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Owolabi EO, Ajayi AI. Adherence to medication, dietary and physical activity recommendations: Findings from a multicenter cross-sectional study among adults with diabetes in rural South Africa. J Eval Clin Pract 2024. [PMID: 38838035 DOI: 10.1111/jep.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/18/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Diabetes is a complex health condition requiring medical therapy and lifestyle modifications to attain treatment targets. Previous studies have not fully explored factors associated with adherence to medication, diets and physical activity recommendations among individuals living with diabetes in rural South Africa. We examined the association between knowledge, health belief and adherence to medication, dietary, and physical activity recommendations and explored self-reported reasons for non-adherence. METHODS This cross-sectional study was conducted among 399 individuals living with diabetes recruited over 12 weeks from six randomly selected primary healthcare centres in rural South Africa. Sociodemographic and clinical data were obtained by self-report. Health beliefs, knowledge, and adherence were assessed using validated measures. Descriptive and inferential statistics were carried out. RESULTS The majority (81.7%) of the participants were females, with a mean age of 62 ± 11 years. Only 39% reported adhering to their prescribed medication regimen, 25% reported adhering to dietary recommendations, and 32% reported adhering to physical activity recommendations. The most cited reasons for non-adherence were lack of access to (n = 64) and cost of drugs (n = 50), perceived high costs of healthy diets (n = 243), and lack of time (n = 181) for physical activity. Level of education was an independent predictor of medication adherence [odds ratio, OR = 2.02 (95% confidence interval, CI: 1.20-3.40)] while diabetes knowledge was independently associated with both medications [OR = 3.04 (95% CI: 1.78-45.12)]; and physical activity adherence [OR = 2.92 (95% CI: 1.04-2.96). Positive health belief was independently associated with adherence to medications [OR = 1.72 (95% CI: 1.15-2.57) and dietary recommendations [OR = 1.75 (95% CI: 1.04-2.96)]. CONCLUSION Adherence to three important self-care practices, medication, diet, and physical activity, was suboptimal in this study setting. Socioeconomic reasons and access barriers were significant drivers of non-adherence, while increased knowledge and positive health beliefs were potential facilitators. Efforts to improve medication adherence and foster engagement in healthy lifestyle behaviours must consider patients' knowledge and health beliefs. Primary healthcare providers should create awareness on the importance of adherence on health outcomes for people with diabetes. Likewise, efforts to increase the availability and affordability of medications for socioeconomically disadvantaged populations should be prioritised by the key health stakeholders.
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Affiliation(s)
- Eyitayo O Owolabi
- Center for Disease Prevention and Health Promotion, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Department of Nursing, University of Fort Hare, East London, South Africa
| | - Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, Africa Population and Health Research Center, Nairobi, Kenya
- Department of Sociology, University of Fort Hare, East London, South Africa
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Matpady P, Maiya AG, Saraswat PP, Rao CR, Pai MS, Anupama SD, Shetty JK, Umakanth S. Barriers and Enablers for Physical Activity Engagement Among Individuals From India With Type 2 Diabetes Mellitus: A Mixed-Method Study. J Phys Act Health 2024; 21:519-527. [PMID: 38402875 DOI: 10.1123/jpah.2023-0574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a complex, chronic condition that can cause multiple complications due to poor glycemic control. Self-management plays a crucial role in the management of T2DM. Lifestyle modifications, including physical activity (PA), are fundamental for self-management. This study explored the knowledge, perception, practice, enablers, and barriers of PA among individuals with T2DM. METHODS A mixed-method study was conducted among individuals with T2DM in Udupi taluk, India. A cross-sectional survey (n = 467) followed by an in-depth interview (n = 35) was performed. The data were analyzed using descriptive statistics and thematic analysis, respectively. RESULTS About half (48.8%) of the participants engaged in PA of which 28.3% had an adequate score in the practice of PA. Walking was the most preferred mode. Self-realization, Comprehension, perception, and source of information, PA training, Current PA practices, enablers and barriers for PA were 6 themes derived under knowledge, perception, and practice of PA. CONCLUSION Despite knowing the importance of PA, compliance with PA was poor. The personal/internal, societal, and external factors constituted the trinity of barriers and enablers in compliance with PA. Behavioral changes, societal changes, policy initiatives, and PA training in health care settings may enhance PA practice among individuals with T2DM.
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Affiliation(s)
- Prabhath Matpady
- WASH and CCES Policy, Advocacy and Networking Expert, CIC, UNICEF, Hyderabad, India
| | - Arun G Maiya
- Department of Physiotherapy, College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Pallavi P Saraswat
- Department of Medicine, Dr TMA Pai Hospital (Udupi) and Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, India
| | - Chythra R Rao
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Mamatha Shivananda Pai
- Department of Child Health Nursing and Department of Obstetrical and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Shekarappa D Anupama
- Department of Global Health Goveranance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jeevan K Shetty
- Department of Biochemistry, Royal College of Surgeons in Ireland-Bahrain, Adliya, Bahrain
| | - Shashikiran Umakanth
- Department of Medicine, Dr TMA Pai Hospital (Udupi) and Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, India
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Mukherji AB, Lu D, Qin F, Hedlin H, Johannsen NM, Chung S, Kobayashi Y, Haddad F, Lamendola C, Basina M, Talamoa R, Myers J, Palaniappan L. Effectiveness of a Community-Based Structured Physical Activity Program for Adults With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2247858. [PMID: 36542382 PMCID: PMC9857601 DOI: 10.1001/jamanetworkopen.2022.47858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE The efficacy of physical activity interventions among individuals with type 2 diabetes has been established; however, practical approaches to translate and extend these findings into community settings have not been well explored. OBJECTIVE To test the effectiveness of providing varying frequencies of weekly structured exercise sessions to improve diabetes control. DESIGN, SETTING, AND PARTICIPANTS The IMPACT (Initiate and Maintain Physical Activity in Communities Trial) study was a controlled randomized clinical trial (randomization occurred from October 2016 to April 2019) that included a 6-month, structured exercise intervention either once or thrice weekly vs usual care (UC; advice only). The exercise intervention was conducted at community-based fitness centers. Follow-up visits were conducted in a university research clinic. Participants included adults with type 2 diabetes (hemoglobin A1c [HbA1c] 6.5%-13.0%, not taking insulin, and no precluding health issues). Data analysis was performed from January to April 2022. INTERVENTIONS A once-weekly structured exercise group, a thrice-weekly structured exercise group, or UC. MAIN OUTCOMES AND MEASURES The primary outcome was HbA1c at 6 months. RESULTS A total of 357 participants (143 women [40.1%]) with a mean (SD) age of 57.4 (11.1) years were randomized (119 each to the UC, once-weekly exercise, and thrice-weekly exercise groups). There was no significant difference in HbA1c change by study group in the intention-to-treat analysis at 6 months. Specifically, HbA1c changed by -0.23% (95% CI, -0.48% to 0.01%) in the thrice-weekly exercise group and by -0.16% (95% CI, -0.41% to 0.09%) in the once-weekly exercise group. A total of 62 participants (52.1%) in the once-weekly exercise group and 56 participants (47.1%) in the thrice-weekly exercise group were at least 50% adherent to the assigned structured exercise regimen and were included in the per-protocol analysis. Per-protocol analysis showed that HbA1c changed by -0.35% (95% CI, -0.60% to -0.10%; P = .005) at 3 months and by -0.38% (95% CI, -0.65% to -0.12%; P = .005) at 6 months in the thrice-weekly exercise group compared with UC. There was no significant decrease in HbA1c in the once-weekly exercise group. The exercise intervention was effective in improving self-reported minutes of metabolic equivalent tasks per week for participants in the thrice-weekly exercise group (both overall and per protocol). CONCLUSIONS AND RELEVANCE Although the intervention was not effective in the intention-to-treat analysis, participants in the thrice-weekly exercise group who attended at least 50% of the sessions during the 6-month exercise intervention program improved HbA1c levels at 6 months. Future efforts should focus on improving adherence to thrice-weekly structured exercise programs to meet exercise guidelines. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02061579.
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Affiliation(s)
- Aishee B. Mukherji
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Di Lu
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - FeiFei Qin
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Haley Hedlin
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Neil M. Johannsen
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge
| | - Sukyung Chung
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Cardiovascular Institute, Stanford, California
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Cardiovascular Institute, Stanford, California
| | - Cynthia Lamendola
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Marina Basina
- Division of Endocrinology, Stanford University School of Medicine, Stanford, California
| | - Ruth Talamoa
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System, Stanford University, Palo Alto, California
| | - Latha Palaniappan
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Ahsan M, Garneau L, Aguer C. The bidirectional relationship between AMPK pathway activation and myokine secretion in skeletal muscle: How it affects energy metabolism. Front Physiol 2022; 13:1040809. [PMID: 36479347 PMCID: PMC9721351 DOI: 10.3389/fphys.2022.1040809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2023] Open
Abstract
Myokines are peptides and proteins secreted by skeletal muscle cells, into the interstitium, or in the blood. Their regulation may be dependent or independent of muscle contraction to induce a variety of metabolic effects. Numerous myokines have been implicated in influencing energy metabolism via AMP-activated protein kinase (AMPK) signalling. As AMPK is centrally involved in glucose and lipid metabolism, it is important to understand how myokines influence its signalling, and vice versa. Such insight will better elucidate the mechanism of metabolic regulation during exercise and at rest. This review encompasses the latest research conducted on the relationship between AMPK signalling and myokines within skeletal muscles via autocrine or paracrine signalling.
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Affiliation(s)
- Mahdi Ahsan
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Léa Garneau
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort –Recherche, Ottawa, ON, Canada
| | - Céline Aguer
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort –Recherche, Ottawa, ON, Canada
- Department of Physiology, Faculty of Medicine and Health Sciences, McGill University—Campus Outaouais, Gatineau, QC, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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5
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Novak JR, Ellis FK. A framework for incorporating physical activity in treatment: Competencies, guidelines, and implications for family therapists. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:523-542. [PMID: 34480488 DOI: 10.1111/jmft.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
Physical activity can have a profound impact on the cognitive, emotional, and social aspects of our clients' lives, and can even boost and sustain therapy outcomes. And yet, family therapists may not be trained or educated in the importance of physical activity nor how to assess, educate, and collaborate with health professionals to incorporate physical activity in treatment. As the evidence grows on the connection between physical activity and biopsychosocial functioning and more family therapists enter medical and healthcare settings, a framework for physical activity competencies is needed. As such, the purpose of this conceptual and empirical review paper is to (a) review the important brain-boosting benefits of physical activity for mental, cognitive, and social health, (b) provide a framework for the domains for family therapists for incorporating exercise in assessment and treatment, and finally, (c) outline recommendations for practice, education and supervision, and research for family therapists.
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Affiliation(s)
- Josh R Novak
- Department of Human Development and Family Science, Auburn University, Auburn, Alabama, USA
| | - Faith K Ellis
- Department of Human Development and Family Science, Auburn University, Auburn, Alabama, USA
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6
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de Oliveira AA, Mendoza VO, Rastogi S, Nunes KP. New insights into the role and therapeutic potential of HSP70 in diabetes. Pharmacol Res 2022; 178:106173. [PMID: 35278625 DOI: 10.1016/j.phrs.2022.106173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Emerging evidence indicates that HSP70 represents a key mechanism in the pathophysiology of β-cell dysfunction, insulin resistance, and various diabetic complications, including micro- and macro-vascular alterations, as well as impaired hemostasis. Hyperglycemia, a hallmark of both types of diabetes, increases the circulating levels of HSP70 (eHSP70), but there is still divergence about whether diabetes up- or down-regulates the intracellular fraction of this protein (iHSP70). Here, we consider that iHSP70 levels reduce in diabetic arterial structures and that the vascular system is in direct contact with all other systems in the body suggesting that a systemic response might also be happening for iHSP70, which is characterized by decreased levels of HSP70 in the vasculature. Furthermore, although many pathways have been proposed to explain HSP70's functions in diabetes, and organs/tissues/cells-specific variations occur, the membrane-bound receptor of the innate immune system, Toll-like receptor 4, and its downstream signal transduction pathways appear to be a constant, not only when we explore the actions of eHSP70, but also when we assess the contributions of iHSP70. In this review, we focus on discussing the multiple roles of HSP70 across organs/tissues/cells affected by hyperglycemia to further explore the possibility of targeting this protein with pharmacological and non-pharmacological approaches in the context of diabetes.
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Affiliation(s)
- Amanda Almeida de Oliveira
- Laboratory of Vascular Biology, Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, United States
| | - Valentina Ochoa Mendoza
- Laboratory of Vascular Biology, Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, United States
| | - Swasti Rastogi
- Laboratory of Vascular Biology, Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, United States
| | - Kenia Pedrosa Nunes
- Laboratory of Vascular Biology, Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, United States.
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7
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Silva ÉQ, Santos DP, Beteli RI, Monteiro RL, Ferreira JSSP, Cruvinel-Junior RH, Donini A, Verissímo JL, Suda EY, Sacco ICN. Feasibility of a home-based foot-ankle exercise programme for musculoskeletal dysfunctions in people with diabetes: randomised controlled FOotCAre (FOCA) Trial II. Sci Rep 2021; 11:12404. [PMID: 34117342 PMCID: PMC8196027 DOI: 10.1038/s41598-021-91901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/02/2021] [Indexed: 11/09/2022] Open
Abstract
This study sought to assess the feasibility of design, adherence, satisfaction, safety and changes in outcomes followed by a home-based foot–ankle exercise guided by a booklet in individuals with diabetic peripheral neuropathy (DPN). 20 participants were allocated usual care [control group (CG)] or usual care plus home-based foot–ankle exercises [intervention group (IG)] for 8 weeks. For feasibility, we assessed contact, preliminary screening and recruitment rates, adherence, and using a 5-point Likert scale to satisfaction and safety of the booklet. In the IG, we assessed preliminary changes in DPN symptoms, DPN severity (classified by a fuzzy model) and foot–ankle range of motion between baseline and Week 8. In the first 20 weeks, 1310 individuals were screened for eligibility by phone contact. Contact rate was 89% (contacted participants/20w), preliminary screening success 28% (participants underwent screening/20w), and recruitment rate 1.0 participants/week (eligible participants/20w). The recruitment rate was less than the ideal rate of 5 participants/week. The adherence to the exercises programme was 77%, and the dropout was 11% and 9% for the IG and CG, respectively. In the IG, participants’ median level of satisfaction was 4 (IQR: 4–5) and perceived safety was 3 (IQR: 3–5). IG significantly decreased the DPN severity (p = 0.020), increased hallux relative to forefoot (first metatarsal) range of motion (ROM) (p < 0.001) and decreased maximum forefoot relative to hindfoot (midfoot motion) dorsiflexion during gait (p = 0.029). The home-based programme was feasible, satisfactory, safe and showed preliminary positive changes in DPN severity and foot motion during gait. Trial Registration ClinicalTrials.gov, NCT04008745. Registered 02/07/2019. https://clinicaltrials.gov/ct2/show/NCT04008745.
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Affiliation(s)
- Érica Q Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Danilo P Santos
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Raquel I Beteli
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Renan L Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil.,Department of Physical Therapy, Universidade Federal do Amapá, Amapá, Brazil
| | - Jane S S P Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Ronaldo H Cruvinel-Junior
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Asha Donini
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Jady L Verissímo
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil
| | - Eneida Y Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil.,Department of Physical Therapy, Universidade Ibirapuera, São Paulo, SP, Brazil
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, SP, 05360-160, Brazil.
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Abstract
Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Regular exercise is important for a healthy pregnancy and can lower the risk of developing GDM. For women with GDM, exercise is safe and can affect the pregnancy outcomes beneficially. A single exercise bout increases skeletal muscle glucose uptake, minimizing hyperglycemia. Regular exercise training promotes mitochondrial biogenesis, improves oxidative capacity, enhances insulin sensitivity and vascular function, and reduces systemic inflammation. Exercise may also aid in lowering the insulin dose in insulin-treated pregnant women. Despite these benefits, women with GDM are usually inactive or have poor participation in exercise training. Attractive individualized exercise programs that will increase adherence and result in optimal maternal and offspring benefits are needed. However, as women with GDM have a unique physiology, more attention is required during exercise prescription. This review (i) summarizes the cardiovascular and metabolic adaptations due to pregnancy and outlines the mechanisms through which exercise can improve glycemic control and overall health in insulin resistance states, (ii) presents the pathophysiological alterations induced by GDM that affect exercise responses, and (iii) highlights cardinal points of an exercise program for women with GDM.
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9
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Ren G, Bowers RL, Kim T, Mahurin AJ, Grandjean PW, Mathews ST. Serum fetuin-A and Ser312 phosphorylated fetuin-A responses and markers of insulin sensitivity after a single bout of moderate intensity exercise. Physiol Rep 2021; 9:e14773. [PMID: 33650781 PMCID: PMC7923554 DOI: 10.14814/phy2.14773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022] Open
Abstract
Fetuin‐A (Fet‐A), secreted by the liver and adipose tissue, inhibits insulin receptor tyrosine kinase activity and modulates insulin action. Numerous studies have shown association of elevated serum Fet‐A concentrations with obesity, non‐alcoholic fatty liver disease, and type 2 diabetes. Both moderate body weight loss (5%–10%) and significant body weight loss have been shown to decrease serum Fet‐A and improve insulin sensitivity. Currently, there are no studies examining the effects of a single bout of exercise on serum Fet‐A or Ser312‐pFet‐A (pFet‐A) responses. We hypothesized that a single bout of moderate‐intensity exercise will lower serum Fet‐A and that these changes will be associated with an improvement in insulin sensitivity. Thirty‐one individuals with obesity and 11 individuals with normal body weight were recruited. Participants underwent a single bout of treadmill walking, expending 500 kcal at 60%–70% VO2max. Oral glucose tolerance tests (OGTT) were administered before the single bout of exercise (Pre Ex) and 24 h after exercise (24h Post Ex). In individuals with obesity, we observed a transient elevation of serum Fet‐A concentrations, but not pFet‐A, immediately after exercise (Post Ex). Further, a single bout of exercise decreased glucoseAUC, insulinAUC, and insulin resistance index in individuals with obesity. Consistent with this improvement in insulin sensitivity, we observed that Fet‐AAUC, pFet‐AAUC, 2 h pFet‐A, and 2 h pFet‐A/Fet‐A were significantly lower following a single bout of exercise. Further, reductions in serum Fet‐AAUC 24h Post Ex were correlated with a reduction in insulin resistance index. Together, this suggests that alterations in serum Fet‐A following a single bout of moderate‐intensity endurance exercise may play a role in the improvement of insulin sensitivity. Clinical Trial Registration NCT03478046; https://clinicaltrials.gov/ct2/show/NCT03478046.
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Affiliation(s)
- Guang Ren
- Department of Nutrition and Dietetics, Auburn University, Auburn, AL, USA
| | | | - Teayoun Kim
- Department of Nutrition and Dietetics, Auburn University, Auburn, AL, USA
| | | | | | - Suresh T Mathews
- Department of Nutrition and Dietetics, Samford University, Birmingham, AL, USA
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Feasibility and safety of a walking football program in middle-aged and older men with type 2 diabetes. Prog Cardiovasc Dis 2020; 63:786-791. [DOI: 10.1016/j.pcad.2020.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 11/21/2022]
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Sanches A, Guzzoni V, Miranda VCDR, Peressim LB, Rocha S, de Lima PO, Marcondes FK, Tanno AP, Cunha TS. Recreational training improves cardiovascular adaptations, metabolic profile and mental health of elderly women with type-2 diabetes mellitus. Health Care Women Int 2020; 42:1279-1297. [DOI: 10.1080/07399332.2020.1821689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Andrea Sanches
- Physiotherapy Course, Faculty of Americana, Santa Barbara d’Oeste, Sao Paulo, Brazil
| | - Vinicius Guzzoni
- Department of Cellular and Molecular Biology, Federal University of Paraíba, Paraíba, Brazil
| | | | | | - Suellen Rocha
- Physiotherapy Course, Faculty of Americana, Santa Barbara d’Oeste, Sao Paulo, Brazil
| | - Patrícia Oliveira de Lima
- Piracicaba Dental School, Department of Biosciences, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Fernanda Klein Marcondes
- Piracicaba Dental School, Department of Biosciences, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Ana Paula Tanno
- College of Health Sciences, Methodist University of Piracicaba, Piracicaba, Sao Paulo, Brazil
| | - Tatiana Sousa Cunha
- Science and Technology Institute, Federal University of São Paulo, São Paulo, Brazil
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Schmidt SK, Hemmestad L, MacDonald CS, Langberg H, Valentiner LS. Motivation and Barriers to Maintaining Lifestyle Changes in Patients with Type 2 Diabetes after an Intensive Lifestyle Intervention (The U-TURN Trial): A Longitudinal Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207454. [PMID: 33066239 PMCID: PMC7602059 DOI: 10.3390/ijerph17207454] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to explore and identify factors that influence motivation for and barriers to adopting and maintaining lifestyle changes in patients with type 2 diabetes, following participation in an intensive multiple-lifestyle intervention. Participants were recruited from the U-TURN trial, a one-year, intensive lifestyle intervention for type 2 diabetes patients. This study was conducted over time; informants were interviewed twice after the trial ended with a six-month interval between interviews. The qualitative data from these individual interviews were analysed using systematic text condensation with an inductive approach. Five themes emerged: Social support and relatedness, Achievement of results, Support from healthcare professionals, Identification with and acceptance of the new lifestyle and Coping with ongoing challenges. These are all important for maintaining lifestyle changes and diabetes self-management. Changing one’s lifestyle can be a constant, difficult struggle. For sustainable progress after an intensive intervention, the changes must be adopted and endorsed by patients and co-opted into their social setting. Belonging to an exercise group, confidence in managing the lifestyle adjustments and handling of challenges through continual support and professional diabetes treatment are crucial in maintaining and adhering to the new lifestyle.
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Affiliation(s)
- Sabrina K. Schmidt
- Department of Sport, Physical Education and Outdoor Studies, Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, 3800 Bø in Telemark, Norway;
- Correspondence:
| | - Liv Hemmestad
- Department of Sport, Physical Education and Outdoor Studies, Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, 3800 Bø in Telemark, Norway;
| | - Christopher S. MacDonald
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
- Department of Infectious Diseases, Rigshospitalet, Section of Social Medicine, CopenRehab, Faculty of Health, University of Copenhagen, 1017 Copenhagen K, Denmark; (H.L.); (L.S.V.)
| | - Henning Langberg
- Department of Infectious Diseases, Rigshospitalet, Section of Social Medicine, CopenRehab, Faculty of Health, University of Copenhagen, 1017 Copenhagen K, Denmark; (H.L.); (L.S.V.)
| | - Laura S. Valentiner
- Department of Infectious Diseases, Rigshospitalet, Section of Social Medicine, CopenRehab, Faculty of Health, University of Copenhagen, 1017 Copenhagen K, Denmark; (H.L.); (L.S.V.)
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, 2200 Copenhagen N, Denmark
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Haines M. Feasibility of procedures for a randomised pilot study of reduced exertion, high-intensity interval training (REHIT) with non-diabetic hyperglycaemia patients. Pilot Feasibility Stud 2020; 6:28. [PMID: 32099663 PMCID: PMC7031996 DOI: 10.1186/s40814-020-00571-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background Physical activity and exercise interventions to improve health frequently bring about intended effects under ideal circumstances but often fail to demonstrate benefits in real-world contexts. The aim of this study was to describe the feasibility of an exercise intervention (reduced-exertion, high-intensity interval training) in non-diabetic hyperglycaemia patients delivered in a National Health Service setting to assess whether it would be appropriate to progress to a future large-scale study. Methods The intention was to recruit 40 participants from a single centre (specialist diabesity centre). Patients were eligible to take part if they were diagnostically defined as non-diabetic hyperglycaemic based on a glycated haemoglobin (HbA1c) value of 42–46 mmol mol. Study procedures including recruitment, occurrence of adverse events, intervention acceptability, and intervention adherence were used to assess feasibility. Results Key criteria for progression to a larger study were not met. The study revealed several issues including patient eligibility, challenges to recruitment, patient consent, and poor clinician engagement. Furthermore, despite the simplicity and convenience of using HbA1c to screen for diabetes risk, the process of accurately screening and case finding eligible patients was problematic. The small sample recruited for this trial (n = 6) also limits the interpretation of data, thus it is not possible to estimate the variability of intended outcomes to use in a formal sample size calculation for a full-scale trial. Some aspects of the intervention worked well. The acceptability of the exercise intervention and outcome measures met progression criteria thresholds and adherence was very high, with 97% of exercise sessions completed for participants that finished the study. Conclusions Given the issues, the trial is not feasible in its current form. Yet, this preparatory stage of trial design pre-empted problems with the intervention that could be changed to optimise the design and conduct of future studies. Solutions to the issues identified in this study revolve around using a dedicated local recruiter with a strong relationship among the healthcare team and patients, using participant incentives to take part, and allowing for a longer recruitment period. Trial registration ClinicalTrials.gov, NCT04011397. Registered 07 July 2019—retrospectively registered.
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Affiliation(s)
- Matthew Haines
- Department of Allied Health Professions, Sport and Exercise, University of Huddersfield, Huddersfield, HD1 3DH UK
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Malay Version of Exercise Self-Efficacy: A Confirmatory Analysis among Malaysians with Type 2 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030922. [PMID: 32024257 PMCID: PMC7037020 DOI: 10.3390/ijerph17030922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/24/2022]
Abstract
Exercise self-efficacy (ESE) is one of the psychological constructs in the Transtheoretical Model (TTM). The objective of the present study is to assess the validity and reliability of the Malay version of Exercise self-efficacy scale (ESE-M) among Malaysians with type 2 diabetes mellitus (T2DM). A cross-sectional study design with convenience sampling method using a self-administered questionnaire was carried out. Participants were invited to complete the ESE-M with 18 items. Confirmatory factor analysis (CFA) was conducted and composite reliability (CR) was computed using Mplus 8. A total of 331 Malaysians with T2DM with a mean age of 63 years old (Standard Deviation = 0.57) completed the questionnaire. Most of the participants were male (52%) and Malay (89.4%). Two initial CFA models (single factor and three factors) of ESE-M scale were tested and they did not fit to the data well. Several re-specifications of the models were conducted. The final model for the ESE-M showed improvement on the value of model fit indices for the single factor model (comparative fit index (CFI) = 0.952, Tucker and Lewis index (TLI) = 0.938, standardised root mean square (SRMR) = 0.044, root mean square error of approximation (RMSEA) = 0.054) and three factors model (CFI = 0.891, TLI = 0.863, SRMR = 0.049, RMSEA = 0.081). The CR for the self-efficacy factor was 0.921 (single factor), while CR for internal feelings, competing demands and situational (three factors) were 0.762, 0.818 and 0.864, respectively. The final model of single factor ESE-M showed better fit to the data compared to the three factors ESE-M. This indicated that the single factor ESE-M is more suitable to be adopted for future study among Malaysians with T2DM.
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Mirahmadizadeh A, Khorshidsavar H, Seif M, Sharifi MH. Adherence to Medication, Diet and Physical Activity and the Associated Factors Amongst Patients with Type 2 Diabetes. Diabetes Ther 2020; 11:479-494. [PMID: 31916213 PMCID: PMC6995790 DOI: 10.1007/s13300-019-00750-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes mellitus (T2D) has increased considerably while the outcome of diabetic management is suboptimal. In order to promote diabetic management, associated factors for adherence to medications, diet, and physical activity (PA) need to be more clearly identified amongst patients with T2D. METHODS This cross-sectional study was conducted on 206 men and 294 women amongst patients with diabetes who were registered in ten special diabetic clinics in Shiraz, Iran from November 2018 to April 2019. Levels of adherence to medication, Mediterranean diet (MD), and physical activity were measured with validated and appropriate questionnaires. RESULTS Mean age (± SD) was 56.92 ± 0.52 years and 294 (58.8%) were female. Data showed that reduced adherence to medication, MD, and PA increased glycated hemoblobin (HbA1c). Adherence to medication among low, moderate, and high levels was 27.2%, 59.2%, and 13.6%, respectively. Associated factors such as 50-64 years of age, at least 65 years of age, overweight, obese, divorced widow, smoker, and ex-smoker had a significant influence on adherence to medication, P = 0.017, P = 0.018, P = 0.008. P = 0.045, P = 0.026, P < 0.004, and P = 0.001, respectively. In addition, adherence to MD among low, moderate, and high levels was 5.4%, 77.2%, and 17.4%, respectively. Associated factors such as 50-64 years of age, at least 65 years of age, overweight, obese, and smoker had a significant influence on adherence to MD, P = 0.011, P = 0.046, P = 0.002, P < 0.001, and P = 0.032, respectively. Furthermore, adherence to PA among low, moderate, and high levels was 21%, 68.6%, and 10.4%, respectively. Only the non-smoker factor played a significant role in PA adherence, P = 0.010. CONCLUSION Levels of adherence to medications, diet, and PA amongst patients with T2D are not within the acceptable range. Recognized associated factors that contribute to adherence might improve diabetes management and allow one to tailor the appropriate message to improve glycemic indices.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Sharifi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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16
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Yasmin F, Ali L, Banu B, Rasul FB, Sauerborn R, Souares A. Understanding patients' experience living with diabetes type 2 and effective disease management: a qualitative study following a mobile health intervention in Bangladesh. BMC Health Serv Res 2020; 20:29. [PMID: 31918704 PMCID: PMC6953219 DOI: 10.1186/s12913-019-4811-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2017, 425 million adults worldwide had diabetes; 80% were living in low and middle-income countries. Bangladesh had 6.9 million adults with diabetes; death from diabetes comprised 3% of the country's total mortality. This study looked at different factors (personal, familial, social, and financial) affecting both the life of patients with diabetes type 2 and the management of the disease. It also explored patient's perception of the mobile health intervention in the context of disease management and helped to explain the findings obtained from the quantitative part of this study. METHOD The study was a mixed-method, sequential explanatory design. A mobile health project (interactive voice call and call center) was implemented in Dhaka district, Bangladesh from January to December, 2014. Patients received treatment at the outpatient department of Bangladesh Institute of Health Science Hospital, Dhaka, Bangladesh, were included in intervention and control groups of the main study following a Randomized Control Trial. Among them, a total of 18 patients (9 + 9) were selected purposefully for the qualitative study, which was conducted in July, 2015. The sample was selected purposefully considering the age, sex, socio-economic status and proximity of living due to the political instability of the country during the data collection period. The interviews were transcribed and analyzed applying investigator triangulation. RESULTS Most patients stated that diabetes has affected their lives. In general, both groups´ evaluation of mobile health services were good and both regarded the recommendations for medication, diet, physical exercise, and other lifestyle behaviors (use of tobacco and betel nuts) as helpful. The cost of overall treatment (medications, physician consultations, laboratory investigations), the lack of availability of safe public places for physical exercise and unfavorable weather conditions (heat, rainfall) were mentioned as barriers to the overall management of the disease. CONCLUSION A patient-centered mobile health intervention supported by a collaborative patient-provider relationship, a strong family support system, available public spaces for exercise and the introduction of a functional public health insurance system could be beneficial for the better management of diabetes.
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Affiliation(s)
- F Yasmin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany.
- Faculty of Health/Department of Human Medicine, University Witten/Herdecke, 58448, Witten, Germany.
| | - L Ali
- Bangladesh University of Health Sciences (BUHS), Mirpur-1, Dhaka, 1216, Bangladesh
| | - B Banu
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - F B Rasul
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
- BRAC James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212, Bangladesh
| | - R Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - A Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
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Ramadhan BJA, Alramadan MJ, Alhassan RE, Almajed HA, Khamseen MAB, Billah B. Adherence to the recommended physical activity duration among Saudis with type 2 diabetes mellitus. J Family Med Prim Care 2019; 8:3668-3677. [PMID: 31803671 PMCID: PMC6881944 DOI: 10.4103/jfmpc.jfmpc_662_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 08/20/2019] [Accepted: 09/10/2019] [Indexed: 12/05/2022] Open
Abstract
Background: Physical activity is important in managing type 2 diabetes, since it leads to better glycemic control, decreases macrovascular complications, and controls diabetes-related comorbidities. Objective: This study aimed to assess the levels of adherence to physical activity in Saudi adults with type 2 diabetes. Method: Participants with type 2 diabetes mellitus who visited diabetes centers in Riyadh, Jeddah, and Hofuf and completed interviewer-administered electronic questionnaires between May 15 and November 31 in 2017 were included in this study. Data related to sociodemographic information, medical history, level of physical activity, and depression and anxiety were collected. In addition, blood pressure, anthropometric measurements, and the most recent HbA1c, and fasting lipid profiles were obtained. Results: In total, 1,111 participants (65.2% women, mean age of 57.5 ± 11 years) were included in the analysis; 62.1% were obese (Body Mass Index [BMI] >30 kg/m2). Mean duration of DM was 13.8 ± 8.3 years. Approximately 75% of participants had uncontrolled diabetes (i.e. HbA1c ≥7%). Furthermore, only 30% adhered to the recommended physical activity duration of 150 min/week. Non-adherence to physical activity was associated with female sex, older age, low education, low economic status, longer disease duration, absence of family support, poor education from the physician or DM educator, and follow-up in health institutions other than the diabetes center. Conclusions: The majority of patients with T2DM in Saudi do not adhere to the recommended duration of physical activity. Sex, age, level of education, monthly income, disease duration, follow-up institution, among others, influenced adherence to physical activity.
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Affiliation(s)
- Basmah Jassim Al Ramadhan
- Postgraduate Center of Family and Community Medicine, Ministry of Health, Al Ahsa Province, Saudi Arabia
| | - Mohammed J Alramadan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rabab E Alhassan
- Postgraduate Center of Family and Community Medicine, Ministry of Health, Al Ahsa Province, Saudi Arabia
| | - Hanan A Almajed
- Postgraduate Center of Family and Community Medicine, Ministry of Health, Al Ahsa Province, Saudi Arabia
| | - Montaser A Bu Khamseen
- Postgraduate Center of Family and Community Medicine, Ministry of Health, Al Ahsa Province, Saudi Arabia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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18
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Mogre V, Johnson NA, Tzelepis F, Shaw JE, Paul C. A systematic review of adherence to diabetes self‐care behaviours: Evidence from low‐ and middle‐income countries. J Adv Nurs 2019; 75:3374-3389. [DOI: 10.1111/jan.14190] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/20/2019] [Accepted: 08/05/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Victor Mogre
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Department of Health Professions Education School of Medicine and Health Sciences University for Development Studies Tamale Ghana
| | - Natalie A. Johnson
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
| | - Flora Tzelepis
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
- Hunter New England Population Health Hunter New England Local Health District Wallsend New South Wales Australia
| | | | - Christine Paul
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
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Beaudry KM, Devries MC. Nutritional Strategies to Combat Type 2 Diabetes in Aging Adults: The Importance of Protein. Front Nutr 2019; 6:138. [PMID: 31555655 PMCID: PMC6724448 DOI: 10.3389/fnut.2019.00138] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022] Open
Abstract
The prevalence of pre-diabetes (PD) and type II diabetes (T2D) has risen dramatically in recent years affecting an estimated 422 million adults worldwide. The risk of T2D increases with age, with the sharpest rise in diagnosis occurring after age 40. With age, there is also a progressive decline in muscle mass starting after the age of 30. The decline in muscle mass and function due to aging is termed sarcopenia and immediately precedes the sharp rise in T2D. The purpose of the current review is to discuss the role of protein to attenuate declines in muscle mass and insulin sensitivity to prevent T2D and sarcopenia in aging adults. The current recommended dietary allowance for protein consumption is set at 0.8 g/kg/day and is based on dated studies on young healthy men and may not be sufficient for older adults. Protein consumption upwards of 1.0-1.5 g/kg/day in older adults is able to induce improvements in glycemic control and muscle mass. Obesity, particularly central or visceral obesity is a major risk factor in the development of PD and T2D. However, the tissue composition of weight loss in older adults includes both lean body mass and fat mass and therefore may have adverse metabolic consequences in older adults who are already at a high risk of lean body mass loss. High protein diets have the ability to increase weight loss while preserving lean body mass therefore inducing "high-quality weight loss," which provides favorable metabolic changes in older adults. High protein diets also induce beneficial outcomes on glycemic markers due to satiety, lowered post-prandial glucose response, increased thermogenesis, and the ability to decrease rates of muscle protein breakdown (MPB). The consumption of dairy specific protein consumption has also been shown to improve insulin sensitivity by improving body composition, enhancing insulin release, accelerating fat oxidation, and stimulating rates of muscle protein synthesis (MPS) in older adults. Exercise, specifically resistance training, also works synergistically to attenuate the progression of PD and T2D by further stimulating rates of MPS thereby increasing muscle mass and inducing favorable changes in glycemic control independent of lean body mass increases.
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Affiliation(s)
- Kayleigh M Beaudry
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Michaela C Devries
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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20
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Type 2 diabetes and physical activity: barriers and enablers to diabetes control in Eastern India. Prim Health Care Res Dev 2019. [PMCID: PMC6536761 DOI: 10.1017/s146342361800097x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction Type 2 diabetes (T2D) has tremendous morbidity burden owing to disease management and complication prevention. Behavior modification identified as a key to management includes healthy diet and regular physical activity (PA). This study aims to identify patterns and preferences of PA of T2D patients and explore perceived enablers and barriers for diabetes control in Bhubaneswar. Methods Cross-sectional, facility-based study conducted in the private sector from June to August 2014 recruited 321 T2D patients using semi-structured questionnaires. Descriptive statistics and associations of PA were computed. Results Almost two-thirds of patients (59%) were reported performing PA frequently. Majority patients cited walking as the most preferred mode of PA (79%) with 41% performing PA daily. Actual versus perceived weight was a complete mismatch with most patients misjudging their weight. Reasons for enabling PA included ‘controlling diabetes’ and ‘doctor’s advice’ as key factors, while ‘lack of time’ and ‘unwillingness’ were main barriers among inactive patients. Conclusion Counseling on PA by physicians during routine visits, along with tailored or patient-specific interventions should be considered. Focus on social support for positive behavioral changes and motivation play a central role in diabetes control.
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Pozzobon D, Ferreira PH, Dario AB, Almeida L, Vesentini G, Harmer AR, Ferreira ML. Is there an association between diabetes and neck and back pain? A systematic review with meta-analyses. PLoS One 2019; 14:e0212030. [PMID: 30789940 PMCID: PMC6383876 DOI: 10.1371/journal.pone.0212030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/26/2019] [Indexed: 01/04/2023] Open
Abstract
Background and objective Approximately half of the population will experience either low back pain or neck pain, at some point in their lives. Previous studies suggest that people with diabetes are more likely to present with chronic somatic pain, including shoulder, knee and spinal pain. This study aimed to systematically review and appraise the literature to explore the magnitude as well as the nature of the association between diabetes and back, neck, or spinal (back and neck) pain. Databases and data treatment A systematic search was performed using the Medline, CINAHL, EMBASE, and Web of Science electronic databases. Studies which assessed the association between diabetes and back or neck pain outcomes, in participants older than 18 years of age were included. Two independent reviewers extracted data on the incidence of pain and reported associations. Results Eight studies were included in the meta-analyses. Meta-analyses showed that people with diabetes are more likely to report low back pain [5 studies; n: 131,431; odds ratio (OR): 1.35; 95% Confidence Interval (CI): 1.20 to 1.52; p<0.001] and neck pain (2 studies; n: 6,560; OR: 1.24; 95% CI: 1.05 to 1.47; p = 0.01) compared to those without diabetes. Results from one longitudinal cohort study suggested that diabetes is not associated with the risk of developing future neck, low back or spinal pain. Conclusions Diabetes is associated with low back and neck individually, and spinal pain. The longitudinal analysis showed no association between the conditions. Our results suggest that diabetes co-exists with back pain; however, a direct causal link between diabetes and back pain was not established. Systematic review registration PROSPERO registration CRD42016050738.
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Affiliation(s)
- Daniel Pozzobon
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Paulo H. Ferreira
- Musculoskeletal Health Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Amabile B. Dario
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lisandra Almeida
- Discipline of Physiotherapy, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Giovana Vesentini
- Department of Gynaecology and Obstetrics, Botucatu Medical School, UNESP–Paulista State University, Botucatu, São Paulo, Brazil
| | - Alison R. Harmer
- Musculoskeletal Health Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Manuela L. Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Andrade EF, de Oliveira Silva V, Orlando DR, Pereira LJ. Mechanisms Involved in Glycemic Control Promoted by Exercise in Diabetics. Curr Diabetes Rev 2019; 15:105-110. [PMID: 29446746 DOI: 10.2174/1573399814666180214144717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/22/2018] [Accepted: 01/31/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Diabetes mellitus is a metabolic disease characterized by high glycemic levels for long periods. This disease has a high prevalence in the world population, being currently observed an increase in its incidence. This fact is mainly due to the sedentary lifestyle and hypercaloric diets. Non-pharmacological interventions for glycemic control include exercise, which promotes changes in skeletal muscle and adipocytes. Thus, increased glucose uptake by skeletal muscle and decreased insulin resistance through modulating adipocytes are the main factors that improve glycemic control against diabetes. CONCLUSION It was sought to elucidate mechanisms involved in the improvement of glycemic control in diabetics in front of the exercise.
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Affiliation(s)
| | | | - Débora Ribeiro Orlando
- Department of Agricultural Sciences, Federal University of Jequitinhonha and Mucuri Valleys, Unai, Brazil
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Cox ER, Keating SE, Coombes JS, Burton NW. Potential Utility of Self-Report Measures of Affect to Optimise Exercise Adherence in People with Type 2 Diabetes. Curr Diabetes Rev 2019; 15:302-308. [PMID: 30117398 DOI: 10.2174/1573399814666180816165351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/20/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022]
Abstract
Exercise is essential for managing type 2 diabetes, however approximately only 40% of people with the condition meet guidelines. The aim of this review is to examine the evidence regarding the use self-report measures of affect to understand and predict exercise adherence. Self-reported affect has been successfully used to regulate exercise intensity, monitor training load, prevent injury, and predict future physical activity participation in otherwise healthy and some clinical populations. Specific recommendations are provided for research to explore the utility of self-report measures of affect to promote exercise adherence in people with type 2 diabetes.
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Affiliation(s)
- Emily R Cox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Australia
| | | | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Australia
| | - Nicola W Burton
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Australia
- School of Applied Psychology, Griffith University, Mt Gravatt, Australia
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Craike M, Wiesner G, Enticott J, Bennie JA, Biddle SJH. Equity of a government subsidised exercise referral scheme: A population study. Soc Sci Med 2018; 216:20-25. [PMID: 30245303 DOI: 10.1016/j.socscimed.2018.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/23/2018] [Accepted: 09/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health inequities could increase if utilisation of physical activity interventions is lower among socioeconomically disadvantaged groups. We examined associations between area level socioeconomic disadvantage and utilisation of Australian government-subsidised, general practitioner (GP)-referred, accredited exercise physiologist (AEPs) services. METHODS We conducted a cross-sectional analysis of Australian Medical Benefits Scheme (MBS) data (N = 228,771 AEP services) for the 2015-2016 financial year and aggregated publicly available data from several sources. Spearman's correlations examined associations between utilisation of AEP services and area-level socioeconomic disadvantage, indicated by Index of Relative Socioeconomic Disadvantage (IRSD) decile scores. Lower IRSD scores indicate greater levels of socioeconomic disadvantage. RESULTS Significant correlations between IRSD score and study variables were as follows: Out-of-pocket expenses/service (rs = 0.52); number of patients/AEP provider (rs = -0.42); number of patients/1000 population (rs = -0.24); AEP services/1000 population (rs = -0.18); average services/patient (rs = 0.24); and AEP provider/1000 population (rs = 0.14). CONCLUSION Patients living in areas of greater disadvantage utilised government-subsidised, GP-referred AEP services at a higher rate and paid lower out-of-pocket fees than those living in more affluent areas. Thus, AEP services are equitably distributed, from a utilisation perspective, and acceptable to patients living in areas of disadvantage. However, the higher caseloads and lower fees that characterise AEP services in areas of greater disadvantage may result in shorter consultation times. Further research on exercise referral schemes is warranted, particularly whether socioeconomic disadvantage is associated with adherence to exercise sessions and health outcomes.
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Affiliation(s)
- Melinda Craike
- Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia; Australian Health Policy Collaboration (AHPC), Australia.
| | - Glen Wiesner
- Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia
| | - Joanne Enticott
- Department of General Practice, Monash University, Melbourne, Australia; Southern Synergy, Department of Psychiatry, Monash University, Melbourne, Australia
| | - Jason A Bennie
- Physically Active Lifestyles Research Group (USQ PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia
| | - Stuart J H Biddle
- Physically Active Lifestyles Research Group (USQ PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia
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Malcolm MP, Atler KE, Schmid AA, Klinedinst TC, Grimm LA, Marchant TP, Marchant DR. Relating Activity and Participation Levels to Glycemic Control, Emergency Department Use, and Hospitalizations in Individuals With Type 2 Diabetes. Clin Diabetes 2018; 36:232-243. [PMID: 30078943 PMCID: PMC6053842 DOI: 10.2337/cd17-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IN BRIEF Participation in domestic, leisure, work, and community-based activities may relate to glycemic control, emergency department use, and hospitalizations in individuals with type 2 diabetes and low socioeconomic status. This study sought to determine how such role-related activity levels relate to A1C, emergency department use, and hospitalizations.
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Affiliation(s)
- Matt P. Malcolm
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO
- Colorado School of Public Health, Colorado State University, Fort Collins, CO
| | - Karen E. Atler
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO
| | - Arlene A. Schmid
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO
| | - Tara C. Klinedinst
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO
| | - Laura A. Grimm
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO
| | - Tasha P. Marchant
- University of Colorado Health, Family Medicine Center, Fort Collins, CO
| | - David R. Marchant
- University of Colorado Health, Family Medicine Center, Fort Collins, CO
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How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review. Transl Behav Med 2018; 7:751-772. [PMID: 28589531 DOI: 10.1007/s13142-017-0502-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although regular physical activity (PA) is a cornerstone of treatment for type 2 diabetes (T2D), most adults with T2D are sedentary. Randomized controlled trials (RCTs) have proven the effectiveness of PA behavioral interventions for adults with T2D but have rarely been conducted in healthcare settings. We sought to identify PA interventions that are effective and practical to implement in clinical practice settings. Our first aim was to use the valid Pragmatic-Explanatory Continuum Indicator Summary 2 (PRECIS-2) tool to assess the potential for future implementation of PA interventions in clinical practice settings. Our second aim was to identify interventions that effectively increased PA and glycemic control among the interventions in the top tertile of PRECIS-2 scores. We searched PubMed MEDLINE from January 1980 through May 2015 for RCTs of behavioral PA interventions coordinated by clinical practices for patients with T2D. Dual investigators assessed pragmatism by PRECIS-2 scores, and study effectiveness was extracted from original RCT publications. The PRECIS-2 scores of the 46 behavioral interventions (n = 13,575 participants) ranged from 3.0 to 4.8, where 5 is the most pragmatic score. In the most pragmatic tertile of interventions (n = 16) by PRECIS-2 scores, 30.8 and 31.3% of interventions improved PA outcomes and hemoglobin A1c, respectively. A minority of published evidence-based PA interventions for adults with T2D were both effective and pragmatic for clinical implementation. These should be tested for dissemination using implementation trial designs.
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Hemmati Maslakpak M, Razmara S, Niazkhani Z. Effects of Face-to-Face and Telephone-Based Family-Oriented Education on Self-Care Behavior and Patient Outcomes in Type 2 Diabetes: A Randomized Controlled Trial. J Diabetes Res 2017; 2017:8404328. [PMID: 29359166 PMCID: PMC5735644 DOI: 10.1155/2017/8404328] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Education of patients and their families is the cornerstone of effective diabetes care. The present study aimed to compare the effects of a face-to-face and telephone-based family-oriented educational program on self-care behavior and patient outcomes in type 2 diabetes patients. METHODS In the present randomized controlled trial, 90 type 2 diabetes patients were randomly divided into three groups of 30 participants: a face-to-face education group, a telephone-based education group, and a control group. The educational program lasted for 3 months. Outcomes evaluated included self-care, fasting blood sugar, hemoglobin A1c, cholesterol, and triglyceride. RESULTS The overall self-care scores in the intervention groups were significantly higher than that in the control group (P = 0.0001). In addition, lipid profiles significantly improved in the interventions compared to the control (P < 0.05). Comparing the two interventions showed better results for the face-to-face group regarding dietary adherence and physical activity, but the latter group had comparable results in blood glucose monitoring, foot care, and cholesterol level. CONCLUSIONS This study shows the beneficiary effects of a family-oriented education on self-care and patient outcomes. It also shows the potential value of low-cost telephone technology in delivering effective diabetes care.
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Affiliation(s)
- Masumeh Hemmati Maslakpak
- Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Department of Medical Surgical Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Somaieh Razmara
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
- Nursing Department, Nursing and Midwifery Faculty, Urmia University of Medical Sciences, Urmia, Iran
| | - Zahra Niazkhani
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
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Interleukin-6 increases the expression and activity of insulin-degrading enzyme. Sci Rep 2017; 7:46750. [PMID: 28429777 PMCID: PMC5399448 DOI: 10.1038/srep46750] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/21/2017] [Indexed: 12/23/2022] Open
Abstract
Impairment of the insulin-degrading enzyme (IDE) is associated with obesity and type 2 diabetes mellitus (T2DM). Here, we used 4-mo-old male C57BL/6 interleukin-6 (IL-6) knockout mice (KO) to investigate the role of this cytokine on IDE expression and activity. IL-6 KO mice displayed lower insulin clearance in the liver and skeletal muscle, compared with wild type (WT), due to reduced IDE expression and activity. We also observed that after 3-h incubation, IL-6, 50 and 100 ng ml−1, increased the expression of IDE in HEPG2 and C2C12 cells, respectively. In addition, during acute exercise, the inhibition of IL-6 prevented an increase in insulin clearance and IDE expression and activity, mainly in the skeletal muscle. Finally, IL-6 and IDE concentrations were significantly increased in plasma from humans, after an acute exercise, compared to pre-exercise values. Although the increase in plasma IDE activity was only marginal, a positive correlation between IL-6 and IDE activity, and between IL-6 and IDE protein expression, was observed. Our outcomes indicate a novel function of IL-6 on the insulin metabolism expanding the possibilities for new potential therapeutic strategies, focused on insulin degradation, for the treatment and/or prevention of diseases related to hyperinsulinemia, such as obesity and T2DM.
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Abstract
BACKGROUND The majority of patients with overweight and type 2 diabetes show insufficient levels of daily physical activity (PA) and usually are among the least likely to engage in or adhere to any form of generic PA. Active video games (exergames) may be a solution to motivate these individuals to overcome their sedentary lifestyle. OBJECTIVES This systematic review was conducted to review the current evidence for the effectiveness of exergaming in overweight and type 2 diabetes mellitus and thus to evaluate the suitability of these games to be used as tools for exercise promotion that meet current PA guidelines. METHODS We searched electronic bibliographic databases (PubMed, Embase, Web of Science, OpenGrey, and the Cochrane Central Register of Controlled Trials) up to March 2015. Randomized controlled trials (RCT) and cross-sectional studies published in English in a peer-reviewed journal and analyzing the effects of exergames on objectively measured intensity parameters of PA in overweight (body mass index [BMI] ≥25 kg/m(2)) adults (mean age ≥18 years) with and without type 2 diabetes were included. Study selection, data extraction, and quality assessment were performed independently by two review authors. Primary outcomes included changes in oxygen uptake (VO2), energy expenditure (EE), heart rate (HR), or activity counts. Secondary outcomes were enjoyment of treatment, exercise adherence, ratings of perceived exertion (RPE), changes in body composition, and changes in blood parameters (serum glucose, long-term blood glucose, blood cholesterol, triglycerides, or serum lactate). RESULTS Of 2845 records, 14 publications (11 studies) met the inclusion criteria. All included studies (ten experimental, cross-sectional laboratory studies and one RCT) were able to show increases in either VO2, EE, HR, or activity counts. However, effects of exergaming in terms of changes in these intensity parameters varied significantly between game modes and consoles as well as because of the vastly differing durations of exergame activity between studies. One of the included studies had a low risk of bias, and three had a high risk of bias; seven studies had an unclear risk of bias as the study description was insufficient. No studies were found investigating the changes in objectively measured PA intensity parameters in patients with type 2 diabetes. CONCLUSION This review suggests that exergames are able to increase PA among overweight individuals. However, the inconsistent results and the overall poor or moderate methodological quality do not permit judgment on whether exergames are suitable to meet PA guidelines in this target group. The lack of research regarding the effects of exergames in type 2 diabetes indicates a great need for future research.
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Advika TS, Idiculla J, Kumari SJ. Exercise in patients with Type 2 diabetes: Facilitators and barriers - A qualitative study. J Family Med Prim Care 2017; 6:288-292. [PMID: 29302534 PMCID: PMC5749073 DOI: 10.4103/2249-4863.219998] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Diabetes is a major noncommunicable disease affecting more than 65 million Indians. Although treatment algorithms suggest lifestyle measures (diet and exercise) along with medications data regarding adherence to exercise as well as facilitators and barriers to the practice of physical activity in such patients are limited. Hence, this qualitative study was conducted. OBJECTIVES The objective of this study is to describe the factors which (1) Facilitated and (2) hindered the practice of regular exercise in patients with Type 2 diabetes. METHODOLOGY The study was conducted on 13 diabetic patients admitted to a tertiary care center in Bengaluru - St. John's Medical College Hospital, to explore factors that acted as facilitators and barriers to physical activity. Data saturation with the coded themes was achieved on interviewing 13 patients, after which, thematic analysis was done, and final themes reported. RESULTS The age of the study participants (7 males, 6 females) ranged from 40 to 80 years. Among those who did exercise, factors such as awareness regarding the benefits of exercise and complications linked with diabetes, positive family support, and emphasis by nursing staff emerged as facilitators. Lack of time, obligations to others, inability to link exercise with blood sugar control, lack of perception of obesity as a health issue, inadequate emphasis by physicians, social/cultural issues, lack of infrastructure, and physical restriction were the factors that acted as barriers to physical activity. In addition to the above, a clear lack of adherence to standard guidelines, while advising patients by physicians was also noted. CONCLUSION A comprehensive approach by both doctors and nurses, based on standard guidelines, could help in implementing adherence to exercise in patients with diabetes.
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Affiliation(s)
- T. S. Advika
- Department of Medicine, St John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Jyothi Idiculla
- Department of Medicine, St John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - S. Jaya Kumari
- Department of Biochemistry, St John's Medical College and Hospital, Bengaluru, Karnataka, India
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Halbert CH, McDonald JA, Magwood G, Jefferson M. Beliefs about Genetically Targeted Care in African Americans. J Natl Med Assoc 2017; 109:98-106. [PMID: 28599763 DOI: 10.1016/j.jnma.2017.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We examined beliefs about genetically targeted care (GTC) among African American men and women in a hospital-based sample and identified sociodemographic, cultural, and clinical factors having significant independent associations with these beliefs. Specifically, beliefs about GTC were evaluated after respondents were randomly primed with a racial or non-racial cue about race and genetics. Despite priming with a racial or non-racial cue, many respondents had positive beliefs about GTC. But, 49% believed that GTC would limit access to medical treatment, 46% believed that people will not trust GTC, and 20% believed that people like them would not benefit from GTC. Racial and non-racial priming did not have significant associations with negative beliefs about GTC. However, cultural beliefs related to temporal orientation were associated significantly with believing that genetically targeted care will limit access to medical treatment. Greater levels of future temporal orientation were associated with a reduced likelihood of endorsing this belief (OR = 0.70, 95% CI = 0.49, 1.01, p = 0.05). Respondents who had a chronic medical condition had an almost three-fold greater likelihood of believing that they would not benefit from GTC (OR = 2.90, 95% CI = 1.00, 8.37, p = 0.05). Greater exposure to information about genetic testing for chronic conditions was also associated with a reduced likelihood of believing that they would not benefit from GTC (OR = 0.40, 95% CI = 0.64, 0.91, p = 0.02). African Americans have diverse beliefs about GTC that should be considered as genetic and genomic services are offered.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Health Equity and Rural Outreach Center, Ralph H. Johnson Department of Medical Affairs, Charleston, SC, USA.
| | - Jasmine A McDonald
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Höchsmann C, Walz SP, Schäfer J, Holopainen J, Hanssen H, Schmidt-Trucksäss A. Mobile Exergaming for Health-Effects of a serious game application for smartphones on physical activity and exercise adherence in type 2 diabetes mellitus-study protocol for a randomized controlled trial. Trials 2017; 18:103. [PMID: 28264717 PMCID: PMC5339965 DOI: 10.1186/s13063-017-1853-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/17/2017] [Indexed: 12/25/2022] Open
Abstract
Background Exergaming is a novel approach to increase motivation for regular physical activity (PA) among sedentary individuals such as patients with type 2 diabetes mellitus (T2DM). Because existing exergames do not offer fitness-level adjusted, individualized workouts and are normally stationary (TV bound), thus not enabling PA anywhere and at any time, we developed a smartphone-based, game-like software application (MOBIGAME) specifically designed for middle-aged T2DM patients to induce a healthier, more active lifestyle as part of successful T2DM treatment and management. In a randomized controlled trial we aim to examine whether our smartphone-based game application can lead to increases in daily PA in T2DM patients that are persistent in the mid to long term and whether these increases are greater than those in a control group. Methods This study is designed as a randomized controlled trial. We plan to recruit a total of 42 T2DM patients [45-70 years, body mass index (BMI) ≥25 kg/m2, low daily PA, regular smartphone use]. The experimental intervention (duration 24 weeks) includes individualized multidimensional home-based exercise and daily PA promotion administered through MOBIGAME. The control intervention consists of a one-time standard lifestyle counseling including the promotion of baseline activities. The primary outcome is daily PA measured as steps per day. Secondary outcome is exercise adherence measured via the usage data from the participants’ smartphones (experimental intervention) and as self-recorded exercise log entries (control intervention). We will test the hypothesis that there will be differences between the experimental and control group with respect to post-interventional daily PA (as well as all other outcomes) using analysis of covariance. For each analysis, an estimate (with 95% confidence interval) of the difference in outcome between both groups will be reported. Discussion This research will investigate the effectiveness of a novel smartphone-based, game-like software application to be used as a way to promote regular daily PA among inactive T2DM patients. The results of this trial may have important implications for future PA-promoting interventions and provide relevant information for the general transferability of such applications to be used as part of the treatment in other chronic diseases. Trial registration ClinicalTrials.gov, NCT02657018. Registered on 11 January 2016. Last status update on 3 May 2016. Kofam.ch, SNCTP-number:SNCTP000001652. Registered on 21 January 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1853-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Höchsmann
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | | | - Juliane Schäfer
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | | | - Henner Hanssen
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
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Miller EG, Nowson CA, Dunstan DW, Kerr DA, Solah V, Menzies D, Daly RM. Recruitment of older adults with type 2 diabetes into a community-based exercise and nutrition randomised controlled trial. Trials 2016; 17:467. [PMID: 27669823 PMCID: PMC5037626 DOI: 10.1186/s13063-016-1589-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recruitment of participants into long-term community-based lifestyle intervention trials, particularly adults with a chronic disease, is often slow and challenging. Currently there is limited data on successful recruitment strategies suitable for older adults with type 2 diabetes into community-based exercise and nutrition programs, and no information on cost estimates associated with such recruitment. The aim of this report is to describe the recruitment strategies used and the success of each approach in recruiting older adults with type 2 diabetes into a 6-month community-based exercise and nutritional supplementation randomised controlled trial (RCT). A secondary aim is to assess the costs associated with the recruitment methods used. METHODS The Resistance Exercise, Vitamin D and Muscle Protein Intervention Trial (REVAMP-IT) for type 2 diabetes is a 24-week RCT targeting 202 adults with type 2 diabetes which is designed to evaluate whether post-exercise ingestion of a whey- protein and vitamin D-enriched drink can enhance the effects of progressive resistance training (PRT) on glycaemic control, body composition and cardiometabolic health. Participants in this trial were randomly allocated to either: (1) the Lift for Life® community-based PRT program combined with additional whey protein and vitamin D, or (2) the Lift for Life® PRT program alone. Recruitment strategies included state and local newspaper and radio advertisements, targeted mail-outs, doctor and allied health referrals, community presentations, web-based media and word of mouth. The number of expressions of interest, participants screened and included in the trial, and how they first heard about the study were recorded by research staff during the screening process. Reasons for ineligibility or non-participation in the trial were also recorded as was the cost of each recruitment method used. RESULTS A total of 1157 expressions of interest were received over a 21-month recruitment period. Overall 959 (83 %) individuals were screened and found to be ineligible for the trial or chose not to participate or could not be contacted further following their initial enquiry. As a result, 198 participants were randomised to the 24-week intervention. The most effective recruitment strategies were targeted mass mail-outs (39 % of the total participant sample), state (27 %) and local (14 %) print media. In total recruitment expenditure was AUD$40,421, which equated to AUD$35 per enquiry and AUD$204 per eligible participant. Targeted mail-outs and state print media were the most expensive strategies each accounting for 38 % of total expenditure. CONCLUSIONS To recruit around 200 older adults with type 2 diabetes into a community-based lifestyle intervention trial in a timely manner, it is important to ensure that an adequate budget is allocated to recruitment as targeted mail-outs and state/local print media were the most costly but effective strategies. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry reference ACTRN12613000592741 . Registered on 27 May 2013.
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Affiliation(s)
- Eliza G Miller
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - David W Dunstan
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Deborah A Kerr
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Vicky Solah
- School of Public Health, Curtin University, Perth, WA, Australia
| | | | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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Bennetter KE, Clench-Aas J, Raanaas RK. Sense of mastery as mediator buffering psychological distress among people with diabetes. J Diabetes Complications 2016; 30:839-44. [PMID: 27085604 DOI: 10.1016/j.jdiacomp.2016.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
AIMS The purpose of this study was to examine the association between diabetes with or without other comorbid somatic diseases and depression and anxiety, and to explore the mediating role of sense of mastery and social support. METHODS Data were obtained from a cross-sectional health survey conducted in Norway (n=6827). People with diabetes alone or with simultaneous comorbid somatic diseases were compared to a group with no known somatic diseases. RESULTS Among people with diabetes alone, 16.3% reported having depression and anxiety. Having diabetes was associated with 3 times greater odds for anxiety compared to the control group, and 2 times greater odds for depression. Among individuals with diabetes and comorbid somatic diseases, 17.4% reported depression and 11.6% reported symptoms of anxiety. The odds for both were approximately 2 times greater than in the control group. Sense of mastery, but not social support, protected against depression in both groups and against anxiety in the diabetes with comorbidity group. CONCLUSIONS Comorbidity between diabetes and other somatic diseases seems to be related to depression to a larger degree, whereas having diabetes alone relates more to anxiety. This can possibly be explained by the overall burden in the comorbidity group and the related absence of sense of mastery.
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MESH Headings
- Adolescent
- Adult
- Aged
- Anxiety/complications
- Anxiety/epidemiology
- Anxiety/etiology
- Anxiety/prevention & control
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/psychology
- Cross-Sectional Studies
- Depression/complications
- Depression/epidemiology
- Depression/etiology
- Depression/prevention & control
- Diabetes Complications/epidemiology
- Diabetes Complications/prevention & control
- Diabetes Complications/psychology
- Diabetes Complications/therapy
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Female
- Health Surveys
- Humans
- Male
- Middle Aged
- Norway/epidemiology
- Prevalence
- Retrospective Studies
- Risk Factors
- Self Concept
- Self Report
- Self-Management/psychology
- Social Support
- Stress, Psychological/complications
- Stress, Psychological/epidemiology
- Stress, Psychological/etiology
- Stress, Psychological/prevention & control
- Young Adult
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Affiliation(s)
- Karin Elisabeth Bennetter
- Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, Norway
| | | | - Ruth Kjærsti Raanaas
- Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, Norway.
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Cardiorespiratory Exertion While Playing Video Game Exercises in Elderly Individuals With Type 2 Diabetes. Clin J Sport Med 2016; 26:326-31. [PMID: 26513387 DOI: 10.1097/jsm.0000000000000258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the suitability of the Wii Fit Plus exergame as a tool to improve cardiorespiratory fitness in individuals with type 2 diabetes. DESIGN Experimental cross-sectional study. SETTING Controlled laboratory. PARTICIPANTS Twelve type 2 diabetic patients (10 male and 2 female; age, 60.2 ± 7.7 years; body mass index, 30.9 ± 6.2 kg/m). INTERVENTIONS At baseline, all participants underwent an all-out cardiopulmonary exercise test on a treadmill to assess peak and average oxygen consumption (V[Combining Dot Above]O2peak and V[Combining Dot Above]O2mean). Forty-eight to 72 hours after the cardiopulmonary exercise test, the same parameters were assessed during three 10-minute bouts of Wii Fit Plus exergaming and converted to percentage of treadmill V[Combining Dot Above]O2peak (%V[Combining Dot Above]O2peak). MAIN OUTCOME MEASURES V[Combining Dot Above]O2peak and V[Combining Dot Above]O2mean during Wii Fit Plus play relative to V[Combining Dot Above]O2peak achieved during the cardiopulmonary exercise test. RESULTS All Wii Fit Plus exercises generated a V[Combining Dot Above]O2peak of around 60% and V[Combining Dot Above]O2mean of around 40% of the V[Combining Dot Above]O2peak as established during the cardiopulmonary exercise test. Mean heart rate and resting energy expenditure (respiratory exchange ratio) lay in a range of moderate aerobic exercise. A moderate-to-strong correlation between treadmill V[Combining Dot Above]O2peak and both exergame V[Combining Dot Above]O2peak and exergame V[Combining Dot Above]O2mean was found. CONCLUSIONS Video gaming has the potential to offer training intensities that concur with established guidelines for type 2 diabetic patients. The training intensity is self-adjusting based on fitness level allowing for an effective workout for different users.
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Catalogna M, Fishman S, Halpern Z, Ben-Shlomo S, Nevo U, Ben-Jacob E. Regulation of glucose dynamics by noninvasive peripheral electrical stimulation in normal and insulin-resistant rats. Metabolism 2016; 65:863-73. [PMID: 27173465 DOI: 10.1016/j.metabol.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/25/2016] [Accepted: 03/09/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The epidemic nature of type 2 diabetes mellitus (T2DM), along with the downsides of current treatments, has raised the need for therapeutic alternatives. METHODS We studied normo-glycemic and high-fat diet (HFD), induced insulin-resistant Wistar Han rats for 2 to 3weeks. Rats received peripheral electrical stimulation (PES) treatment (2Hz/16Hz bursts, 10mA) in their hind limbs for 3min, 3 times per week. Glucose tolerance was evaluated by using a glucose tolerance test at the beginning and again at the end of the study. The effect of an acute PES treatment on metabolic rates of glucose appearance and turnover was measured by using the hyperinsulinemic-euglycemic clamp (HEGC) test. RESULTS Repeated PES treatment significantly inhibited the progression of glucose intolerance in normal and insulin-resistant rats and prevented HFD-induced gains in body weight and fat mass. Acute treatment induced a prolonged effect on glucose turnover, as evaluated by the HEGC test. Increased hepatic glucose output was observed during the basal state (P<0.005). Under hyperinsulinemic conditions, PES improved tissue sensitivity to insulin (41.1%, P<0.01), improved suppression of hepatic glucose production (58.9±4.4% vs. 87.1±4.4%, P<0.02) and significantly elevated the rate of glycogenesis (P<0.01), compared with controls. CONCLUSIONS The present study indicates that a noninvasive PES treatment of very short duration is sufficiently potent to stimulate glucose utilization and improve hepatic insulin sensitivity in rats. Repeated PES treatment may have a beneficial effect on HFD-induced adiposity and control of body weight.
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Affiliation(s)
- Merav Catalogna
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
| | - Sigal Fishman
- Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv, Israel
| | - Zamir Halpern
- Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv, Israel
| | - Shani Ben-Shlomo
- Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv, Israel
| | - Uri Nevo
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel.
| | - Eshel Ben-Jacob
- School of Physics and Astronomy, Raymond & Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Israel; Center for Theoretical Biological Physics, Rice University, Houston, TX, USA
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Akter S, Rahman MM, Abe SK, Sultana P. Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey. Bull World Health Organ 2014; 92:204-13, 213A. [PMID: 24700980 DOI: 10.2471/blt.13.128371] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/17/2013] [Accepted: 11/19/2013] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors. METHODS Sociodemographic and anthropometric data and data on blood pressure and blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities. FINDINGS The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence. CONCLUSION Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.
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Affiliation(s)
- Shamima Akter
- Department of Epidemiology and Prevention, Clinical Research Center, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo 162-8655, Japan
| | - M Mizanur Rahman
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Sarah Krull Abe
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Papia Sultana
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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SCHNEIDER KRISTINL, ANDREWS CHRISTOPHER, HOVEY KATHLEENM, SEGUIN REBECCAA, MANINI TODD, LAMONTE MICHAELJ, MARGOLIS KARENL, WARING MOLLYE, NING YI, SIMS STACY, MA YUNSHENG, OCKENE JUDITH, STEFANICK MARCIAL, PAGOTO SHERRYL. Change in physical activity after a diabetes diagnosis: opportunity for intervention. Med Sci Sports Exerc 2014; 46:84-91. [PMID: 23860414 PMCID: PMC4028702 DOI: 10.1249/mss.0b013e3182a33010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Moderate-intensity physical activity is recommended for individuals with diabetes to control glucose and prevent diabetes-related complications. The extent to which a diabetes diagnosis motivates patients to increase physical activity is unclear. This study used data from the Women's Health Initiative Observational Study (baseline data collected from 1993 to 1998) to examine change in physical activity and sedentary behavior in women who reported a diabetes diagnosis compared with women who did not report diabetes during 7 yr of follow-up (up to 2005). METHODS Participants (n = 84,300) were postmenopausal women who did not report diabetes at baseline (mean ± SD; age = 63.49 ± 7.34 yr; body mass index = 26.98 ± 5.67 kg·m). Linear mixed-model analyses were conducted adjusting for study year, age, race/ethnicity, body mass index, education, family history of diabetes, physical functioning, pain, energy/fatigue, social functioning, depression, number of chronic diseases, and vigorous exercise at age 18 yr. Analyses were completed in August 2012. RESULTS Participants who reported a diabetes diagnosis during follow-up were more likely to report increasing their total physical activity (P = 0.002), walking (P < 0.001), and number of physical activity episodes (P < 0.001) compared with participants who did not report a diabetes diagnosis. On average, participants reporting a diabetes diagnosis reported increasing their total physical activity by 0.49 MET·h·wk, their walking by 0.033 MET·h·wk, and their number of physical activity episodes by 0.19 MET·h·wk. No differences in reported sedentary behavior change were observed (P = 0.48). CONCLUSIONS A diabetes diagnosis may prompt patients to increase physical activity. Healthcare professionals should consider how best to capitalize on this opportunity to encourage increased physical activity and maintenance.
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Affiliation(s)
- KRISTIN L. SCHNEIDER
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - CHRISTOPHER ANDREWS
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - KATHLEEN M. HOVEY
- Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY
| | | | - TODD MANINI
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL
| | - MICHAEL J. LAMONTE
- Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY
| | - KAREN L. MARGOLIS
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - MOLLY E. WARING
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - YI NING
- Department of Epidemiology and Community Health, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - STACY SIMS
- Department of Medicine, Stanford University, Stanford, CA
| | - YUNSHENG MA
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - JUDITH OCKENE
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | | | - SHERRY L. PAGOTO
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
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Bagnasco A, Di Giacomo P, Da Rin Della Mora R, Catania G, Turci C, Rocco G, Sasso L. Factors influencing self-management in patients with type 2 diabetes: a quantitative systematic review protocol. J Adv Nurs 2013; 70:187-200. [PMID: 23763567 DOI: 10.1111/jan.12178] [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] [Accepted: 05/04/2013] [Indexed: 12/11/2022]
Abstract
AIM To describe a protocol for a quantitative systematic review, to identify critique and summarize factors that influence self-management education. BACKGROUND Self-management education enables patients to manage their condition successfully and it is associated with better self-care, good control over lifestyle and leading the best possible quality of life, notwithstanding the presence of a chronic disease. Type II Diabetes is a chronic disease that requires lifestyle adjustments and disease management to keep glycaemia and long-term complications under control. Education has to be customized and based on an assessment that includes factors influencing self-management, such as personal characteristics that can optimize the educational intervention. DESIGN The protocol for the systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination, York (UK). METHOD The review question was defined in terms of population, interventions, comparators, outcomes and study designs. The protocol included decisions about the review question, inclusion criteria, search strategy, study selection, data extraction, quality assessment, data synthesis and plans for dissemination. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome. DISCUSSION An initial summary will be made by tabulating the data; the review will be reported in a narrative style and be developed according to the PRISMA guidelines. The protocol for the systematic review will allow us to identify, among the factors influencing self-management in people with Type II diabetes, the personal characteristics most relevant to the factors of motivation and empowerment. In addition, the systematic review will also identify an appropriate self-management model.
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Affiliation(s)
| | | | | | | | - Carlo Turci
- Member of the Centre of Excellence for Nursing Scholarship, Rome, Italy
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship, President Ipasvi Rome Nursing Board, Rome, Italy
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Kim KH, Kim SH, Min YK, Yang HM, Lee JB, Lee MS. Acute exercise induces FGF21 expression in mice and in healthy humans. PLoS One 2013; 8:e63517. [PMID: 23667629 PMCID: PMC3646740 DOI: 10.1371/journal.pone.0063517] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 04/04/2013] [Indexed: 01/12/2023] Open
Abstract
Fibroblast growth factor 21 (FGF21) plays an important role in the regulation of energy homeostasis during starvation and has an excellent therapeutic potential for the treatment of type 2 diabetes in rodents and monkeys. Acute exercise affects glucose and lipid metabolism by increasing glucose uptake and lipolysis. However, it is not known whether acute exercise affects FGF21 expression. Here, we showed that serum FGF21 level is increased in mice after a single bout of acute exercise, and that this is accompanied by increased serum levels of free fatty acid, glycerol and ketone body. FGF21 gene expression was induced in the liver but not in skeletal muscle and white adipose tissue of mice after acute exercise, and further, the gene expression levels of hepatic peroxisome proliferator-activated receptor α (PPARα) and activating transcription factor 4 (ATF4) were also increased. In addition, we observed increased FGF21 level in serum of healthy male volunteers performing a treadmill run at 50 or 80% VO2max. These results suggest that FGF21 may also be associated with exercise-induced lipolysis in addition to increased catecholamines and reduced insulin.
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Affiliation(s)
- Kook Hwan Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul, Korea
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul, Korea
| | - Seong Hun Kim
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul, Korea
| | - Young-Ki Min
- Department of Physiology, College of Medicine, Soonchunhyang University, 366-1 Ssang yong-dong, Cheonan, Korea
| | - Hun-Mo Yang
- Department of Physiology, College of Medicine, Soonchunhyang University, 366-1 Ssang yong-dong, Cheonan, Korea
| | - Jeong-Beom Lee
- Department of Physiology, College of Medicine, Soonchunhyang University, 366-1 Ssang yong-dong, Cheonan, Korea
- * E-mail: (J-BL); (M-SL)
| | - Myung-Shik Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul, Korea
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul, Korea
- * E-mail: (J-BL); (M-SL)
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Psychometric properties of the Perceived Therapeutic Efficacy Scale for adhering to a cholesterol-lowering diet. J Cardiovasc Nurs 2013; 29:257-63. [PMID: 23612039 DOI: 10.1097/jcn.0b013e31828f910f] [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: 11/26/2022]
Abstract
BACKGROUND Outcome expectancy may play an important role in behavior change. Previous studies tested the validity and the reliability of the Perceived Therapeutic Efficacy Scale (PTES), a scale that measures outcome expectancy related to adhering to a cholesterol-lowering diet. Further study was needed to examine its psychometric properties in a larger sample. OBJECTIVE The aim of this study was to test the psychometric properties of the 10-item PTES in a large sample. METHODS The PTES and the Connor Diet Habit Survey were administered to adults enrolled in a cardiac rehabilitation program. RESULTS The final sample for the analysis (N = 224) was, on average, 69.35 years old and was predominantly men (66.50%) and white (92.40%); nearly all (96.00%) completed high school. The inter-item correlation matrix revealed that correlation coefficients were greater than 0.80 between 4 pairs of items, suggesting that the 4 items were redundant. After consulting with a content expert and an examination of item content, we removed the 4 redundant items (items 2, 3, 4, and 10) and reduced the scale to 6 items. Principal component analysis revealed a 1-factor scale with high loadings for the 6 items, each greater than 0.70. The reliability of the scale, measured by Cronbach's α, was 0.91. The total PTES score had a moderate correlation with self-reported behaviors of adhering to a cholesterol-lowering diet, as measured by the Connor Diet Habit Survey subscale for cholesterol and fat intake (r = 0.36, P < 0.05). CONCLUSIONS This study demonstrated that the revised and shortened PTES scale is reliable and valid to measure outcome expectancy related to adhering to a cholesterol-lowering diet.
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Großschädl F, Titze S, Burkert N, Stronegger WJ. Moderate- and vigorous-intensity exercise behaviour according to the Transtheoretical Model: associations with smoking and BMI among Austrian adults. Wien Klin Wochenschr 2013; 125:270-8. [PMID: 23595523 DOI: 10.1007/s00508-013-0361-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/20/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Regular physical activity leads to a number of physiological benefits, such as reduced risk of coronary heart disease, diabetes mellitus and obesity. In Austria, there is little information about the prevalence of physically inactive people, as well as about who is more likely to belong to the inactive or irregularly active groups. The aim of this study is to describe the socio-demographic distributions across the stages of behavioural change for moderate- and vigorous-intensity physical activity, according to the Transtheoretical Model, and to identify associations with smoking and body mass index (BMI). METHOD Data were collected in a standardised procedure using a self-report questionnaire from 489 adults who attended a health check in an outpatient clinic in southern Austria. Height and weight were measured by physicians. The subjects were categorised into the five stages of change (pre-contemplation, contemplation, preparation, action, maintenance), separately assessed for moderate- and vigorous-intensity physical activity. RESULTS The likelihood of being in the stage of maintenance of moderate-intensity physical activity was highest in older subjects (p < 0.05). Participants of a high educational level showed the highest likelihood of being physically active in vigorous-intensity physical activity (p < 0.05). Furthermore, the lowest stages of change behaviour were associated with higher BMI levels for vigorous-intensity physical activity (p < 0.05). Smokers were significantly (p < 0.05) more likely not to perform vigorous-intensity physical activity than non-smokers. CONCLUSION Our findings contribute to a better understanding of behavioural correlates of regular physical activity. The results may prove useful for developing promotion programmes for physical activity, allowing targeting of the identified risk groups.
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Affiliation(s)
- Franziska Großschädl
- Institute for Social Medicine and Epidemiology, Medical University of Graz, Universitätsplatz 6/I, 8010, Graz, Austria.
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Smith AG, Marcus R. Exercise for diabetic neuropathy: a toe in the therapeutic door. J Diabetes Complications 2012; 26:361-2. [PMID: 22818656 DOI: 10.1016/j.jdiacomp.2012.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 11/16/2022]
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