PSUN337 Evaluation of Intensive Behavioral Therapy as a Tool to Combat Obesity in a Rural Outpatient Endocrinology Clinic

Introduction

The prevalence of obesity in the United States has risen from 30.5% in 2000 to 42.4% in 2018. Given this steep increase and the association of obesity with multiple comorbidities, the focus has now turned to behavioral modifications. In 2011, Medicare began to reimburse providers for intensive behavior therapy (IBT) for obesity.

Background

Medicare beneficiaries with a BMI ≥ 30 kg/ m2 are eligible for IBT. The program at Hamilton Diabetes and Endocrinology Center (HDEC), followed a structure similar to that of the nationwide IBT program. It begins with a nutritional assessment and a personalized lifestyle intervention plan. The program includes 20 visits over a 12-month period. At the six-month point mark, we aim to achieve a target weight loss of 6.6 lbs. A thorough literature review revealed limited data on the outcomes of the program. The purpose of our study is to present data which has shown effectiveness of this program in the rural setting.

Methods

A retrospective cohort study was conducted with data obtained between September 2020 to October 2021. The sample being studied included 96 participants after exclusion of those that were unable to complete the program. The participants were matched based on their baseline demographic characteristics. The outcomes studied were weight in pounds, BMI and HbA1C. Using paired t-tests we compared the change in weight before and after implementation of the program, with BMI and HbA1C as secondary outcomes.

Results

The participants began the IBT program with an initial mean weight of 249.4 lbs. and ended the program with a final mean weight of 244.7 lbs. Comparison of the data using paired t-tests revealed that the change in weight was about 4.7 lbs. (95% confidence interval of 2.9 - 6.6, P <0.001). The change in BMI was 0.8 kg/m2 (95% CI: 0.5–1.1, P <0.001). About 31.25% of our study participants were able to lose more than 6.6 lbs. However, it is pertinent to note that our study was conducted during the time of the pandemic, leading to missed appointments and effects on lifestyle. Despite our limitations, the data revealed a statistically significant difference in weight and BMI at the final visit compared to the initial visit. The HbA1C values were reduced by 0.25%, however this change was not statistically significant (P = 0.185).

Conclusion

Analysis of the IBT program at the HDEC has shown a favorable response. In an ideal world, free of limitations by the pandemic, this program is likely to, achieve an even greater degree of weight loss. This brings about a need for raising awareness within the community. Implementation of IBT programs and promoting lifestyle interventions result in reduction of obesity and therefore lead to an improved quality of life.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Assessment of arterial stiffness in patients with metabolic syndrome in Ecuador: A cross-sectional study

BACKGROUND

Metabolic syndrome increases cardiovascular risk, and causes damage to the vascular wall. Through this mechanism, it might increase arterial rigidity, leading to further complications and heart strain. The use of a device that measures arterial rigidity can help determine if metabolic syndrome is related to a higher vascular stiffness and changes in estimated arterial age.

METHODOLOGY

Cross-sectional study at Luis Vernaza hospital of Guayaquil, Ecuador. Inpatients and outpatients from the Department of Cardiology with a full blood panel and echocardiogram were included. We used the IDF criteria to diagnose metabolic syndrome and measured arterial rigidity parameters in all of them, including augmentation indexes, central blood pressure, pulse wave velocity and arterial age.

RESULTS

95 patients were included for analysis, 44.2% were females and 55.8% were males. Mean age was 61.7 years (±13.1). Metabolic syndrome was diagnosed in 49.5% of our patients and it was significantly more prevalent in women. We found significant differences in PWV, augmentation indexes, and peripheral and central blood pressure between metabolic and non-metabolic syndrome patients. There was a non-significant relationship between estimated arterial age and metabolic syndrome (p=0.32).

CONCLUSION

Patients with metabolic syndrome have an increased arterial rigidity. This, added to the high prevalence of the disease we found in our sample, shows the high cardiovascular risk these patients are at. A multidisciplinary approach to management is needed, along with patient collaboration. The introduction of these devices to measure arterial stiffness in developing countries can improve diagnosis and therapy of patients with cardio-metabolic conditions.

Abstract 214: Arterial Stiffness in Patients with Metabolic Syndrome: a Cross-Sectional Study in Guayaquil, Ecuador

Background: metabolic syndrome (MetS) can chronically affect blood vessels, leading to cardiovascular disease. Techniques that assess arterial rigidity and age such as Arteriograph® can provide insight on blood vessel function. We aimed to evaluate arterial stiffness in patients with MetS.

Methodology: cross-sectional study at Luis Vernaza hospital between November and December 2015. We included patients from the Cardiology Department with a full blood panel. We obtained clinical data for age, gender, history of smoking, hypertension, diabetes, and left ventricular hypertrophy, and measured abdominal girth and blood pressure. Using the Arteriograph®, we measured brachial and central augmentation indexes, central blood pressure, pulse wave velocity (PWV) and arterial age. We retrieved values for triglycerides, HDL, and glycemia from laboratory data. We used IDF criteria to diagnose MetS, but ALAD criteria were used to detect increased abdominal girth. A p value of <0.05 accepted for significance.

Results: 95 patients were selected for analysis. 42 (44.2%) were female and 53 (55.8%) were male, with mean age of 61.7 years (SD 13.1). 58 (61.1%) of our patients had hypertension, 29 (30.5%) had diabetes, and 33 (34.7%) had ventricular hypertrophy. 47 (49.5%) of our patients had MetS. We found significant differences in arterial measurements in MetS vs. non-MetS patients, with higher values in the former (Table 1). We obtained non-significant results for the relationship between arterial age and MetS (p=0.32), even after adjusting for smoking (p=0.28) or ventricular hypertrophy (p=0.71). We found non-significant correlation between age and PWV (p=0.32), and found MetS to be significantly more common in women (p<0.001).

Conclusion: MetS patients have a higher grade of arterial stiffness. Arterial age was not related to MetS, and it was more prevalent in women. Arteriograph® measurements are helpful to improve diagnosis and management of cardiovascular patients.

Prevalence of metabolic syndrome and prediabetes in an urban population of Guayaquil, Ecuador

AIMS

To determine the prevalence of metabolic syndrome and prediabetes in a population of the city of Guayaquil, Ecuador, aged 55-65 years; to observe if there are differences in prevalence between males and females, and to describe the frequency with which each component of the metabolic syndrome is found in this population.

MATERIALS AND METHODS

population-based cross-sectional study in Guayaquil. We recruited people of both genders, with ages ranging from 55 to 65 years. Through clinical history, physical examination and laboratory tests, we obtained necessary data to diagnose metabolic syndrome and/or prediabetes. Statistical analysis was performed using SPSS(®) 22.

RESULTS

we obtained a sample of 213 patients, 64.5% were females and 35.5% were males. Mean age was 60.3 years (±3.1). A total 65.8% of patients had increased waist circumference, and 45% were diagnosed with metabolic syndrome. Hypertriglyceridemia was the most prevalent condition in males, while women more commonly had low HDL. Prediabetes was diagnosed in 45.9% of our patients, and 19.5% had both disorders. There was no significant difference on metabolic syndrome prevalence between genders, but prediabetes was significantly more common in women.

CONCLUSION

we found a high prevalence of metabolic syndrome and prediabetes in Guayaquil, higher than what was reported in other areas. Abdominal obesity is even more prevalent. Women have prediabetes more frequently than men. Our patients, given their age, are at higher risk of cardiovascular disease and cognitive decline by having metabolic syndrome and/or prediabetes.