakane N. Diabetes prevention in the real world: Insights from the JDPP and J-DOIT1. J Gen Fam Med 2017; 18:325-330. [PMID: 29264060 PMCID: PMC5729318 DOI: 10.1002/jgf2.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 12/12/2016] [Indexed: 11/07/2022] Open
Abstract
Type 2 diabetes (T2D) is associated with increased risks of morbidity and mortality. Diabetes prevention is an urgent issue in Japan. The Finnish Diabetes Prevention Study and US Diabetes Prevention Program revealed that intensive lifestyle intervention can prevent or delay the development of T2D in high-risk populations. Translational research varies in hospitals, primary care, communities, the workplace, and other settings. Translational research is feasible but less effective. There have been no long-term follow-ups. The outcome of the studies was mainly weight changes. The Japan Diabetes Prevention Program (JDPP) is a trial to test the efficacy of a lifestyle intervention program, which carried out in a primary healthcare setting using existing resources. The Japan Diabetes Outcome Trial-1 (J-DOIT1) is a nationwide telephone-delivered lifestyle intervention in a real-world setting. This review will focus on the effectiveness of a diabetes prevention program (recruitment, target population, method of intervention, and evaluation) in the real world and insights from the JDPP and J-DOIT1.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
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12
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Ghelani H, Razmovski-Naumovski V, Nammi S. Chronic treatment of (R)- α-lipoic acid reduces blood glucose and lipid levels in high-fat diet and low-dose streptozotocin-induced metabolic syndrome and type 2 diabetes in Sprague-Dawley rats. Pharmacol Res Perspect 2017; 5:e00306. [PMID: 28603627 PMCID: PMC5464337 DOI: 10.1002/prp2.306] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/11/2017] [Indexed: 12/16/2022] Open
Abstract
(R)‐ α ‐lipoic acid (ALA), an essential cofactor in mitochondrial respiration and a potential antioxidant, possesses a wide array of metabolic benefits including anti‐obesity, glucose lowering, insulin‐sensitizing, and lipid‐lowering effects. In this study, the curative effects of ALA (100 mg/kg) on a spectrum of conditions related to metabolic syndrome and type 2 diabetes (T2D) were investigated in a high‐fat diet (HFD)‐fed and low‐dose streptozotocin (STZ)‐induced rat model of metabolic syndrome and T2D. The marked rise in the levels of glucose, triglycerides, total‐cholesterol, LDL‐cholesterol, and VLDL‐cholesterol in the blood of HFD‐fed and low‐dose STZ‐injected rats were significantly reduced by ALA treatment. Furthermore, ALA treatment significantly increased the serum HDL‐cholesterol levels and tended to inhibit diabetes‐induced weight reduction. Mathematical computational analysis revealed that ALA also significantly improved insulin sensitivity and reduced the risk of atherosclerotic lesions and coronary atherogenesis. This study provides scientific evidence to substantiate the use of ALA to mitigate the glucose and lipid abnormality in metabolic syndrome and T2D.
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Affiliation(s)
- Hardik Ghelani
- School of Science and Health Western Sydney University New South Wales 2751 Australia.,National Institute of Complementary Medicine (NICM) Western Sydney University New South Wales 2751 Australia
| | - Valentina Razmovski-Naumovski
- School of Science and Health Western Sydney University New South Wales 2751 Australia.,National Institute of Complementary Medicine (NICM) Western Sydney University New South Wales 2751 Australia.,South Western Sydney Clinical School School of Medicine University of New South Wales New South Wales 2052 Australia
| | - Srinivas Nammi
- School of Science and Health Western Sydney University New South Wales 2751 Australia.,National Institute of Complementary Medicine (NICM) Western Sydney University New South Wales 2751 Australia
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13
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Sadikot SM, Das AK, Wilding J, Siyan A, Zargar AH, Saboo B, Aravind SR, Sosale B, Kalra S, Vijayakumar G, Manojan KK, Maheshwari A, Panda JK, Banerjee S, Chawla R, Vasudevan SP, Sundar OSS, Kesavadev J. Consensus recommendations on exploring effective solutions for the rising cost of diabetes. Diabetes Metab Syndr 2017; 11:141-147. [PMID: 28325543 DOI: 10.1016/j.dsx.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/03/2017] [Indexed: 12/16/2022]
Abstract
Diabetes remains asymptomatic for a long period of time and its real burden gets noticed only once the complications set in. The number of individuals affected with the disease is also on the rise and more so in the low income countries. This scenario calls for urgent precautionary measures that need to be undertaken to equip ourselves to fight against this chronic disease. Individuals with financial constraints cannot afford to access even the basic treatment facilities and thus stands the most burdened. The International Diabetes Federation calls for 'Eyes on Diabetes' for the society to focus on early screening and early intervention. The rising cost of diabetes results from delayed and denied treatment. The panel discussion organized as a part of 4th Annual global diabetes convention of Jothydev's Professional Education Forum (JPEF, 2016) facilitated a platform to address diabetes as a serious health concern that needs to be given immediate priority by the policymakers as well as public and also to discuss about the feasible measures that will help achieve cost effective and affordable diabetes treatment. This was followed by in-depth literature search and finally a set of recommendations have been arrived at by the key opinion leaders to realize the dream of affordable diabetes care to all deserving individuals.
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Affiliation(s)
- Shaukat M Sadikot
- Department of Endocrinology/Diabetology, Jaslok Hospital & Research Centre, Mumbai, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - John Wilding
- Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom
| | | | | | - Banshi Saboo
- Dia Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | | | | | - Sanjay Kalra
- Department of Endocrinology, Bharati Hospital, Karnal, Haryana, India
| | - G Vijayakumar
- Medical Trust Hospital, Kulanada, Pathanamthitta, Kerala, India
| | - K K Manojan
- Sree Gokulam Medical College, Trivandrum, Kerala, India
| | - Anuj Maheshwari
- Department of Internal Medicine, Babu Banarsi Das University, Lucknow, India
| | - Jayant K Panda
- Department of Medicine, SCB Medical College, Cuttack, India
| | - Samar Banerjee
- Department of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, India
| | | | | | - O S Syam Sundar
- Department of Medicine, Government General Hospital, Trivandrum, India
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Lin S, Naseri T, Linhart C, Morrell S, Taylor R, Mcgarvey ST, Magliano DJ, Zimmet P. Diabetes incidence and projections from prevalence surveys in Samoa over 1978-2013. Int J Public Health 2017; 62:687-694. [PMID: 28280865 PMCID: PMC5487887 DOI: 10.1007/s00038-017-0961-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 01/05/2023] Open
Abstract
Objectives This study estimates type 2 diabetes (T2DM) incidence in Samoans aged 25–64 years from sequential, irregularly spaced, cross-sectional population prevalence surveys. Methods T2DM prevalence from eight population surveys conducted over 1978–2013 (n = 12,516) was adjusted for census region, sex, and 5-year age group to the nearest previous census. Annual T2DM incidence was calculated from adjusted prevalences (by sex), using birth cohorts constructed from age-period matrices. Projections of T2DM incidence to 2020 were estimated, based on various scenarios of population weight change using Poisson regression. Results Over 1978–2013, T2DM incidence was estimated to increase from 1.12 to 8.44 per 1000 person-years in men and from 2.55 to 8.04 per 1000 in women. Based on regression modeling, if mean population weight was stabilized from 2013, absolute incidence reductions of 0.9 per 1000 person-years (7% lower) are predicted in 2020, compared to the current period trend in weight gain. Conclusions T2DM incidence can be calculated from irregularly conducted population risk factor surveys which may be useful in developing countries with limited resources. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-0961-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophia Lin
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Christine Linhart
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen Morrell
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | - Stephen T Mcgarvey
- International Health Institute, Brown University, Providence, Rhode Island, USA
| | | | - Paul Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Sun Y, You W, Almeida F, Estabrooks P, Davy B. The Effectiveness and Cost of Lifestyle Interventions Including Nutrition Education for Diabetes Prevention: A Systematic Review and Meta-Analysis. J Acad Nutr Diet 2017; 117:404-421.e36. [PMID: 28236962 PMCID: PMC5330213 DOI: 10.1016/j.jand.2016.11.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 11/28/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Type 2 diabetes is a significant public health concern. With the completion of the Diabetes Prevention Program, there has been a proliferation of studies attempting to translate this evidence base into practice. However, the cost, effectiveness, and cost-effectiveness of these adapted interventions is unknown. OBJECTIVE The purpose of this systematic review was to conduct a comprehensive meta-analysis to synthesize the effectiveness, cost, and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent (dietitian vs non-dietitian) and channel (in-person vs technology-delivered). METHODS English and full-text research articles published up to July 2015 were identified using the Cochrane Library, PubMed, Education Resources Information Center, CAB Direct, Science Direct, and Google Scholar. Sixty-nine studies met inclusion criteria. Most employed both dietary and physical activity intervention components (four of 69 were diet-only interventions). Changes in weight, fasting and 2-hour blood glucose concentration, and hemoglobin A1c were extracted from each article. Heterogeneity was measured by the I2 index, and study-specific effect sizes or mean differences were pooled using a random effects model when heterogeneity was confirmed. RESULTS Participants receiving intervention with nutrition education experienced a reduction of 2.07 kg (95% CI 1.52 to 2.62; P<0.001; I2=90.99%, 95% CI 88.61% to 92.87%) in weight at 12 months with effect sizes over time ranging from small (0.17, 95% CI 0.04 to 0.30; P=0.012; I2= 86.83%, 95% CI 80.42% to 91.14%) to medium (0.65, 95% CI 0.49 to 0.82; P<0.001; I2=98.75%, 95% CI 98.52% to 98.94). Effect sizes for 2-hour blood glucose and hemoglobin A1c level changes ranged from small to medium. The meta-regression analysis revealed a larger relative weight loss in dietitian-delivered interventions than in those delivered by nondietitians (full sample: -1.0 kg; US subsample: -2.4 kg), and did not find statistical evidence that the delivery channel was an important predictor of weight loss. The average cost per kilogram weight loss ranged from $34.06 over 6 months to $1,005.36 over 12 months. The cost of intervention per participant delivered by dietitians was lower than interventions delivered by non-dietitians, although few studies reported costs. CONCLUSIONS Lifestyle interventions are effective in reducing body weight and glucose-related outcomes. Dietitian-delivered interventions, compared with those delivered by other personnel, achieved greater weight reduction. No consistent trend was identified across different delivery channels.
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Abstract
This study assessed the effectiveness of a 12-week pilot employee wellness program in reducing risk factors for coronary heart disease. Fifty university employees with at least one cardiovascular disease risk factor participated in the program. Interventions focused on diet, exercise, and monthly workshops. Pre- and post-intervention measurements included weight, body composition, blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and blood sugar. Twenty-five employees had post-intervention measurements. A survey was administered to assess adherence. The correlation between adherence and improvement in cardiovascular disease risk factors was also tested. Significant differences were observed between pre- and post-intervention measurements of total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and weight. A significant correlation existed between self-reported level of participation in the diet aspect of the program and improvement in LDL levels. This multi-component, 12-week pilot employee wellness program was effective in reducing cardiovascular disease risk.
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Affiliation(s)
- Karen White
- Bird Health Center, Western Carolina University, Cullowhee, NC, USA
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Moshki M, Dehnoalian A, Alami A. Effect of Precede-Proceed Model on Preventive Behaviors for Type 2 Diabetes Mellitus in High-Risk Individuals. Clin Nurs Res 2016; 26:241-253. [PMID: 26749209 DOI: 10.1177/1054773815621026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to assess the effect of precede-proceed model on preventive behaviors for type 2 diabetes mellitus (DM) in high-risk individuals. In this semi-experimental study, 164 high-risk individuals for type 2 DM were selected and were randomly divided into two groups of intervention and control ( n = 85). Educational intervention was performed as a single session face-to-face instruction for 1.5 hr for the intervention group participants. Data were collected before (baseline) and immediately and 1 month after the intervention in the two groups. The mean score of predisposing (knowledge) factors ( p = .001), reinforcing factors ( p = .001), and enabling factors ( p = .02) were significantly different at baseline and 1 month after the intervention in the intervention group compared with the control group ( p < .05). A significant improvement occurred in the nutritional habits of high-risk participants in the intervention group at 1 month after the intervention compared with controls ( p = .001). The precede-proceed model can be effective for promoting the preventive behaviors for type 2 DM in high-risk individuals.
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Affiliation(s)
- Mahdi Moshki
- 1 Department of Public Health, School of Health Sciences, Social Development & Health Promotion Research Centre, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Atefeh Dehnoalian
- 2 MSN in Medical & Surgical Nursing, School of Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Alami
- 3 Department of Health, School of Public Health, Social Determinants of Health Research Centre, Gonabad University of Medical Sciences, Gonabad, Iran
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Abstract
The social and economic burden of diabetes is large and growing. Diabetes is a significant public health issue in the Appalachian region; women constitute approximately 50% of those diagnosed with diabetes. This cross-sectional study examined the relationship among sociodemographic, anthropometric, lifestyle, and psychosocial factors (cognitive and affective representations) and perceived risk of diabetes in non-diabetic, non-elderly (21-50 years) Appalachian women residing in West Virginia (N = 202). Participants were recruited through social media, flyers, and a newsletter from the West Virginia University Extension. The final survey was conducted from March 2015 to June 2015. Bivariate analyses were used to examine unadjusted relations among sociodemographic, anthropometric, lifestyle, and psychosocial factors and comparative perceived risk of diabetes. In a multivariable logistic regression model, we found that younger age, higher body mass index, non-White race, greater diabetes knowledge, personal control, and moderate amounts of physical activity were significantly, positively associated with higher diabetes risk perception (p < .05). Our results indicated that diabetes knowledge, personal control, and physical activity were related to diabetes risk perception among Appalachian women. Understanding perceived diabetes-related risk may aid in the development of effective intervention strategies to reduce the burden of diabetes among Appalachian and other populations. These cross-sectional findings need further evaluation in longitudinal studies.
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Affiliation(s)
- Ishveen Chopra
- a School of Pharmacy , West Virginia University , Morgantown , West Virginia , USA
| | - Avijeet Chopra
- b Department of Molecular and Cell Biology , University of Connecticut , Storrs , Connecticut , USA
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Guess N, Perreault L, Kerege A, Strauss A, Bergman BC. Dietary Fatty Acids Differentially Associate with Fasting Versus 2-Hour Glucose Homeostasis: Implications for The Management of Subtypes of Prediabetes. PLoS One 2016; 11:e0150148. [PMID: 26999667 PMCID: PMC4801380 DOI: 10.1371/journal.pone.0150148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
Over-nutrition has fuelled the global epidemic of type 2 diabetes, but the role of individual macronutrients to the diabetogenic process is not well delineated. We aimed to examine the impact of dietary fatty acid intake on fasting and 2-hour plasma glucose concentrations, as well as tissue-specific insulin action governing each. Normoglycemic controls (n = 15), athletes (n = 14), and obese (n = 23), as well as people with prediabetes (n = 10) and type 2 diabetes (n = 11), were queried about their habitual diet using a Food Frequency Questionnaire. All subjects were screened by an oral glucose tolerance test (OGTT) and studied using the hyperinsulinemic/euglycemic clamp with infusion of 6,62H2-glucose. Multiple regression was performed to examine relationships between dietary fat intake and 1) fasting plasma glucose, 2) % suppression of endogenous glucose production, 3) 2-hour post-OGTT plasma glucose, and 4) skeletal muscle insulin sensitivity (glucose rate of disappearance (Rd) and non-oxidative glucose disposal (NOGD)). The %kcal from saturated fat (SFA) was positively associated with fasting (β = 0.303, P = 0.018) and 2-hour plasma glucose (β = 0.415, P<0.001), and negatively related to % suppression of hepatic glucose production (β = -0.245, P = 0.049), clamp Rd (β = -0.256, P = 0.001) and NOGD (β = -0.257, P = 0.001). The %kcal from trans fat was also negatively related to clamp Rd (β = -0.209, P = 0.008) and NOGD (β = -0.210, P = 0.008). In contrast, the %kcal from polyunsaturated fat (PUFA) was negatively associated with 2-hour glucose levels (β = -0.383, P = 0.001), and positively related to Rd (β = 0.253, P = 0.007) and NOGD (β = 0.246, P = 0.008). Dietary advice to prevent diabetes should consider the underlying pathophysiology of the prediabetic state.
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Affiliation(s)
- Nicola Guess
- Department of Medicine, Imperial College London, Du Cane Road, London, United Kingdom
- Diabetes and Nutritional Sciences Division, Kings College London, London, United Kingdom
- * E-mail:
| | - Leigh Perreault
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States of America
| | - Anna Kerege
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States of America
| | - Allison Strauss
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States of America
| | - Bryan C. Bergman
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States of America
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Andrade JF, Silva V, Melnik T. Mulberry therapy for type 2 diabetes mellitus. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Janaina F Andrade
- Federal University of São Paulo (UNIFESP); Department of Evidence-Based Health; São Paulo Brazil
| | - Valter Silva
- Federal University of São Paulo (UNIFESP); Department of Evidence-Based Health; São Paulo Brazil
| | - Tamara Melnik
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Federal University of Sao Paulo (Unifesp) Martiniano de Carvalho Street, 864/ cj 302 São Paulo São Paulo Brazil 01321-000
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Ang SH, Thevarajah M, Alias Y, Khor SM. Current aspects in hemoglobin A1c detection: A review. Clin Chim Acta 2015; 439:202-11. [DOI: 10.1016/j.cca.2014.10.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 11/29/2022]
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Papaetis GS. Incretin-based therapies in prediabetes: Current evidence and future perspectives. World J Diabetes 2014; 5:817-834. [PMID: 25512784 PMCID: PMC4265868 DOI: 10.4239/wjd.v5.i6.817] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/10/2014] [Accepted: 11/10/2014] [Indexed: 02/05/2023] Open
Abstract
The prevalence of type 2 diabetes (T2D) is evolving globally at an alarming rate. Prediabetes is an intermediate state of glucose metabolism that exists between normal glucose tolerance (NGT) and the clinical entity of T2D. Relentless β-cell decline and failure is responsible for the progression from NGT to prediabetes and eventually T2D. The huge burden resulting from the complications of T2D created the need of therapeutic strategies in an effort to prevent or delay its development. The beneficial effects of incretin-based therapies, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, on β-cell function in patients with T2D, together with their strictly glucose-depended mechanism of action, suggested their possible use in individuals with prediabetes when greater β-cell mass and function are preserved and the possibility of β-cell salvage is higher. The present paper summarizes the main molecular intracellular mechanisms through which GLP-1 exerts its activity on β-cells. It also explores the current evidence of incretin based therapies when administered in a prediabetic state, both in animal models and in humans. Finally it discusses the safety of incretin-based therapies as well as their possible role in order to delay or prevent T2D.
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Gonder-Frederick L. Lifestyle modifications in the management of type 1 diabetes: still relevant after all these years? Diabetes Technol Ther 2014; 16:695-8. [PMID: 25265471 PMCID: PMC4201293 DOI: 10.1089/dia.2014.0175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Linda Gonder-Frederick
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia , Charlottesville, Virginia
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Tapia-Conyer R, Gallardo-Rincón H, Saucedo-Martinez R. CASALUD: an innovative health-care system to control and prevent non-communicable diseases in Mexico. Perspect Public Health 2013; 135:180-90. [PMID: 24285554 DOI: 10.1177/1757913913511423] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mexico and other Latin American countries are currently facing a dramatic increase in the number of adults suffering from non-communicable diseases (NCDs) such as diabetes, cardiovascular disease (CVD) and chronic kidney disease (CKD), which require prolonged, continuous care. This epidemiological shift has created new challenges for health-care systems. Both the World Health Organization (WHO) and the United Nations (UN) have recognised the growing human and economic costs of NCDs and outlined an action plan, recognising that NCDs are preventable, often with common preventable risk factors linked to risky health behaviours. In line with international best practices, Mexico has applied a number of approaches to tackle these diseases. However, challenges remain for the Mexican health-care system, and in planning a strategy for combating and preventing NCDs, it must consider how best to integrate these strategies with existing health-care infrastructure. Shifting the paradigm of care in Mexico from a curative, passive approach to a preventive, proactive model will require an innovative and replicable system that guarantees availability of medicines and services, strengthens human capital through ongoing professional education, expands early and continuous access to care through proactive prevention strategies and incorporates technological innovations in order to do so. Here, we describe CASALUD: an innovative model in health-care that leverages international best practices and uses innovative technology to deliver NCD care, control and prevention. In addition, we describe the lessons learned from the initial implementation of the model for its effective use in Mexico, as well as the plans for wider implementation throughout the country, in partnership with the Mexican Ministry of Health.
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Khavandi K, Amer H, Ibrahim B, Brownrigg J. Strategies for preventing type 2 diabetes: an update for clinicians. Ther Adv Chronic Dis 2013; 4:242-61. [PMID: 23997928 PMCID: PMC3752182 DOI: 10.1177/2040622313494986] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Diabetes is a major and growing public health challenge which threatens to overwhelm medical services in the future. Type 2 diabetes confers significant morbidity and mortality, most notably with target organ damage to the eyes, kidneys, nerves and heart. The magnitude of cardiovascular risk associated with diabetes is best illustrated by its position as a coronary heart disease risk equivalent. Complications related to neuropathy are also vast, often working in concert with vascular abnormalities and resulting in serious clinical consequences such as foot ulceration. Increased understanding of the natural history of this disorder has generated the potential to intervene and halt pathological progression before overt disease ensues, after which point management becomes increasingly challenging. The concept of prediabetes as a formal diagnosis has begun to be translated from the research setting to clinical practice, but with continually updated guidelines, varied nomenclature, emerging pharmacotherapies and an ever-changing evidence base, clinicians may be left uncertain of best practice in identifying and managing patients at the prediabetic stage. This review aims to summarize the epidemiological data, new concepts in disease pathogenesis and guideline recommendations in addition to lifestyle, pharmacological and surgical therapies targeted at stopping progression of prediabetes to diabetes. While antidiabetic medications, with newer anti-obesity medications and interventional bariatric procedures have shown some promising benefits, diet and therapeutic lifestyle change remains the mainstay of management to improve the metabolic profile of individuals with glucose dysregulation. New risk stratification tools to identify at-risk individuals, coupled with unselected population level intervention hold promise in future practice.
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Affiliation(s)
- Kaivan Khavandi
- BHF Centre of Excellence in Cardiovascular Research, The Rayne Institute, Department of Cardiology, King's College London, St Thomas' Hospital, Westminster Palace Road, London SE1 7EH, UK
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Yu X, Chen P, Wang H, Zhu T. Pioglitazone ameliorates endothelial dysfunction in those with impaired glucose regulation among the first-degree relatives of type 2 diabetes mellitus patients. Med Princ Pract 2013; 22:156-60. [PMID: 22964975 PMCID: PMC5586722 DOI: 10.1159/000341770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 07/08/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To study the effects of pioglitazone on endothelial dysfunction of subjects with impaired glucose regulation (IGR) among the first-degree relatives of patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS The first-degree relatives of T2DM patients were screened with oral glucose test and IGR was diagnosed. IGR subjects whose blood glucose was still above the level after 1-month exercise were randomized to receive pioglitazone (15 mg/day) or vehicle for 12 weeks. Endothelial function was assessed as endothelium-dependent and -independent vasodilation. Blood nitric oxide (NO), blood pressure, body mass index, insulin and serum lipids were also measured. Area under the curve of glucose (AUC(glu)) and insulin (AUC(INS)), homeostasis model assessment of insulin resistance (HOMA-IR), HOMA of β-cell function (HOMA-β) and early insulin secretion index (ΔI(30)/ΔG(30)) were calculated. RESULTS After pioglitazone treatment, fasting plasma, 2-hour plasma glucose, triglyceride (TG), fasting insulin, AUC(glu), HOMA-β and HOMA-IR, 2-hour insulin, AUC(INS) and ΔI(30)/ΔG(30) decreased. Endothelium-dependent vasodilation and NO were significantly improved in the treatment group. Furthermore, the changes of endothelium-dependent vasodilation were negatively correlated with changes in AUC(INS) but positively with NO and HOMA-β. Stepwise multivariate regression analysis showed that changes in NO and HOMA-β were both independent parameters for improvement of endothelial dysfunction. CONCLUSION Pioglitazone decreased blood glucose and TG, increased insulin sensitivity, and ameliorated endothelial dysfunction of IGR subjects among the first-degree relatives of T2DM patients. Increased NO production may be associated with the improvement of endothelial dysfunction.
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Affiliation(s)
- Xuemei Yu
- *Xuemei Yu, MD, Department of Endocrinology, Fengxian Central Hospital, 9588 Nanfeng Road, Nanqiao, Fengxian, Shanghai 201400 (P.R. China), Tel. +86 21 5742 2967, E-Mail
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Dhippayom T, Fuangchan A, Tunpichart S, Chaiyakunapruk N. Opportunistic screening and health promotion for type 2 diabetes: an expanding public health role for the community pharmacist. J Public Health (Oxf) 2012; 35:262-9. [PMID: 22976588 DOI: 10.1093/pubmed/fds078] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection to identify people at risk of diabetes is an important approach to prevent or delay type 2 diabetes. This study aimed to implement the Diabetes Prevention Program in community pharmacy using a diabetes risk prediction tool. METHODS The program was conducted in seven pharmacies in Bangkok, Thailand. Participants were the pharmacy's clients aged ≥ 35 years without the history of diabetes. A validated risk prediction tool was used to assess individuals' diabetes risk. Educational information was offered to all participants. Those with a high risk score (≥ 9 out of 17) were offered a self-check of fasting capillary blood glucose (CBG). A referral was made for those with CBG ≥ 126 mg/dl. RESULTS During a 3-month service, 397 individuals participated in the program. Nearly half of the participants (49.4%) were at a high risk of diabetes (risk score: ≥ 9). Ninety five (48.5%) of these high risk individuals undertook fasting CBG. Elevated fasting CBG (≥ 126 mg/dl) was found in 12 persons (12.7%). Overall, two patients with diabetes were identified during the provision of the program. CONCLUSIONS The Diabetes Prevention Program in community pharmacies uncovered half of the clients who were at risk of diabetes and provided an opportunity for participants to learn more about the prevention of diabetes.
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Affiliation(s)
- Teerapon Dhippayom
- Pharmaceutical Care Research Unit (PRU), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Kirk S, Brehm B, Saelens BE, Woo JG, Kissel E, D'Alessio D, Bolling C, Daniels SR. Role of carbohydrate modification in weight management among obese children: a randomized clinical trial. J Pediatr 2012; 161:320-7.e1. [PMID: 22381024 PMCID: PMC3406261 DOI: 10.1016/j.jpeds.2012.01.041] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/05/2011] [Accepted: 01/19/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of carbohydrate (CHO)-modified diets with a standard portion-controlled (PC) diet in obese children. STUDY DESIGN Obese children (n=102) aged 7-12 years were randomly assigned to a 3-month intervention of a low-CHO (LC), reduced glycemic load (RGL), or standard PC diet, along with weekly dietary counseling and biweekly group exercise. Anthropometry, dietary adherence, and clinical measures were evaluated at baseline and 3, 6, and 12 months. Analyses applied intention-to-treat longitudinal mixed models. RESULTS Eighty-five children (83%) completed the 12-month assessment. Daily caloric intake decreased from baseline to all time points for all diet groups (P<.0001), although LC diet adherence was persistently lower (P<.0002). At 3 months, body mass index z score was lower in all diet groups (LC, -0.27 ± 0.04; RGL, -0.20 ± 0.04; PC, -0.21 ± 0.04; P<.0001) and was maintained at 6 months, with similar results for waist circumference and percent body fat. At 12 months, participants in all diet groups had lower body mass index z scores than at baseline (LC, -0.21 ± 0.04; RGL, -0.28 ± 0.04; PC, -0.31 ± 0.04; P<.0001), and lower percent body fat, but no reductions in waist circumference were maintained. All diets demonstrated some improved clinical measures. CONCLUSION Diets with modified CHO intake were as effective as a PC diet for weight management in obese children. However, the lower adherence to the LC diet suggests that this regimen is more difficult for children to follow, particularly in the long term.
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Affiliation(s)
- Shelley Kirk
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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Kota SK, Ugale S, Gupta N, Modi KD. Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Diabetes Metab Syndr 2012; 6:125-131. [PMID: 23158974 DOI: 10.1016/j.dsx.2012.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of the present study was to prospectively evaluate the results of laparoscopic ileal interposition (II) with diverted sleeve gastrectomy (DSG) for control of T2DM and related metabolic abnormalities. METHODS All patients underwent II +DSG. They had T2DM≥5 years with poor glycemic control despite adequate dosage of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (HbA1C<6.5% without OHAs/insulin), and secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome. RESULTS We report the preliminary postoperative follow-up data of 9.1±5.3 months (range: 3-21 months). There were 17 patients (male:female=12:5) with mean age of 50.7±8.1 (range, 34-66 years), duration of diabetes of 15.1±5.8 years (range, 5-30 years), and preoperative body mass index of 29.2±7.5 kg/m(2)(range, 22.4-37.5 kg/m(2)). Eight patients (45%) had hypertension, while dyslipidemia and microalbuminuria was present in 7 patients (39%) each. Twelve patients (70.5%) had diabetes remission. Seven/eight (87.5%) patients had remission in hypertension. All participants had weight loss ranging between 15% and 30%. Postoperatively statistically significant decline was observed in the glycemic and lipid parameters, microalbuminuria at all intervals (p<0.05). Two patients had vitamin B12 deficiency 1 year after surgery. CONCLUSION Ileal interposition combined with DSG addresses both foregut and hindgut theories and brings about remissions in T2DM patients with reasonable safety. Our preliminary observations demonstrated the feasibility and efficacy of this novel surgical procedure as a promising option in T2DM.
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Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India.
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Ibarra-Pastrana E, Candia Plata MDC, Alvarez G, Valencia ME. Estimation of Insulin Resistance in Mexican Adults by the [(13)C]Glucose Breath Test Corrected for Endogenous Total CO(2) Production. Int J Endocrinol 2012; 2012:907818. [PMID: 22848216 PMCID: PMC3405658 DOI: 10.1155/2012/907818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/16/2012] [Indexed: 11/18/2022] Open
Abstract
Objective. To evaluate the efficacy of the [(13)C]glucose breath test for measuring insulin resistance in Mexican adults with different glycemic states. Research Design and Methods. Fifty-eight adults underwent a [(13)C]glucose breath test with simultaneous measurement of total CO(2) production by indirect calorimetry, at baseline and 90 minutes after the ingestion of 15 g of dextrose and 25 mg of [(13)C]glucose. HOMA was used as a marker of insulin resistance. Results. We found an inverse correlation between HOMA and the breath test δ(13)CO(2) (‰), r = -0.41 (P = 0.001). After adjusting for total CO(2) production, correlations between HOMA and fasting glucose were less strong but remained significant. An ROC curve was constructed using δ(13)CO(2) (‰) and HOMA values; the cut-off point was 9.99‰ δ(13)CO(2), corresponding to a sensitivity of 80.0 (95% CI: 51.9, 95.7) and a specificity of 67.4 (95% CI: 51.5, 80.9). Conclusions. The [(13)C]glucose breath test is a simple noninvasive procedure but was not sufficiently robust for an accurate diagnosis of insulin resistance. Our findings suggest that the test might be helpful in identifying individuals who are not IR, which in turn may contribute to improved diabetes prevention.
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Affiliation(s)
- Erika Ibarra-Pastrana
- Nutrition Division, Centro de Investigación en Alimentacion y Desarrollo, A.C., Mexico
| | | | - Gerardo Alvarez
- Department of Medicine and Health Sciences, University of Sonora, Hermosillo, Mexico
| | - Mauro E. Valencia
- Nutrition Division, Centro de Investigación en Alimentacion y Desarrollo, A.C., Mexico
- Energy Metabolism and Body Composition Laboratory, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Mexico
- *Mauro E. Valencia:
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Urrutia-Rojas X, McConathy W, Willis B, Menchaca J, Luna-Hollen M, Marshall K, Lacko A, Spellman C. Abnormal glucose metabolism in Hispanic parents of children with acanthosis nigricans. ISRN ENDOCRINOLOGY 2011; 2011:481371. [PMID: 22363881 PMCID: PMC3262632 DOI: 10.5402/2011/481371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 11/13/2011] [Indexed: 11/23/2022]
Abstract
Objective. Assess the prevalence of abnormal glucose metabolism among Hispanic parents of children with acanthosis nigricans (AN). Methods. Hispanic families (n = 258) were evaluated for metabolic and anthropometric parameters including fasting glucose levels and AN status. Results. Mothers with AN+ children had IFG (17.3%) and 4% had glucose levels ≥126 mg/dL (P = 0.028) compared to 7.1% and 1.8% of mothers with AN− children, respectively. Mothers of AN+ children also had greater odds of having impaired fasting glucose levels (OR: 3.917, 95% CI: 1.475–10.404; P < 0.004) but this was not the case for fathers (OR: 1.125, 95% CI: 0.489–2.586; P = 0.781). Mothers of AN+ children were also more likely to be AN+ (OR: 5.76, 95% CI: 2.98–11.13, P < 0.001). Screening discovered glucose levels >126 mg/dL in 9% of fathers with AN+ children. Conclusions. Hispanic mothers of AN+ children are at higher risk of carbohydrate metabolism abnormalities. AN in children can be a marker for prevention and delay programs aimed at identifying adults at risk for diabetes.
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Affiliation(s)
- Ximena Urrutia-Rojas
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Yates T, Davies MJ, Sehmi S, Gorely T, Khunti K. The Pre-diabetes Risk Education and Physical Activity Recommendation and Encouragement (PREPARE) programme study: are improvements in glucose regulation sustained at 2 years? Diabet Med 2011; 28:1268-71. [PMID: 21672008 DOI: 10.1111/j.1464-5491.2011.03357.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether improvements in glucose regulation following the PREPARE structured education programme were sustained at 24 months. PATIENTS AND METHODS Ninety-eight overweight or obese individuals with impaired glucose tolerance were randomized to receive: (1) advice leaflet, (2) 3-h structured education programme aimed at promoting physical activity, (iii) 3-h structured education with personalized pedometer use. The primary outcome was change in 2-h post-challenge plasma glucose. RESULTS Seventy-three (74%) individuals were included for analysis at 24 months; age 65 ± 8 years, BMI 29.3 ± 4.8 kg/m(2), South Asian ethnicity 21%. A statistically significant reduction in 2-h glucose of -1.6 mmol/l (-0.4 to -2.7) was seen in the education-with-pedometer group compared with the control group. There is no significant difference in the education-only group. CONCLUSION Improvements in glucose regulation following a pragmatic group-based structured education with pedometer use were sustained at 24 months.
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Affiliation(s)
- T Yates
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
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Denham SA, Ware LJ, Raffle H, Leach K. Family inclusion in diabetes education: a nationwide survey of diabetes educators. DIABETES EDUCATOR 2011; 37:528-35. [PMID: 21690434 DOI: 10.1177/0145721711411312] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate perceptions about family inclusion and support in diabetes self-management education. METHODS Surveys were mailed to certified diabetes educators (CDEs) in all 50 states and the District of Columbia, with a return of 225 surveys. Descriptive and inferential statistics (eg, t test, analysis of variance, correlation, and chi-square) were used as appropriate. RESULTS Levels of importance placed on family involvement in diabetes education were significantly related to the emphasis placed on family during CDEs' formal or preprofessional education. CDEs' formal exposure to family theory influenced perceptions of their knowledge about family and the frequency that family support was emphasized in self-management activities but was unrelated to perceptions of their skillfulness in educating family members. Diabetes educators' personal values of family support were significantly related to how frequently family members were asked to participate in formal diabetes education classes. CDEs perceived that they were meeting individuals' self-management needs significantly better than those of families. Regional differences did not appear to be a factor in how CDEs incorporated family in diabetes education. CONCLUSIONS Diabetes educators without formal exposure to family theory may be overestimating how much they emphasize family support in diabetes education. Increasing formal education about the importance of family involvement in self-management behaviors could positively affect individual diabetes self-management outcomes.
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Taylor LM, Spence JC, Raine K, Sharma AM, Plotnikoff RC. Self-reported physical activity preferences in individuals with prediabetes. PHYSICIAN SPORTSMED 2011; 39:41-9. [PMID: 21673484 DOI: 10.3810/psm.2011.05.1894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE The primary objective of this study was to determine the physical activity (PA) preferences in a sample of individuals with prediabetes. METHODS Individuals with prediabetes (N = 232) residing in Northern Alberta, Canada completed a mailed questionnaire that assessed demographic and health variables, self-reported PA (Godin Leisure-Time Exercise Questionnaire), and PA preferences. RESULTS Respondents indicated they would like to be counseled about PA (75%), were physically able to participate (96%), were interested in a PA program for individuals with prediabetes (86%), and were most interested in walking (71%). Activity status, number of comorbidities, level of employment, marital status, body mass index, and time since diagnosis with prediabetes all demonstrated significant influence on different PA preference variables. CONCLUSIONS There is a demand for PA-related programs for individuals with prediabetes. Incorporating identified PA preferences of those with prediabetes might aid in the development of relevant intervention tools, programs, and strategies to support PA.
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Affiliation(s)
- Lorian M Taylor
- Faculty of Physical Education and Recreation, University of Alberta, Alberta, Canada.
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Nichols GA, Moler EJ. Cardiovascular disease, heart failure, chronic kidney disease and depression independently increase the risk of incident diabetes. Diabetologia 2011; 54:523-6. [PMID: 21107522 PMCID: PMC3034036 DOI: 10.1007/s00125-010-1965-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 10/14/2010] [Indexed: 12/03/2022]
Abstract
AIMS/HYPOTHESIS Diabetes increases the risk of cardiovascular disease (CVD) and heart failure, as well as other serious complications, such as renal disease and depression. However, these conditions are often present prior to diabetes diagnosis. We sought to determine whether they increase the risk of developing diabetes independent of other risk factors. METHODS We identified 58,056 non-diabetic adults aged ≥30 years with no evidence of diabetes. Using electronic medical records, we identified the presence of four conditions at baseline (CVD, heart failure, renal disease and depression) and then estimated diabetes incidence over 5 years separately for patients with and without each of these conditions. Each incidence estimate was adjusted for baseline values of age, sex, fasting glucose, body mass index, systolic blood pressure, triacylglycerol, HDL-cholesterol, smoking and the presence of the other three conditions. RESULTS Patients with CVD were 35% (95% CI 23-48%) more likely to develop diabetes after controlling for other risk factors. Heart failure was independently associated with an increase in diabetes incidence of 48% (95% CI 27-73%), and depression was associated with a 10% (95% CI 2-20%) increase. Chronic kidney disease was associated with a non-significant risk increase of 10% (95% CI -2-25%). CONCLUSIONS/INTERPRETATION Complications of diabetes are more prevalent among patients who will ultimately develop diabetes, and increase the risk of diabetes independently of other known risk factors. The apparent bidirectional relationships suggest that primary prevention of CVD may also help prevent diabetes.
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Affiliation(s)
- G A Nichols
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, USA.
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Costa JDA, Balga RSM, Alfenas RDCG, Cotta RMM. Promoção da saúde e diabetes: discutindo a adesão e a motivação de indivíduos diabéticos participantes de programas de saúde. CIENCIA & SAUDE COLETIVA 2011; 16:2001-9. [DOI: 10.1590/s1413-81232011000300034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 07/10/2008] [Indexed: 11/22/2022] Open
Abstract
Este estudo teve como objetivo analisar, por meio de revisão sistemática, informações publicadas sobre a adesão e a motivação de pessoas portadoras de diabetes mellitus (DM) participantes de programas de saúde que visam ao estímulo à adoção de um estilo de vida saudável. Deu-se ênfase à ingestão de dieta adequada e à realização regular de exercícios físicos, enfocando tanto percepções e conhecimentos acerca da doença pelo portador de DM e seus cuidadores quanto a importância da mudança no estilo de vida, evidenciando-se caminhos a se buscar para melhora da qualidade de vida, demonstrando que é possível viver bem mesmo sendo portador de uma doença crônica como o DM. Para a revisão sistemática, consultaram-se publicações das principais bases de dados em saúde pública (Medline, Lilacs e Scielo, dentre outras) no período de 1994 a 2006. Foram selecionados 37 artigos que tratam do assunto saúde e doença versus diabetes nas mais variadas formas. Retrataram-se dificuldades diárias sentidas pelo portador de DM e por seus familiares para o controle da doença. Tais dificuldades podem influenciar diretamente na adesão do portador de DM ao tratamento prescrito. Assim, os fatores comportamentais e emocionais apresentados por paciente devem ser considerados no planejamento de ações de saúde para assistência integral a essa população.
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Pandit D, Kinare A, Chiplonkar S, Khadilkar A, Khadilkar V. Carotid arterial stiffness in overweight and obese Indian children. J Pediatr Endocrinol Metab 2011; 24:97-102. [PMID: 21528825 DOI: 10.1515/jpem.2011.086] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate carotid arterial stiffness and intima media thickness (IMT) in obese children in comparison with healthy children, and to examine associations of lipid profile and blood pressure with carotid artery morphology. METHODS Anthropometric and blood parameters were assessed in 44 overweight, 95 obese (6-17 years) and 69 healthy age-matched normal children. Percent body fat was measured by dual-energy X-ray absorptiometry and stiffness and IMT of the common carotid artery were evaluated using Aloka alpha 10 equipment. RESULTS Anthropometric and lipid parameters were significantly higher in overweight and obese than in normal children (p < 0.05). Stiffness (beta), pulse wave velocity (PWV), elastic modulus (Ep) and blood pressure were significantly higher in obese and overweight children than in normal children (p < 0.05). However, overweight and obese children did not show any significant difference in IMT compared with normal children (p > 0.1). Significant positive correlation of PWV, beta and Ep and negative correlation of arterial compliance with body fat and triglyceride was noted (p < 0.05). Different multinomial regression models for each e-Tracking parameter indicated that the relative risk of hypertension was highest with high PWV, followed by LDL cholesterol, Ep and body fat. CONCLUSION PWV may be considered an important marker for evaluation of early functional changes of the carotid artery in children and adolescents.
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Affiliation(s)
- Deepa Pandit
- Agharkar Research Institute, Agarakar Road, Pune, India
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Whittemore R, Melkus GD, Alexander N, Zibel S, Visone E, Muench U, Magenheimer E, Wilborne S. Implementation of a lifestyle program in primary care by nurse practitioners. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 2010; 22:684-93. [PMID: 21129077 PMCID: PMC3058230 DOI: 10.1111/j.1745-7599.2010.00562.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study is to describe the implementation process and participant satisfaction with a lifestyle program provided by nurse practitioners (NPs) in primary care to adults at risk for type 2 diabetes (T2D) compared to enhanced standard care. DATA SOURCES A mixed-method clinical trial design was used (n= 58). NPs were interviewed prior to beginning the program, at 3 months, and at completion of the program. NPs also completed a questionnaire on lifestyle counseling at baseline. Process data were collected on attendance, attrition, and intervention fidelity. Participants completed a satisfaction survey at completion of the program and a sub-sample were interviewed at the end of the program. CONCLUSIONS NPs reported that they felt well-prepared and moderately effective in providing lifestyle change counseling. Participant attendance was high and in-person sessions were implemented with good success. Participants in the lifestyle program were more satisfied with the program, reporting that the program was a good experience. IMPLICATIONS FOR PRACTICE Implementation of a lifestyle program to prevent T2D in primary care is feasible and acceptable to NPs and participants. Developing a structured program may improve health outcomes.
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Church TS, Blair SN, Cocreham S, Johannsen N, Johnson W, Kramer K, Mikus CR, Myers V, Nauta M, Rodarte RQ, Sparks L, Thompson A, Earnest CP. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA 2010; 304:2253-62. [PMID: 21098771 PMCID: PMC3174102 DOI: 10.1001/jama.2010.1710] [Citation(s) in RCA: 605] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Exercise guidelines for individuals with diabetes include both aerobic and resistance training although few studies have directly examined this exercise combination. OBJECTIVE To examine the benefits of aerobic training alone, resistance training alone, and a combination of both on hemoglobin A(1c) (HbA(1c)) in individuals with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS A randomized controlled trial in which 262 sedentary men and women in Louisiana with type 2 diabetes and HbA(1c) levels of 6.5% or higher were enrolled in the 9-month exercise program between April 2007 and August 2009. INTERVENTION Forty-one participants were assigned to the nonexercise control group, 73 to resistance training 3 days a week, 72 to aerobic exercise in which they expended 12 kcal/kg per week; and 76 to combined aerobic and resistance training in which they expended 10 kcal/kg per week and engaged in resistance training twice a week. Main Outcome Change in HbA(1c) level. Secondary outcomes included measures of anthropometry and fitness. RESULTS The study included 63.0% women and 47.3% nonwhite participants who were a mean (SD) age of 55.8 years (8.7 years) with a baseline HbA(1c) level of 7.7% (1.0%). Compared with the control group, the absolute mean change in HbA(1c) in the combination training exercise group was -0.34% (95% confidence interval [CI], -0.64% to -0.03%; P = .03). The mean changes in HbA(1c) were not statistically significant in either the resistance training (-0.16%; 95% CI, -0.46% to 0.15%; P = .32) or the aerobic (-0.24%; 95% CI, -0.55% to 0.07%; P = .14) groups compared with the control group. Only the combination exercise group improved maximum oxygen consumption (mean, 1.0 mL/kg per min; 95% CI, 0.5-1.5, P < .05) compared with the control group. All exercise groups reduced waist circumference from -1.9 to -2.8 cm compared with the control group. The resistance training group lost a mean of -1.4 kg fat mass (95% CI, -2.0 to -0.7 kg; P < .05) and combination training group lost a mean of -1.7 (-2.3 to -1.1 kg; P < .05) compared with the control group. CONCLUSIONS Among patients with type 2 diabetes mellitus, a combination of aerobic and resistance training compared with the nonexercise control group improved HbA(1c) levels. This was not achieved by aerobic or resistance training alone. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00458133.
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Affiliation(s)
- Timothy S Church
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Rd, Baton Rouge, LA 70808-4124, USA.
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Gill RS, Birch DW, Shi X, Sharma AM, Karmali S. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 2010; 6:707-13. [PMID: 20947447 DOI: 10.1016/j.soard.2010.07.011] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 06/02/2010] [Accepted: 07/22/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Existing evidence has suggested that bariatric surgery produces sustainable weight loss and remission or cure of type 2 diabetes mellitus (DM). Laparoscopic sleeve gastrectomy (LSG) has garnered considerable interest as a low morbidity bariatric surgical procedure that leads to effective weight loss and control of co-morbid disease. The objective of the present study was to systematically review the effect of LSG on type 2 DM. METHODS An electronic data search of MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, TRIP, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database was completed. The search terms used included LSG, vertical gastrectomy, bariatric surgery, metabolic surgery, and diabetes (DM), type 2 DM, or co-morbidities. All human studies, not limited to those in the English language, that had been reported from 2000 to April 2010 were included. RESULTS After an initial screen of 3621 titles, 289 abstracts were reviewed, and 28 studies met the inclusion criteria and the full report was assessed. One study was excluded after a careful assessment because the investigators had combined LSG with ileal interposition. A total of 27 studies and 673 patients were analyzed. The baseline mean body mass index for the 673 patients was 47.4 kg/m(2) (range 31.0-53.5). The mean percentage of excess weight loss was 47.3% (range 6.3-74.6%), with a mean follow-up of 13.1 months (range 3-36). DM had resolved in 66.2% of the patients, improved in 26.9%, and remained stable in 13.1%. The mean decrease in blood glucose and hemoglobin A1c after sleeve gastrectomy was -88.2 mg/dL and -1.7%, respectively. CONCLUSION Most patients with type 2 DM experienced resolution or improvement in DM markers after LSG. LSG might play an important role as a metabolic therapy for patients with type 2 DM.
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Affiliation(s)
- Richdeep S Gill
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Prevention of type 2 diabetes: risk status, clinic, and community. J Gen Intern Med 2010; 25:154-7. [PMID: 19890677 PMCID: PMC2837490 DOI: 10.1007/s11606-009-1148-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/24/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
Abstract
Although the idea of preventing type 2 diabetes has been articulated since the discovery of insulin, only in the past decade have clinical trials demonstrated that diabetes can be prevented or delayed. These trials found lifestyle intervention reduces diabetes incidence by over 50% and is more efficacious than metformin. Evidence from prevention trials comes from persons with "pre-diabetes" in which blood glucose levels are elevated but not yet in the diabetes range. In normoglycemic persons, lifestyle or drug intervention has little impact on diabetes incidence. Prevention programs are often conducted outside the clinical sector where participants' glycemic status is usually unknown; these programs may include many normoglycemic participants, which greatly reduces cost-effectiveness. An economically sustainable system for diabetes prevention will require effective partnerships among the clinical sector, community-based lifestyle programs, and third-party payers to ensure that limited resources for diabetes prevention are focused on persons at high risk of diabetes.
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Nedeltcheva AV, Kessler L, Imperial J, Penev PD. Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance. J Clin Endocrinol Metab 2009; 94:3242-50. [PMID: 19567526 PMCID: PMC2819825 DOI: 10.1210/jc.2009-0483] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Epidemiological data indicate that reduced sleep duration is associated with increased incidence of type-2 diabetes. OBJECTIVE The aim of the study was to test the hypothesis that, when part of a Western-like lifestyle, recurrent bedtime restriction may result in decreased glucose tolerance and reduced insulin secretion and action. DESIGN AND SETTING We conducted a randomized crossover study at a university clinical research center and sleep research laboratory. PARTICIPANTS Eleven healthy volunteers (five females and six males) with a mean (+/-sd) age of 39 +/- 5 yr and body mass index of 26.5 +/- 1.5 kg/m(2) participated in the study. INTERVENTION The study included two 14-d periods of controlled exposure to sedentary living with ad libitum food intake and 5.5- or 8.5-h bedtimes. MAIN OUTCOME MEASURES Oral and iv glucose challenges were used to obtain measures of glucose tolerance, glucose effectiveness, insulin secretion, and insulin sensitivity at the end of each intervention. Secondary measures included circulating concentrations of the glucose counter-regulatory hormones, cortisol, GH, epinephrine, and norepinephrine. RESULTS Bedtime restriction reduced daily sleep by 122 +/- 25 min. Both study periods were associated with comparable weight gain; however, recurrent sleep restriction resulted in reduced oral glucose tolerance (2-h glucose value, 144 +/- 25 vs. 132 +/- 36 mg/dl; P < 0.01) and insulin sensitivity [3.3 +/- 1.1 vs. 4.0 +/- 1.6 (mU/liter)(-1) x min(-1); P < 0.03], and increased glucose effectiveness (0.023 +/- 0.005 vs. 0.020 +/- 0.005 min(-1); P < 0.04). Although 24-h cortisol and GH concentrations did not change, there was a modest increase in 24-h epinephrine and nighttime norepinephrine levels during the 5.5-h bedtime condition. CONCLUSIONS Experimental bedtime restriction, designed to approximate the short sleep times experienced by many individuals in Westernized societies, may facilitate the development of insulin resistance and reduced glucose tolerance.
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Affiliation(s)
- Arlet V Nedeltcheva
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC-1027, Chicago, Illinois 60637, USA
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Geraldo JM, Alfenas RDCG. [Role of diet on chronic inflammation prevention and control - current evidences]. ACTA ACUST UNITED AC 2009; 52:951-67. [PMID: 18820806 DOI: 10.1590/s0004-27302008000600006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 05/15/2008] [Indexed: 11/21/2022]
Abstract
It is known that low chronic inflammation occurs in several stages of non transmissible chronic diseases, including cardiovascular diseases, obesity and diabetes mellitus, among others. Observational studies and clinical trials indicate that diet plays an important role in the reduction of such diseases. The present manuscript discusses the studies that linked diet macronutrient composition and the levels of inflammatory markers. It has been suggested that the consumption of high glycemic index diets, which have low fiber content and are rich in trans fat cause the activation of the immune system, leading to excessive production of pro-inflammatory mediators and the reduction of the anti-inflammatory ones. Although the results are controversial, healthy dietary intakes with the reduction in fat intake (especially trans and saturated fat) and the increase in fruits, vegetables, and whole grain consumption seem to be associated with the improvement in subclinical inflammatory condition.
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Affiliation(s)
- Júnia M Geraldo
- Departamento de Nutrição e Saúde da Universidade Federal de Viçosa, MG, Brasil.
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Yates T, Davies M, Gorely T, Bull F, Khunti K. Effectiveness of a pragmatic education program designed to promote walking activity in individuals with impaired glucose tolerance: a randomized controlled trial. Diabetes Care 2009; 32:1404-10. [PMID: 19602539 PMCID: PMC2713638 DOI: 10.2337/dc09-0130] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether a pragmatic structured education program with and without pedometer use is effective for promoting physical activity and improving glucose tolerance in those with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS Overweight and obese individuals with IGT were recruited from ongoing screening studies at the University Hospitals of Leicester, U.K. Participants were randomly assigned to one of three groups. Group 1 received a 3-h group-based structured education program designed to promote walking activity using personalized steps-per-day goals and pedometers. Group 2 received a 3-h group-based structured education program designed to promote walking activity using generic time-based goals. Group 3 received a brief information leaflet (control condition). Outcomes included an oral glucose tolerance test, standard anthropometric measures, ambulatory activity, and psychological variables. Follow-up was conducted at 3, 6, and 12 months. RESULTS A total of 87 individuals (66% male, mean age 65 years) were included in this study. At 12 months, significant decreases in 2-h postchallenge glucose and fasting glucose of -1.31 mmol/l (95% CI -2.20 to -0.43) and -0.32 mmol/l (-0.59 to -0.03), respectively, were seen in the pedometer group compared with the control group. No significant improvements in glucose control were seen in those given the standard education program. CONCLUSIONS This study suggests that a pragmatic structured education program that incorporates pedometer use is effective for improving glucose tolerance in those with IGT. This result is likely to have important implications for future primary care-based diabetes prevention initiatives.
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Affiliation(s)
- Thomas Yates
- Department of Cardiovascular Sciences, University of Leicester, U.K.
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Payne WR, Walsh KJ, Harvey JT, Livy MF, McKenzie KJ, Donaldson A, Atkinson MG, Keogh JB, Moss RS, Dunstan DW, Hubbard WA. Effect of a low-resource-intensive lifestyle modification program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults. Diabetes Care 2008; 31:2244-50. [PMID: 18796621 PMCID: PMC2584172 DOI: 10.2337/dc08-0152] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the effectiveness of a low-resource-intensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk. RESEARCH DESIGN AND METHODS A quasi-experimental two-group study was undertaken with 122 participants with diabetes risk factors; 36.9% had impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) at baseline. The intervention included a 6-week group self-management education program, a gymnasium-based or home-based 12-week resistance training program, and a 34-week maintenance program. Fasting plasma glucose (FPG) and 2-h plasma glucose, blood lipids, blood pressure, body composition, physical activity, and diet were assessed at baseline and week 52. RESULTS Mean 2-h plasma glucose and FPG fell by 0.34 mmol/l (95% CI -0.60 to -0.08) and 0.15 mmol/l (-0.23 to -0.07), respectively. The proportion of participants with IFG or IGT decreased from 36.9 to 23.0% (P = 0.006). Mean weight loss was 4.07 kg (-4.99 to -3.15). The only significant difference between resistance training groups was a greater reduction in systolic blood pressure for the gymnasium-based group (P = 0.008). CONCLUSIONS This intervention significantly improved diabetes diagnostic status and reduced diabetes risk to a degree comparable to that of other low-resource-intensive lifestyle modification programs and more intensive interventions applied to individuals with IGT. The effects of home-based and gymnasium-based resistance training did not differ significantly.
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Kahn R, Robertson RM, Smith R, Eddy D. The impact of prevention on reducing the burden of cardiovascular disease. Diabetes Care 2008; 31:1686-96. [PMID: 18663233 PMCID: PMC2494659 DOI: 10.2337/dc08-9022] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the U.S. RESEARCH DESIGN AND METHODS We used person-specific data from a representative sample of the U.S. population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20-80 years in the U.S. today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real U.S. population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible. RESULTS Approximately 78% of adults aged 20-80 years alive today in the U.S. are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by approximately 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced approximately 36% and 20%, respectively. Implementation of all prevention activities would add approximately 221 million life-years and 244 million quality-adjusted life-years to the U.S. adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the U.S. population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years. CONCLUSIONS Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the U.S. today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.
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Affiliation(s)
- Richard Kahn
- American Diabetes Association, Alexandria, Virginia, USA.
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Williams PT. Vigorous exercise, fitness and incident hypertension, high cholesterol, and diabetes. Med Sci Sports Exerc 2008; 40:998-1006. [PMID: 18461008 PMCID: PMC2825216 DOI: 10.1249/mss.0b013e31816722a9] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Current physical activity guidelines are based in part on studies of cardiorespiratory fitness, however, the effects of fitness may differ from activity. Analyses were undertaken to determine the dose-response relationships of fitness to incident hypertension, hypercholesterolemia, and diabetes independent of activity. METHODS Self-reported physician-diagnosed incident diabetes, hypercholesterolemia, and hypertension were compared to baseline running distance in 29,139 men and 11,985 women followed prospectively for 7.7 and 7.4 yr, respectively, and compared to cardiorespiratory fitness (m.s 10-km performance) in 85% of men and 76% of women. RESULTS During follow up, 2342 men (8.53%) and 499 women (4.26%) became hypertensive, 3330 men (12.2%) and 599 women (5.14%) became hypercholesterolemic, and 197 men (0.68%) and 28 women (0.23%) became diabetic. Longer baseline distance predicted lower incident hypertension (men, P < 0.0001; women, P = 0.08), hypercholesterolemia (men and women, P < 0.0001), and diabetes (men, P < 0.001; women, P < 0.01) during follow up. The odds for hypercholesterolemia decreased significantly with each 16 km.wk increment in distance through 64 km.wk in men and 48 km.wk in women. Higher baseline fitness predicted significantly lower odds for incident hypertension (men, P < 0.0001; women, P < 0.001), hypercholesterolemia (men, P < 0.0001; women, P < 0.01), and diabetes (men, P < 0.001; women, P < 0.01), independent of distance. Compared to the least fit men, the fittest men had 62% lower odds for becoming hypertensive, 67% lower odds for becoming hypercholesterolemic, and 86% lower odds for becoming diabetic. When adjusted for BMI, greater fitness predicted significantly lower odds for hypertension, hypercholesterolemia, and diabetes in men. CONCLUSIONS Higher cardiorespiratory fitness reduces the odds for hypertension, hypercholesterolemia, and diabetes, independent of physical activity and is an important risk factor separate from physical activity.
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Affiliation(s)
- Paul T Williams
- Donner Laboratory, Life Sciences Division, Ernest Orlando Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA.
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Crandall JP, Knowler WC, Kahn SE, Marrero D, Florez JC, Bray GA, Haffner SM, Hoskin M, Nathan DM. The prevention of type 2 diabetes. ACTA ACUST UNITED AC 2008; 4:382-93. [PMID: 18493227 DOI: 10.1038/ncpendmet0843] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 04/09/2008] [Indexed: 01/12/2023]
Abstract
Type 2 diabetes mellitus (T2DM) affects more than 7% of adults in the US and leads to substantial personal and economic burden. In prediabetic states insulin secretion and action--potential targets of preventive interventions--are impaired. In trials lifestyle modification (i.e. weight loss and exercise) has proven effective in preventing incident T2DM in high-risk groups, although weight loss has the greatest effect. Various medications (e.g. metformin, thiazolidinediones and acarbose) can also prevent or delay T2DM. Whether diabetes-prevention strategies also ultimately prevent the development of diabetic vascular complications is unknown, but cardiovascular risk factors are favorably affected. Preventive strategies that can be implemented in routine clinical settings have been developed and evaluated. Widespread application has, however, been limited by local financial considerations, even though cost-effectiveness might be achieved at the population level.
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Affiliation(s)
- Jill P Crandall
- Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Abstract
Kidney disease may be the cause or a consequence of hypertension. Hypertension affects 25% of the adult population in the United States. Similarly, chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been steadily increasing in incidence because of the increasing age of the US population and rise in the incidence of risk factors, including hypertension. Substantial evidence supports the notion that elevated blood pressure is the most significant risk factor for developing CKD. Microalbuminuria has been shown to be the early marker of hypertensive renal disease. Furthermore, therapy to reduce microalbuminuria was associated with delayed progression of renal disease. Black Americans are at higher risk for developing hypertensive nephrosclerosis than whites. Hypertension is a major risk factor for cardiovascular events in patients with CKD and ESRD and those who have undergone renal transplantation. Studies have documented that elevated serum creatinine and CKD are risk factors for a cardiovascular event. Tight blood pressure control has been shown to reduce microalbuminuria and proteinuria and to delay progression of renal disease. Tailoring antihypertensive medication to the clinical setting to achieve a blood pressure goal is critical in reducing complications from this deadly connection.
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Affiliation(s)
- Yousri M Barri
- Division of Nephrology and Transplantation, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA.
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DePaula AL, Macedo ALV, Rassi N, Machado CA, Schraibman V, Silva LQ, Halpern A. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc 2008; 22:706-16. [PMID: 17704886 DOI: 10.1007/s00464-007-9472-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a common disease with numerous complications. Bariatric surgery is an efficient procedure for controlling T2DM in morbidly obese patients. In T2DM, the incretin effect is either greatly impaired or absent. This study aimed to evaluate the preliminary results from interposing a segment of ileum into the proximal jejunum associated with a sleeve or diverted sleeve gastrectomy to control T2DM in patients with a body mass index (BMI) less than 35 kg/m(2). METHODS For this study, 39 patients (16 women and 23 men) underwent two laparoscopic procedures comprising different combinations of ileal interposition into the proximal jejunum via a sleeve or diverted sleeve gastrectomy. The mean age of these patients was 50.3 years (range, 36-66 years). The mean BMI was 30.1 kg/m(2) (range, 23.4-34.9 kg/m(2)). All the patients had a diagnosis of T2DM that had persisted for at least 3 years and evidence of stable treatment with oral hypoglycemic agents or insulin for at least 12 months. The mean duration of T2DM was 9.3 years (range, 3-22 years). RESULTS The mean operative time was 185 min, and the median hospital stay was 4.3 days. Four major complications occurred in the short term (30-days), and the mortality rate was 2.6%. The mean postoperative follow-up period was 7 months (range, 4-16 months), and the mean percentage of weight loss was 22%. The mean postoperative BMI was 24.9 kg/m(2) (range, 18.9-31.7 kg/m(2)). An adequate glycemic control was achieved for 86.9% of the patients, and 13.1% had important improvement. The patients whose glycemia was not normalized were using a single oral hypoglycemic agent. No patient needed insulin therapy postoperatively. All the patients except experienced normalization of their cholesterol levels. Targeted triglycerides levels were achieved by 71% of the patients, and hypertension was controlled for 95.8%. CONCLUSIONS The laparoscopic ileal interposition via either a sleeve gastrectomy or diverted sleeve gastrectomy seems to be a promising procedure for the control of T2DM and the metabolic syndrome. A longer follow-up period is needed.
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Affiliation(s)
- A L DePaula
- Department of Surgery, Hospital de Especialidades, Goiânia, Brazil.
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