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Horton E, Johnson B, Vidula M, Kondaveety S, Denduluri S, Segers P, Herrmann HC, Chirinos JA. ARTERIAL PROPERTIES AND VENTRICULAR-ARTERIAL INTERACTIONS IN SEVERE AORTIC STENOSIS: IMPACT ON PROGNOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Cunnings ES, Aboabdo M, McMurtry S, Patil P, Horton E. RECURRENT EMBOLIC STROKES IN A YOUNG PATIENT - A CASE OF LATE TAVR THROMBOSIS AND ENDOCARDITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Tekkis NP, Rafi D, Brown S, Courtney A, Kawka M, Howell AM, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Brown S, Kawka M, Mclean K, Savva N, Wilkinson P, Sam AH, Singal A, Chia C, Chia W, Ganesananthan S, Ooi SZY, Pengelly S, Wellington J, Mak S, Subbiah Ponniah H, Heyes A, Aberman I, Ahmed T, Al-Shamaa S, Appleton L, Arshad A, Awan H, Baig Q, Benedict K, Berkes S, Citeroni NL, Damani A, de Sancha A, Fisayo T, Gupta S, Haq M, Heer B, Jones A, Khan H, Kim H, Meiyalagan N, Miller G, Minta N, Mirza L, Mohamed F, Ramjan F, Read P, Soni L, Tailor V, Tas RN, Vorona M, Walker M, Winkler T, Bardon A, Acquaah J, Ball T, Bani W, Elmasry A, Hussein F, Kolluri M, Lusta H, Newman J, Nott M, Perwaiz MI, Rayner R, Shah A, Shaw I, Yu K, Cairns M, Clough R, Gaier S, Hirani D, Jeyapalan T, Li Y, Patel CR, Shabir H, Wang YA, Weatherhead A, Dhiran A, Renney O, Wells P, Ferguson S, Joyce A, Mergo A, Adebayo O, Ahmad J, Akande O, Ang G, Aniereobi E, Awasthi S, Banjoko A, Bates J, Chibada C, Clarke N, Craner I, Desai DD, Dixon K, Duffaydar HI, Kuti M, Mughal AZ, Nair D, Pham MC, Preest GG, Reid R, Sachdeva GS, Selvaratnam K, Sheikh J, Soran V, Stoney N, Wheatle M, Howarth K, Knapp-Wilson A, Lee KS, Mampitiya N, Masson C, McAlinden JJ, McGowan N, Parmar SC, Robinson B, Wahid S, Willis L, Risquet R, Adebayo A, Dhingra L, Kathiravelupillai S, Narayanan R, Soni J, Ghafourian P, Hounat A, Lennon KA, Abdi Mohamud M, Chou W, Chong L, Graham CJ, Piya S, Riad AM, Vennard S, Wang J, Kawar L, Maseland C, Myatt R, Tengku Saifudin TNS, Yong SQ, Douglas F, Ogbechie C, Sharma K, Zafar L, Bajomo MO, Byrne MHV, Obi C, Oluyomi DI, Patsalides MA, Rajananthanan A, Richardson G, Clarke A, Roxas A, Adeboye W, Argus L, McSweeney J, Rahman-Chowdhury M, Hettiarachchi DS, Masood MT, Antypas A, Thomas M, de Andres Crespo M, Zimmerman M, Dhillon A, Abraha S, Burton O, Jalal AHB, Bailey B, Casey A, Kathiravelupillai A, Missir E, Boult H, Campen D, Collins JM, Dulai S, Elhassan M, Foster Z, Horton E, Jones E, Mahapatra S, Nancarrow T, Nyamapfene T, Rimmer A, Robberstad M, Robson-Brown S, Saeed A, Sarwar Y, Taylor C, Vetere G, Whelan MK, Williams J, Zahid D, Chand C, Matthews M. The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey. Med Teach 2022; 44:574-575. [PMID: 34428109 DOI: 10.1080/0142159x.2021.1962835] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Damir Rafi
- School of Medicine, Imperial College London, London, UK
| | - Sam Brown
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Alona Courtney
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michal Kawka
- School of Medicine, Imperial College London, London, UK
| | - Ann-Marie Howell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kenneth McLean
- Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Matthew Gardiner
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amir H Sam
- School of Medicine, Imperial College London, London, UK
| | - Nicos Savva
- Division of Management Science and Operations, London Business School, London, UK
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- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - T Ball
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - W Bani
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Elmasry
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - F Hussein
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Kolluri
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - H Lusta
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - J Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Nott
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M I Perwaiz
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - R Rayner
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Shah
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - I Shaw
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - K Yu
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | | | | | - S Gaier
- Queen Mary University of London
| | | | | | - Y Li
- Queen Mary University of London
| | | | | | | | | | - A Dhiran
- St George's Hospital Medical School
| | - O Renney
- St George's Hospital Medical School
| | - P Wells
- St George's Hospital Medical School
| | | | - A Joyce
- The Queen's University of Belfast
| | | | | | - J Ahmad
- The University of Birmingham
| | | | - G Ang
- The University of Birmingham
| | | | | | | | - J Bates
- The University of Birmingham
| | | | | | | | | | - K Dixon
- The University of Birmingham
| | | | - M Kuti
- The University of Birmingham
| | | | - D Nair
- The University of Birmingham
| | | | | | - R Reid
- The University of Birmingham
| | | | | | | | - V Soran
- The University of Birmingham
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Soni
- The University of Cambridge
| | | | | | | | | | - W Chou
- The University of East Anglia
| | | | | | - S Piya
- The University of Edinburgh
| | | | | | - J Wang
- The University of Edinburgh
| | | | | | | | | | | | | | | | | | | | | | | | - C Obi
- The University of Leicester
| | | | | | | | | | | | | | | | - L Argus
- The University of Manchester
| | | | | | | | | | | | | | | | | | | | | | | | | | - B Bailey
- University of Brighton and Sussex
| | - A Casey
- University of Brighton and Sussex
| | | | - E Missir
- University of Brighton and Sussex
| | - H Boult
- University of Exeter Medical School
| | - D Campen
- University of Exeter Medical School
| | | | - S Dulai
- University of Exeter Medical School
| | | | - Z Foster
- University of Exeter Medical School
| | - E Horton
- University of Exeter Medical School
| | - E Jones
- University of Exeter Medical School
| | | | | | | | - A Rimmer
- University of Exeter Medical School
| | | | | | - A Saeed
- University of Exeter Medical School
| | - Y Sarwar
- University of Exeter Medical School
| | - C Taylor
- University of Exeter Medical School
| | - G Vetere
- University of Exeter Medical School
| | | | | | - D Zahid
- University of Exeter Medical School
| | - C Chand
- University of Hull and the University of York
| | - M Matthews
- University of Hull and the University of York
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Goldberg RB, Tripputi MT, Boyko EJ, Budoff M, Chen ZZ, Clark JM, Dabelea DM, Edelstein SL, Gerszten RE, Horton E, Mather KJ, Perreault L, Temprosa M, Wallia A, Watson K, Irfan Z. Hepatic Fat in Participants With and Without Incident Diabetes in the Diabetes Prevention Program Outcome Study. J Clin Endocrinol Metab 2021; 106:e4746-e4765. [PMID: 33705543 PMCID: PMC8530730 DOI: 10.1210/clinem/dgab160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT There is little information about fatty liver in prediabetes as it transitions to early diabetes. OBJECTIVE This study is aimed at evaluating the prevalence and determinants of fatty liver in the Diabetes Prevention Program (DPP). METHODS We measured liver fat as liver attenuation (LA) in Hounsfield units (HU) in 1876 participants at ~14 years following randomization into the DPP, which tested the effects of lifestyle or metformin interventions versus standard care to prevent diabetes. LA was compared among intervention groups and in those with versus without diabetes, and associations with baseline and follow-up measurements of anthropometric and metabolic covariates were assessed. RESULTS There were no differences in liver fat between treatment groups at 14 years of follow-up. Participants with diabetes had lower LA (mean ± SD: 46 ± 16 vs 51 ± 14 HU; P < 0.001) and a greater prevalence of fatty liver (LA < 40 HU) (34% vs 17%; P < 0.001). Severity of metabolic abnormalities at the time of LA evaluation was associated with lower LA categories in a graded manner and more strongly in those with diabetes. Averaged annual fasting insulin (an index of insulin resistance [OR, 95% CI 1.76, 1.41-2.20]) waist circumference (1.63, 1.17-2.26), and triglyceride (1.42, 1.13-1.78), but not glucose, were independently associated with LA < 40 HU prevalence. CONCLUSION Fatty liver is common in the early phases of diabetes development. The association of LA with insulin resistance, waist circumference, and triglyceride levels emphasizes the importance of these markers for hepatic steatosis in this population and that assessment of hepatic fat in early diabetes development is warranted.
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Affiliation(s)
- Ronald B Goldberg
- Diabetes Research Institute, Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL 33136USA
- Correspondence: Ronald B Goldberg, MD, Diabetes Research Institute, Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, 1450 Northwest 10th Avenue, Miami, FL 33136 USA.
| | - Mark T Tripputi
- Milken Institute School of Public Health and Health Services, The Biostatistics Center, George Washington University, Rockville, MD 20852USA
| | - Edward J Boyko
- University of Washington, Department of Medicine, Seattle, WA 98108USA
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, Torrance CA 90502USA
| | - Zsu-Zsu Chen
- Division of Endocrinology, Bone, and Metabolism, Beth Israel Deaconess Medical Center, Harvard, Boston, MA 02215, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, The Johns Hopkins University, Baltimore MD 21287USA
| | - Dana M Dabelea
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045USA
| | - Sharon L Edelstein
- Milken Institute School of Public Health and Health Services, The Biostatistics Center, George Washington University, Rockville, MD 20852USA
- Sharon L. Edelstein, ScM, The Biostatistics Center, Milken Institute School of Public Health, The George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA.
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard, Boston, MA 02215, USA
| | | | | | - Leigh Perreault
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045USA
| | - Marinella Temprosa
- Milken Institute School of Public Health and Health Services, The Biostatistics Center, George Washington University, Rockville, MD 20852USA
| | - Amisha Wallia
- Northwestern University Feinberg School of Medicine, Chicago IL 60610USA
| | - Karol Watson
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095USA
| | - Zeb Irfan
- J. W. Ruby Memorial Hospital, Morgantown, WV 26505USA
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Vidula MK, Orlenko A, Zhao L, Salvador L, Small AM, Horton E, Cohen JB, Adusumalli S, Denduluri S, Kobayashi T, Hyman M, Fiorilli P, Magro C, Singh B, Pourmussa B, Greczylo C, Basso M, Ebert C, Yarde M, Li Z, Cvijic ME, Wang Z, Walsh A, Maranville J, Kick E, Luettgen J, Adam L, Schafer P, Ramirez-Valle F, Seiffert D, Moore JH, Gordon D, Chirinos JA. Plasma biomarkers associated with adverse outcomes in patients with calcific aortic stenosis. Eur J Heart Fail 2021; 23:2021-2032. [PMID: 34632675 DOI: 10.1002/ejhf.2361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Enhanced risk stratification of patients with aortic stenosis (AS) is necessary to identify patients at high risk for adverse outcomes, and may allow for better management of patient subgroups at high risk of myocardial damage. The objective of this study was to identify plasma biomarkers and multimarker profiles associated with adverse outcomes in AS. METHODS AND RESULTS We studied 708 patients with calcific AS and measured 49 biomarkers using a Luminex platform. We studied the correlation between biomarkers and the risk of (i) death and (ii) death or heart failure-related hospital admission (DHFA). We also utilized machine-learning methods (a tree-based pipeline optimizer platform) to develop multimarker models associated with the risk of death and DHFA. In this cohort with a median follow-up of 2.8 years, multiple biomarkers were significantly predictive of death in analyses adjusted for clinical confounders, including tumour necrosis factor (TNF)-α [hazard ratio (HR) 1.28, P < 0.0001], TNF receptor 1 (TNFRSF1A; HR 1.38, P < 0.0001), fibroblast growth factor (FGF)-23 (HR 1.22, P < 0.0001), N-terminal pro B-type natriuretic peptide (NT-proBNP) (HR 1.58, P < 0.0001), matrix metalloproteinase-7 (HR 1.24, P = 0.0002), syndecan-1 (HR 1.27, P = 0.0002), suppression of tumorigenicity-2 (ST2) (IL1RL1; HR 1.22, P = 0.0002), interleukin (IL)-8 (CXCL8; HR 1.22, P = 0.0005), pentraxin (PTX)-3 (HR 1.17, P = 0.001), neutrophil gelatinase-associated lipocalin (LCN2; HR 1.18, P < 0.0001), osteoprotegerin (OPG) (TNFRSF11B; HR 1.26, P = 0.0002), and endostatin (COL18A1; HR 1.28, P = 0.0012). Several biomarkers were also significantly predictive of DHFA in adjusted analyses including FGF-23 (HR 1.36, P < 0.0001), TNF-α (HR 1.26, P < 0.0001), TNFR1 (HR 1.34, P < 0.0001), angiopoietin-2 (HR 1.26, P < 0.0001), syndecan-1 (HR 1.23, P = 0.0006), ST2 (HR 1.27, P < 0.0001), IL-8 (HR 1.18, P = 0.0009), PTX-3 (HR 1.18, P = 0.0002), OPG (HR 1.20, P = 0.0013), and NT-proBNP (HR 1.63, P < 0.0001). Machine-learning multimarker models were strongly associated with adverse outcomes (mean 1-year probability of death of 0%, 2%, and 60%; mean 1-year probability of DHFA of 0%, 4%, 97%; P < 0.0001). In these models, IL-6 (a biomarker of inflammation) and FGF-23 (a biomarker of calcification) emerged as the biomarkers of highest importance. CONCLUSIONS Plasma biomarkers are strongly associated with the risk of adverse outcomes in patients with AS. Biomarkers of inflammation and calcification were most strongly related to prognosis.
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Affiliation(s)
- Mahesh K Vidula
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alena Orlenko
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lei Zhao
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Lisa Salvador
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Aeron M Small
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward Horton
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Srinivas Denduluri
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Taisei Kobayashi
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Hyman
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Fiorilli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline Magro
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bibi Singh
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bianca Pourmussa
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Candy Greczylo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael Basso
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Melissa Yarde
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Zhuyin Li
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Zhaoqing Wang
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Alice Walsh
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Ellen Kick
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Leonard Adam
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Peter Schafer
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | | | - Jason H Moore
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Gordon
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Vidula M, Orlenko A, Zhao L, Salvador L, Smalll A, Horton E, Cohen J, Margo C, Singh B, Pourmussa B, Greczylo C, Yarde M, Li Z, Cvijic ME, Wang Z, Schafer P, Ramirez-Valle F, Seiffert D, Gordon D, Rader D, Chirinos J. PLASMA BIOMARKERS FOR RISK STRATIFICATION OF OUTCOMES IN PATIENTS WITH AORTIC STENOSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carmichael OT, Neiberg RH, Dutton GR, Hayden KM, Horton E, Pi-Sunyer FX, Johnson KC, Rapp SR, Spira AP, Espeland MA. Long-term Change in Physiological Markers and Cognitive Performance in Type 2 Diabetes: The Look AHEAD Study. J Clin Endocrinol Metab 2020; 105:5897494. [PMID: 32845968 PMCID: PMC7566388 DOI: 10.1210/clinem/dgaa591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT The effects of physiological improvements on cognitive function among persons with type 2 diabetes mellitus (T2DM) are not fully understood. OBJECTIVE To determine whether improvements in physiological markers (body weight, blood sugar control, and physical activity) during intensive lifestyle intervention (ILI) are associated with enhancements in cognitive function in older adults with T2DM. DESIGN Multisite randomized controlled trial. SETTING Academic research centers. PATIENTS OR OTHER PARTICIPANTS Participants were aged 45-76 years, with T2DM. INTERVENTION The Action for Health in Diabetes (Look AHEAD) study, a randomized, controlled clinical trial of ILI. MAIN OUTCOME MEASURE Two to 3 cognitive assessments were collected from 1089 participants, the first and last occurring a mean (standard deviation) of 8.6 (1.0) and 11.5 (0.7) years after enrollment. RESULTS Greater improvement in blood sugar control was associated with better cognitive scores (fasting glucose and Rey Auditory Verbal Learning Test [AVLT]: P = 0.0148; fasting glucose and Digit Symbol Coding (DSC): P = 0.0360; HbA1C and DSC: P = 0.0477); but weight loss had mixed associations with cognitive scores (greater body mass index [BMI] reduction and worse AVLT overall: P = 0.0053; and greater BMI reduction and better DSC scores among those overweight but not obese at baseline: P = 0.010). Associations were strongest among those who were overweight (not obese) at baseline, and among those with a history of cardiovascular disease (CVD) at baseline. CONCLUSIONS Improvements in glycemic control, but not necessarily weight status, during ILI may be associated with better subsequent cognitive performance. These associations may differ by adiposity and CVD history.
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Affiliation(s)
- Owen T Carmichael
- Biomedical Imaging Center, Pennington Biomedical Research Center, Baton Rouge, Louisiana
- Correspondence and Reprint Requests: Owen T. Carmichael, PhD, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA. E-mail:
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gareth R Dutton
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathleen M Hayden
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward Horton
- Joslin Diabetes Center, Harvard University, Boston, Massachusetts
| | - F Xavier Pi-Sunyer
- Division of Endocrinology, Obesity/Nutrition Research Center, Columbia University College of Physicians and Surgeons, New York, NY
| | - Karen C Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Stephen R Rapp
- Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Mark A Espeland
- Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Aroda VR, Christophi CA, Edelstein SL, Perreault L, Kim C, Golden SH, Horton E, Mather KJ. Circulating sex hormone binding globulin levels are modified with intensive lifestyle intervention, but their changes did not independently predict diabetes risk in the Diabetes Prevention Program. BMJ Open Diabetes Res Care 2020; 8:8/2/e001841. [PMID: 33328161 PMCID: PMC7745696 DOI: 10.1136/bmjdrc-2020-001841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Sex hormone binding globulin (SHBG) levels are reported to be inversely associated with diabetes risk. It is unknown whether diabetes prevention interventions increase SHBG and whether resultant changes in SHBG affect diabetes risk. The purpose of this analysis was to determine whether intensive lifestyle intervention (ILS) or metformin changed circulating SHBG and if resultant changes influenced diabetes risk in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS This is a secondary analysis from the DPP (1996-2001), a randomized trial of ILS or metformin versus placebo on diabetes risk over a mean follow-up of 3.2 years. The DPP was conducted across 27 academic study centers in the USA. Men, premenopausal and postmenopausal women without hormone use in the DPP were evaluated. The DPP included overweight/obese persons with elevated fasting glucose and impaired glucose tolerance. Main outcomes measures were changes in SHBG levels at 1 year and risk of diabetes over 3 years. RESULTS ILS resulted in significantly higher increases (postmenopausal women: p<0.01) or smaller decrements (men: p<0.05; premenopausal women: p<0.01) in SHBG compared with placebo or metformin. Changes in SHBG were primarily attributable to changes in adiposity. There were no consistent associations of change in SHBG with the risk of diabetes by treatment arm or participant group. CONCLUSIONS Lifestyle intervention may be associated with favorable changes in circulating SHBG, which is largely due to changes in adiposity. Changes in circulating SHBG do not independently predict reductions in diabetes incidence.
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Affiliation(s)
- Vanita R Aroda
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Costas A Christophi
- The Biostatistics Center, The George Washington University Milken Institute of Public Health, Rockville, Maryland, USA
| | - Sharon L Edelstein
- The Biostatistics Center, The George Washington University Milken Institute of Public Health, Rockville, Maryland, USA
| | - Leigh Perreault
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine Kim
- Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sherita H Golden
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Kieren J Mather
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Serrablo-Torrejon I, Lopez-Valenciano A, Ayuso M, Horton E, Mayo X, Medina-Gomez G, Liguori G, Jimenez A. High intensity interval training exercise-induced physiological changes and their potential influence on metabolic syndrome clinical biomarkers: a meta-analysis. BMC Endocr Disord 2020; 20:167. [PMID: 33172413 PMCID: PMC7653723 DOI: 10.1186/s12902-020-00640-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite the current debate about the effects of high intensity interval training (HIIT), HIIT elicits big morpho-physiological benefit on Metabolic Syndrome (MetS) treatment. However, no review or meta-analysis has compared the effects of HIIT to non-exercising controls in MetS variables. The aim of this study was to determine through a systematic review, the effectiveness of HIIT on MetS clinical variables in adults. METHODS Studies had to be randomised controlled trials, lasting at least 3 weeks, and compare the effects of HIIT on at least one of the MetS clinical variables [fasting blood glucose (BG), high-density lipoprotein (HDL-C) triglyceride (TG), systolic (SBP) or diastolic blood pressure (DBP) and waist circumference (WC)] compared to a control group. The methodological quality of the studies selected was evaluated using the PEDro scale. RESULTS Ten articles fulfilled the selection criteria, with a mean quality score on the PEDro scale of 6.7. Compared with controls, HIIT groups showed significant and relevant reductions in BG (- 0.11 mmol/L), SBP (- 4.44 mmHg), DBP (- 3.60 mmHg), and WC (- 2.26 cm). Otherwise, a slight increase was observed in HDL-C (+ 0.02 mmol/L). HIIT did not produce any significant changes in TG (- 1.29 mmol/L). CONCLUSIONS HIIT improves certain clinical aspects in people with MetS (BG, SBP, DBP and WC) compared to people with MetS who do not perform physical exercise. Plausible physiological changes of HIIT interventions might be related with large skeletal muscle mass implication, improvements in the vasomotor control, better baroreflex control, reduction of the total peripheral resistance, increases in excess post-exercise oxygen consumption, and changes in appetite and satiety mechanisms.
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Affiliation(s)
- I Serrablo-Torrejon
- Faculty Research Centre for Sport, Exercise & Life Sciences, School of Health and Life Sciences, Coventry University, Coventry, UK.
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain.
| | - A Lopez-Valenciano
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain
- Observatory of Healthy & Active Living, Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - M Ayuso
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain
| | - E Horton
- Faculty Research Centre for Sport, Exercise & Life Sciences, School of Health and Life Sciences, Coventry University, Coventry, UK
| | - X Mayo
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain
- Observatory of Healthy & Active Living, Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - G Medina-Gomez
- Observatory of Healthy & Active Living, Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - G Liguori
- University of Rhode Island, Kingston, RI, USA
| | - A Jimenez
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain
- Observatory of Healthy & Active Living, Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
- Advanced Wellbeing Research Centre, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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Lin PI, Cardenas A, Hauser R, Gold D, Kleinman K, Hivert MF, Fleisch A, Webster T, Horton E, Sanchez-Guerra M, Osorio-Yanez C, Oken E. Dietary Characteristics and Exposure to Per- and Polyfluoroalkyl Substances Among Pre-diabetic Adults in Diabetes Prevention Program (OR17-06-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz039.or17-06-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To identify dietary characteristics associated with variation in plasma per- and polyfluoroalkyl substances (PFAS) concentrations among pre-diabetic adults in the US.
Methods
We evaluated cross-sectional associations between diet and plasma PFAS concentrations among pre-diabetic adults in the US enrolled in the Diabetic Prevention Program 1996–1999. Participants reported their diet over the previous year using a 117-item food frequency questionnaire. Plasma concentrations of 6 PFASs were measured using SPE-LC/MS/MS. We calculated daily intake for major food groups and characterized dietary patterns using principal component analysis (PCA). We estimated differences in plasma PFAS concentrations relative to diet using multivariate linear regression models adjusting for age, sex, race, marital status, education, income, smoking, waist circumference and total caloric intake.
Results
Participants (N = 941, 65% female , 58% Caucasian, 68% married, 75% with higher education, 95% nonsmoker) had similar plasma PFAS concentrations compared to the general US population measured in 1999–2000. Mean (SD) daily energy intake was 2091 (975) kcal. Using single food group approach, the strongest predictor for plasma PFAS concentrations was fried fish; each SD increase (0.1 serving/day) was associated with 13.6% (95% CI: 7.7, 19.9) and 6.9% (95% CI: 2.2, 11.8) higher median plasma concentration of perfluorononanoic acid (PFNA) and straight-chain perfluorooctanesulfonic acid (n-PFOS), respectively. Some food groups had inverse associations, with the strongest predictor being cruciferous vegetable [11.5% (95% CI: −16.1, −6.6) decrease in median concentration of plasma 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (MeFOSAA) per SD (0.3 serving/day) increase in intake]. PCA showed a vegetable diet to be associated with lower plasma PFAS concentrations, and diet patterns of high-fat meat diet and high-fat and low-fiber grains to be associated with higher PFAS concentrations.
Conclusions
Dietary patterns may influence PFAS exposures and/or excretion and absorption pathways. Studies of PFASs with diet-sensitive disease outcomes should account for confounding by diet.
Funding Sources
This work was supported by the US National Institutes of Health grant R01ES024765.
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Affiliation(s)
- Pi-i Lin
- Harvard Medical School and Harvard Pilgrim Health Care Institute
| | | | | | - Diane Gold
- Harvard T.H. Chan School of Public Health
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Herman WH, Pan Q, Edelstein SL, Mather KJ, Perreault L, Barrett-Connor E, Dabelea DM, Horton E, Kahn SE, Knowler WC, Lorenzo C, Pi-Sunyer X, Venditti E, Ye W. Erratum. Impact of lifestyle and metformin interventions on the risk of progression to diabetes and regression to normal glucose regulation in overweight or obese people with impaired glucose regulation. Diabetes Care 2017;40:1668-1677. Diabetes Care 2019; 42:701. [PMID: 30894384 PMCID: PMC6429634 DOI: 10.2337/dc19-er04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Horton E, Lee N, Layton AM, Eady EA. Response to 'Views of oral antibiotics and advice seeking about acne: a qualitative study of online discussion forums' based on evidence obtained from The Acne Priority Setting Partnership. Br J Dermatol 2019; 180:1265-1266. [PMID: 30604870 DOI: 10.1111/bjd.17599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- E Horton
- Department of Dermatology, Chapel Allerton Hospital, Leeds, U.K
| | - N Lee
- Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - A M Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, U.K
| | - E A Eady
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, U.K
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13
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Connelly K, Gandhi S, Horton E. Lifestyle and CV Risk in Patients With Diabetes: Time to Get "Back to Basics". J Am Coll Cardiol 2018; 71:2877-2879. [PMID: 29929609 DOI: 10.1016/j.jacc.2018.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kim Connelly
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Ontario, Canada.
| | - Sumeet Gandhi
- St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Edward Horton
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
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Herman WH, Pan Q, Edelstein SL, Mather KJ, Perreault L, Barrett-Connor E, Dabelea DM, Horton E, Kahn SE, Knowler WC, Lorenzo C, Pi-Sunyer X, Venditti E, Ye W. Erratum. Impact of Lifestyle and Metformin Interventions on the Risk of Progression to Diabetes and Regression to Normal Glucose Regulation in Overweight or Obese People With Impaired Glucose Regulation. Diabetes Care 2017;40:1668-1677. Diabetes Care 2018; 41:913. [PMID: 29475844 PMCID: PMC5860847 DOI: 10.2337/dc18-er04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Herman WH, Pan Q, Edelstein SL, Mather KJ, Perreault L, Barrett-Connor E, Dabelea DM, Horton E, Kahn SE, Knowler WC, Lorenzo C, Pi-Sunyer X, Venditti E, Ye W. Impact of Lifestyle and Metformin Interventions on the Risk of Progression to Diabetes and Regression to Normal Glucose Regulation in Overweight or Obese People With Impaired Glucose Regulation. Diabetes Care 2017; 40:1668-1677. [PMID: 29021207 PMCID: PMC5711336 DOI: 10.2337/dc17-1116] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/31/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Both lifestyle and metformin interventions can delay or prevent progression to type 2 diabetes mellitus (DM) in people with impaired glucose regulation, but there is considerable interindividual variation in the likelihood of receiving benefit. Understanding an individual's 3-year risk of progressing to DM and regressing to normal glucose regulation (NGR) might facilitate benefit-based tailored treatment. RESEARCH DESIGN AND METHODS We used the values of 19 clinical variables measured at the Diabetes Prevention Program (DPP) baseline evaluation and Cox proportional hazards models to assess the 3-year risk of progression to DM and regression to NGR separately for DPP lifestyle, metformin, and placebo participants who were adherent to the interventions. Lifestyle participants who lost ≥5% of their initial body weight at 6 months and metformin and placebo participants who reported taking ≥80% of their prescribed medication at the 6-month follow-up were defined as adherent. RESULTS Eleven of 19 clinical variables measured at baseline predicted progression to DM, and 6 of 19 predicted regression to NGR. Compared with adherent placebo participants at lowest risk of developing diabetes, participants at lowest risk of developing diabetes who adhered to a lifestyle intervention had an 8% absolute risk reduction (ARR) of developing diabetes and a 35% greater absolute likelihood of reverting to NGR. Participants at lowest risk of developing diabetes who adhered to a metformin intervention had no reduction in their risk of developing diabetes and a 17% greater absolute likelihood of reverting to NGR. Participants at highest risk of developing DM who adhered to a lifestyle intervention had a 39% ARR of developing diabetes and a 24% greater absolute likelihood of reverting to NGR, whereas those who adhered to the metformin intervention had a 25% ARR of developing diabetes and an 11% greater absolute likelihood of reverting to NGR. CONCLUSIONS Unlike our previous analyses that sought to explain population risk, these analyses evaluate individual risk. The models can be used by overweight and obese adults with fasting hyperglycemia and impaired glucose tolerance to facilitate personalized decision-making by allowing them to explicitly weigh the benefits and feasibility of the lifestyle and metformin interventions.
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Affiliation(s)
| | - Qing Pan
- George Washington University Biostatistics Center, Rockville, MD
| | | | | | | | | | | | | | - Steven E Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Carlos Lorenzo
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | | | - Wen Ye
- University of Michigan, Ann Arbor, MI
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Espeland MA, Luchsinger JA, Neiberg RH, Carmichael O, Laurienti PJ, Pi-Sunyer X, Wing RR, Cook D, Horton E, Casanova R, Erickson K, Nick Bryan R. Long Term Effect of Intensive Lifestyle Intervention on Cerebral Blood Flow. J Am Geriatr Soc 2017; 66:120-126. [PMID: 29082505 DOI: 10.1111/jgs.15159] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether long-term behavioral intervention targeting weight loss through increased physical activity and reduced caloric intake would alter cerebral blood flow (CBF) in individuals with type 2 diabetes mellitus. DESIGN Postrandomization assessment of CBF. SETTING Action for Health in Diabetes multicenter randomized controlled clinical trial. PARTICIPANTS Individuals with type 2 diabetes mellitus who were overweight or obese and aged 45 to 76 (N = 310). INTERVENTIONS A multidomain intensive lifestyle intervention (ILI) to induce weight loss and increase physical activity for 8 to 11 years or diabetes support and education (DSE), a control condition. MEASUREMENTS Participants underwent cognitive assessment and standardized brain magnetic resonance imaging (MRI) (3.0 Tesla) to assess CBF an average of 10.4 years after randomization. RESULTS Weight changes from baseline to time of MRI averaged -6.2% for ILI and -2.8% for DSE (P < .001), and increases in self-reported moderate or intense physical activity averaged 444.3 kcal/wk for ILI and 114.8 kcal/wk for DSE (P = .03). Overall mean CBF was 6% greater for ILI than DSE (P = .04), with the largest mean differences between ILI and DSE in the limbic region (3.39 mL/100 g per minute, 95% confidence interval (CI) = 0.07-6.70 mL/100 g per minute) and occipital lobes (3.52 mL/100 g per minute, 95% CI = 0.20-6.84 mL/100 g per minute). In ILI, greater CBF was associated with greater decreases in weight and greater increases in physical activity. The relationship between CBF and scores on a composite measure of cognitive function varied between intervention groups (P = .02). CONCLUSIONS Long-term weight loss intervention in overweight and obese adults with type 2 diabetes mellitus is associated with greater CBF.
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Affiliation(s)
- Mark A Espeland
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jose A Luchsinger
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Rebecca H Neiberg
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Owen Carmichael
- Brain and Metabolism Imaging in Chronic Disease Laboratory and Institute for Dementia Research and Prevention, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Paul J Laurienti
- Department of Radiology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Xavier Pi-Sunyer
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Delilah Cook
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | | | - Ramon Casanova
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kirk Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Nick Bryan
- University of Pennsylvania, Philadelphia, Pennsylvania
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Hayden KM, Baker LD, Bray G, Carvajal R, Demos-McDermott K, Hergenroeder AL, Hill JO, Horton E, Jakicic JM, Johnson KC, Neiberg RH, Rapp SR, Wadden TA, Miller ME. Long-term impact of intensive lifestyle intervention on cognitive function assessed with the National Institutes of Health Toolbox: The Look AHEAD study. Alzheimers Dement (Amst) 2017; 10:41-48. [PMID: 29159267 PMCID: PMC5675717 DOI: 10.1016/j.dadm.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction This study sought to determine whether 10 years of assignment to intensive lifestyle intervention (ILI) relative to diabetes support and education leads to better cognition. We examine intervention effects overall and among clinical subgroups, and report correlations between computer-administered and interviewer-administered cognitive batteries. Methods The Action for Health in Diabetes (Look AHEAD) was a 16-site randomized controlled trial with overweight/obese individuals (aged 45-76) who had type 2 diabetes. The NIH Toolbox Cognition Battery tests developed to measure cognition across the lifespan were used to evaluate cognition. Results were compared with standard paper-and-pencil tests. The Toolbox and paper-and-pencil tests were administered an average of 10.9 years after randomization to 1002 participants. Results Toolbox measures significantly correlated with interviewer-administered measures, with the strongest correlations between the Toolbox Fluid Cognition Composite and Trails B (r = -0.64, P < .0001) and Digit Symbol Coding (r = 0.63, P < .0001), and between the Toolbox Dimensional Change Card Sort (r = 0.55, P < .0001) and the Digit Symbol Coding test. Overall, ILI and diabetes support and education groups had similar adjusted mean cognitive outcomes (P > .05 for all). Subgroup analyses identified different intervention effects within baseline body mass index groups for Picture Sequence Memory (P = .01), within baseline cardiovascular disease groups for Picture Vocabulary (P = .01) and Fluid Cognition Composite (P = .02) measures, and within baseline age groups for Picture Vocabulary (P = .02). Discussion Correlations between Toolbox and interviewer-administered outcomes provide a measure of internal validity. Findings suggest no overall effect of the intervention on cognition and that an ILI resulting in weight loss may have negative implications for cognition in individuals aged ≥60, with previous history of cardiovascular disease, and those with body mass index ≥40.
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Affiliation(s)
- Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura D Baker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - George Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Raymond Carvajal
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Andrea L Hergenroeder
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - James O Hill
- Anschultz Health and Wellness Center, Aurora, CO, USA
| | | | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca H Neiberg
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen R Rapp
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Goldberg RB, Temprosa M, Mele L, Orchard T, Mather K, Bray G, Horton E, Kitabchi A, Krakoff J, Marcovina S, Perreault L, White N. Erratum to: "Change in adiponectin explains most of the change in HDL particles induced by lifestyle intervention but not metformin treatment in the diabetes prevention program" [Metabolism (2016) 65; 764-775]. Metabolism 2017; 68:184-186. [PMID: 28065437 DOI: 10.1016/j.metabol.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ronald B Goldberg
- Diabetes Research Institute, University of Miami, 1450 NW 10th Avenue, Suite 2054, Miami, FL, 33136.
| | - Marinella Temprosa
- The George Washington University, Biostatistics Center, 6110 Executive Blvd, Suite 750, Rockville, MD, 20852
| | - Lisa Mele
- The George Washington University, Biostatistics Center, 6110 Executive Blvd, Suite 750, Rockville, MD, 20852
| | - Trevor Orchard
- University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213
| | - Kieren Mather
- Department of Medicine, Indiana University, 541 Clinical Drive CL 365, Indianapolis, IN, 46202
| | - George Bray
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Rd, Baton Rouge, LA, 70808
| | - Edward Horton
- Section on Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
| | - Abbas Kitabchi
- Division of Endocrinology, University of Tennessee Health Science Center, 920 Madison Ave Suite 300A, Memphis, TN, 38163
| | - Jonathan Krakoff
- National Institute of Diabetes and Digestive and Kidney Diseases, 1550 E. Indian School Road, Phoenix, AZ, 85014
| | - Santica Marcovina
- University of Washington, Northwest Lipid Research Labs, 401 Queen Anne Avenue, North Seattle, WA, 98109
| | - Leigh Perreault
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave., Aurora, CO, 80045
| | - Neil White
- Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110
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Gregg E, Jakicic J, Blackburn G, Bloomquist P, Bray G, Clark J, Coday M, Curtis J, Egan C, Evans M, Foreyt J, Foster G, Hazuda H, Hill J, Horton E, Hubbard V, Jeffery R, Johnson K, Kitabchi A, Knowler W, Kriska A, Lang W, Lewis C, Montez M, Nathan D, Neiberg R, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Redmon B, Regensteiner J, Rejeski J, Ribisl P, Safford M, Stewart K, Trence D, Wadden T, Wing R, Yanovski S. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016; 4:913-921. [PMID: 27595918 PMCID: PMC5094846 DOI: 10.1016/s2213-8587(16)30162-0] [Citation(s) in RCA: 395] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Findings from the Look AHEAD trial showed no significant reductions in the primary outcome of cardiovascular disease incidence in adults with type 2 diabetes randomly assigned to an intensive lifestyle intervention for weight loss compared with those randomly assigned to diabetes support and education (control). We examined whether the incidence of cardiovascular disease in Look AHEAD varied by changes in weight or fitness. METHODS Look AHEAD was a randomised clinical trial done at 16 clinical sites in the USA, recruiting patients from Aug 22, 2001, to April 30, 2004. In the trial, 5145 overweight or obese adults aged 45-76 years with type 2 diabetes were assigned (1:1) to an intensive lifestyle intervention or diabetes support and education. In this observational, post-hoc analysis, we examined the association of magnitude of weight loss and fitness change over the first year with incidence of cardiovascular disease. The primary outcome of the trial and of this analysis was a composite of death from cardiovascular causes, non-fatal acute myocardial infarction, non-fatal stroke, or admission to hospital for angina. The secondary outcome included the same indices plus coronary artery bypass grafting, carotid endartectomy, percutaneous coronary intervention, hospitalisation for congestive heart failure, peripheral vascular disease, or total mortality. We adjusted analyses for baseline differences in weight or fitness, demographic characteristics, and risk factors for cardiovascular disease. The Look AHEAD trial is registered with ClinicalTrials.gov, number NCT00017953. FINDINGS For the analyses related to weight change, we excluded 311 ineligible participants, leaving a population of 4834; for the analyses related to fitness change, we excluded 739 participants, leaving a population of 4406. In analyses of the full cohort (ie, combining both study groups), over a median 10·2 years of follow-up (IQR 9·5-10·7), individuals who lost at least 10% of their bodyweight in the first year of the study had a 21% lower risk of the primary outcome (adjusted hazard ratio [HR] 0·79, 95% CI 0·64-0·98; p=0·034) and a 24% reduced risk of the secondary outcome (adjusted HR 0·76, 95% CI 0·63-0·91; p=0·003) compared with individuals with stable weight or weight gain. Achieving an increase of at least 2 metabolic equivalents in fitness change was associated with a significant reduction in the secondary outcome (adjusted HR 0·77, 95% CI 0·61-0·96; p=0·023) but not the primary outcome (adjusted HR 0·78, 0·60-1·03; p=0·079). In analyses treating the control group as the reference group, participants in the intensive lifestyle intervention group who lost at least 10% of their bodyweight had a 20% lower risk of the primary outcome (adjusted HR 0·80, 95% CI 0·65-0·99; p=0·039), and a 21% lower risk of the secondary outcome (adjusted HR 0·79, 95% CI 0·66-0·95; p=0·011); however, change in fitness was not significantly associated with a change in the primary outcome. INTERPRETATION The results of this post-hoc analysis of Look AHEAD suggest an association between the magnitude of weight loss and incidence of cardiovascular disease in people with type 2 diabetes. These findings suggest a need to continue to refine approaches to identify individuals who are most likely to benefit from lifestyle interventions and to develop strategies to improve the magnitude of sustained weight loss with lifestyle interventions. FUNDING US National Institute of Diabetes and Digestive and Kidney Diseases.
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Doupis J, Papanas N, Cohen A, McFarlan L, Horton E. Pulse Wave Analysis by Applanation Tonometry for the Measurement of Arterial Stiffness. Open Cardiovasc Med J 2016; 10:188-95. [PMID: 27651842 PMCID: PMC5012082 DOI: 10.2174/1874192401610010188] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 07/05/2016] [Accepted: 07/17/2016] [Indexed: 12/13/2022] Open
Abstract
The aim of our study was to investigate the association between pulse wave velocity (PWV) and pulse wave analysis (PWA)-derived measurements for the evaluation of arterial stiffness. A total of 20 (7 male and 13 female) healthy, non-smoking individuals, with mean age 31 ± 12years were included. PWV and PWA measurements were performed using a SphygmoCor apparatus (Atcor Medical Blood Pressure Analysis System, Sydney Australia). PWV significantly correlated with all central aortic haemodynamic parameters, especially with pulse pressure (PP) (p < 0.0001), augmentation index corrected for 75 pulses/min (AI75) (p = 0.035) and augmentation pressure (AP) (p = 0.005). Male subjects presented significantly higher PWV compared with females (p = 0.03), while there were no differences in PP, AP and AI75. In conclusion, PWA is strongly correlated with PWV as a method for the evaluation of arterial stiffness.
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Affiliation(s)
- John Doupis
- Joslin Diabetes Centre, Harvard Medical School, Boston, MA, USA
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alison Cohen
- Joslin Diabetes Centre, Harvard Medical School, Boston, MA, USA
| | | | - Edward Horton
- Joslin Diabetes Centre, Harvard Medical School, Boston, MA, USA
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Goldberg RB, Temprosa M, Mele L, Orchard T, Mather K, Bray G, Horton E, Kitabchi A, Krakoff J, Marcovina S, Perreault L, White N. Change in adiponectin explains most of the change in HDL particles induced by lifestyle intervention but not metformin treatment in the Diabetes Prevention Program. Metabolism 2016; 65:764-775. [PMID: 27085783 PMCID: PMC5122461 DOI: 10.1016/j.metabol.2015.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In addition to slowing diabetes development among participants in the Diabetes Prevention Program (DPP), intensive lifestyle change and metformin raised HDL-cholesterol (HDL-C) compared to placebo treatment. We investigated the lifestyle and metabolic determinants as well as effects of biomarkers of inflammation, endothelial dysfunction and coagulation and their changes resulting from lifestyle and metformin interventions on the increase in HDL-C in the DPP. METHODS The effects of a 1year period of intensive lifestyle change aimed at achieving 7% weight loss or metformin 850mg twice daily versus placebo on HDL-C were assessed in 3070 participants with impaired glucose tolerance, and on HDL particle concentration (HDL-P) and size in a subgroup of 1645 individuals. Treatment-associated changes in lifestyle and metabolic factors as well as in novel biomarkers were investigated for their associations with change in HDL-C using multiple regression analysis. RESULTS After adjusting for BMI, insulin resistance, glycemia, dietary saturated fat, alcohol intake, physical activity and nine different biomarkers, only adiponectin accounted for the effect of intensive lifestyle change on HDL-C via an increase in large HDL-P. By contrast baseline and change in BMI and tissue plasminogen activator levels attenuated the effect of metformin on HDL-C, with adiponectin having no specific effect. CONCLUSION While both lifestyle and metformin interventions used to prevent diabetes increase HDL-C, the mechanisms involved differ between the two treatments and may have consequences for future risk of cardiovascular disease.
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Affiliation(s)
- Ronald B Goldberg
- Diabetes Research Institute, University of Miami, 1450 NW 10th Avenue, Suite 2054, Miami, FL, 33136.
| | - Marinella Temprosa
- The George Washington University, Biostatistics Center, 6110 Executive Blvd, Suite 750, Rockville, MD, 20852
| | - Lisa Mele
- The George Washington University, Biostatistics Center, 6110 Executive Blvd, Suite 750, Rockville, MD, 20852
| | - Trevor Orchard
- University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213
| | - Kieren Mather
- Department of Medicine, Indiana University, 541 Clinical Drive CL 365, Indianapolis, IN, 46202
| | - George Bray
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Rd, Baton Rouge, LA, 70808
| | - Edward Horton
- Section on Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
| | - Abbas Kitabchi
- Division of Endocrinology, University of Tennessee Health Science Center, 920 Madison Ave Suite 300A, Memphis, TN, 38163
| | - Jonathan Krakoff
- National Institute of Diabetes and Digestive and Kidney Diseases, 1550 E. Indian School Road, Phoenix, AZ, 85014
| | - Santica Marcovina
- University of Washington, Northwest Lipid Research Labs, 401 Queen Anne Avenue, North Seattle, WA, 98109
| | - Leigh Perreault
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave., Aurora, CO, 80045
| | - Neil White
- Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110
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Heckman-Stoddard BM, Crandall JP, Edelstein SL, Hamman RF, Prorok PC, Ryan A, Dabelea D, Hazuda HP, Horton E, Hoskin MA, Jeffries S, Knowler WC, Mather KJ, Shapiro SM, Walcott FL, Ford LG. Abstract A23: Cancer outcomes in the diabetes prevention program outcomes study. Cancer Prev Res (Phila) 2015. [DOI: 10.1158/1940-6215.prev-14-a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Numerous observational studies have reported decreased cancer incidence and cancer-related mortality in patients with diabetes receiving standard doses of metformin. A recent meta-analysis of these studies suggested a 31% reduction in overall cancer incidence, summary relative risk (0.69; 95% confidence interval, 0.52-0.90), in subjects taking metformin as compared with other antidiabetic drugs. Separate meta-analyses of studies that adjusted for BMI or time-related bias suggested an attenuation of this signal, but still showed a significant reduction in cancer incidence. However, studies published to date are limited by the observational nature of the data and the randomized controlled trials that have been used to examine metformin's potential as an anti-cancer agent in patients with diabetes have had insufficient follow-up for cancer endpoints. These data also do not address the cancer risk in non-diabetic populations, in which the cancer preventive potential of metformin is unknown.
The Diabetes Prevention Program (DPP) was a national multi-center, randomized, placebo-controlled clinical trial, which enrolled 3234 participants between 1996 and 1999, designed to investigate whether intensive lifestyle modification or treatment with metformin (850mg twice a day) delayed or prevented the onset of type 2 diabetes in a high risk population. The DPP and its follow up study, the Diabetes Prevention Program Outcomes Study (DPPOS), provide a unique opportunity to examine the role of metformin and lifestyle intervention in reducing cancer incidence in an overweight adult population with impaired glucose regulation, before the onset of diabetes. The National Cancer Institute Division of Cancer Prevention, in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the DPPOS investigators, proposed a study to examine the hypothesis that metformin and/or lifestyle intervention can modify total cancer incidence and/or obesity-related cancer incidence (breast, colorectal, endometrium, pancreas, lower esophagus, gall-bladder, and kidney) in DPP/DPPOS participants.
The DPPOS protocol and consent were modified to allow collection of data to support the inclusion of cancer incidence as an endpoint of interest in the study. Participants complete a cancer risk questionnaire that includes family history of cancer, cancer screening activities, and use of aspirin and NSAIDs including dose and frequency. The participants who previously reported a cancer diagnosis, through the SAE reporting process and/or an annual questionnaire, or during a subsequent follow-up visit, are asked to provide physician information to obtain medical records for case adjudication. This protocol will allow for the examination of the effect of metformin and lifestyle intervention on cancer incidence in an initially pre-diabetic population potentially through a median of 20 years of follow-up.
Data from this study will compare incidence of total and obesity-related cancers between the original treatment groups; assess cancer (total and obesity-related) incidence by metformin exposure across all treatment groups, using a “met-years” variable, and explore subgroups to investigate effect modification by sex, age group, race/ethnicity, diabetes status, or weight loss at 1 year or mean weight loss since study baseline.
Citation Format: Brandy M. Heckman-Stoddard, Jill P. Crandall, Sharon L. Edelstein, Richard F. Hamman, Philip C. Prorok, Anne Ryan, Dana Dabelea, Helen P. Hazuda, Edward Horton, Mary A. Hoskin, Susan Jeffries, William C. Knowler, Kieren J. Mather, Susana M. Shapiro, Farzana L. Walcott, Leslie G. Ford. Cancer outcomes in the diabetes prevention program outcomes study. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A23.
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Affiliation(s)
| | | | | | | | | | - Anne Ryan
- 1National Cancer Institute, Rockville, MD,
| | | | - Helen P. Hazuda
- 5University of Texas Health Science Center, San Antonio, TX,
| | | | - Mary A. Hoskin
- 7Southwestern American Indian Center, ACKCO Inc., Phoenix, AZ,
| | | | - William C. Knowler
- 9National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ,
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Hamman RF, Horton E, Barrett-Connor E, Bray GA, Christophi CA, Crandall J, Florez JC, Fowler S, Goldberg R, Kahn SE, Knowler WC, Lachin JM, Murphy MB, Venditti E. Factors affecting the decline in incidence of diabetes in the Diabetes Prevention Program Outcomes Study (DPPOS). Diabetes 2015; 64:989-98. [PMID: 25277389 PMCID: PMC4338587 DOI: 10.2337/db14-0333] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/21/2014] [Indexed: 12/21/2022]
Abstract
During the first 7 years of the Diabetes Prevention Program Outcomes Study (DPPOS), diabetes incidence rates, when compared with the Diabetes Prevention Program (DPP), decreased in the placebo (-42%) and metformin (-25%), groups compared with the rates in the intensive lifestyle intervention (+31%) group. Participants in the placebo and metformin groups were offered group intensive lifestyle intervention prior to entering the DPPOS. The following two hypotheses were explored to explain the rate differences: "effective intervention" (changes in weight and other factors due to intensive lifestyle intervention) and "exhaustion of susceptible" (changes in mean genetic and diabetes risk scores). No combination of behavioral risk factors (weight, physical activity, diet, smoking, and antidepressant or statin use) explained the lower DPPOS rates of diabetes progression in the placebo and metformin groups, whereas weight gain was the factor associated with higher rates of progression in the intensive lifestyle intervention group. Different patterns in the average genetic risk score over time were consistent with exhaustion of susceptibles. Results were consistent with exhaustion of susceptibles for the change in incidence rates, but not the availability of intensive lifestyle intervention to all persons before the beginning of the DPPOS. Thus, effective intervention did not explain the lower diabetes rates in the DPPOS among subjects in the placebo and metformin groups compared with those in the DPP.
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Affiliation(s)
- Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado at Denver, Aurora, CO
| | - Edward Horton
- Section on Clinical Research, Joslin Diabetes Center, Boston, MA
| | | | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | | | | | | | - Sarah Fowler
- Biostatistics Center, George Washington University, Rockville, MD
| | - Ronald Goldberg
- Diabetes Research Institute, University of Miami School of Medicine, Miami, FL
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - John M Lachin
- Biostatistics Center, George Washington University, Rockville, MD
| | - Mary Beth Murphy
- Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN
| | - Elizabeth Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center Health Systems, Pittsburgh, PA
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Walford GA, Ma Y, Christophi CA, Goldberg RB, Jarolim P, Horton E, Mather KJ, Barrett-Connor E, Davis J, Florez JC, Wang TJ. Circulating natriuretic peptide concentrations reflect changes in insulin sensitivity over time in the Diabetes Prevention Program. Diabetologia 2014; 57:935-9. [PMID: 24554005 PMCID: PMC4158711 DOI: 10.1007/s00125-014-3183-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS We aimed to study the relationship between measures of adiposity, insulin sensitivity and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the Diabetes Prevention Program (DPP). METHODS The DPP is a completed clinical trial. Using stored samples from this resource, we measured BMI, waist circumference (WC), an insulin sensitivity index (ISI; [1/HOMA-IR]) and NT-proBNP at baseline and at 2 years of follow-up in participants randomised to placebo (n = 692), intensive lifestyle intervention (n = 832) or metformin (n = 887). RESULTS At baseline, log NT-proBNP did not differ between treatment arms and was correlated with baseline log ISI (p < 0.0001) and WC (p = 0.0003) but not with BMI (p = 0.39). After 2 years of treatment, BMI decreased in the lifestyle and metformin groups (both p < 0.0001); WC decreased in all three groups (p < 0.05 for all); and log ISI increased in the lifestyle and metformin groups (both p < 0.001). The change in log NT-proBNP did not differ in the lifestyle or metformin group vs the placebo group (p > 0.05 for both). In regression models, the change in log NT-proBNP was positively associated with the change in log ISI (p < 0.005) in all three study groups after adjusting for changes in BMI and WC, but was not associated with the change in BMI or WC after adjusting for changes in log ISI. CONCLUSION/INTERPRETATION Circulating NT-proBNP was associated with a measure of insulin sensitivity before and during preventive interventions for type 2 diabetes in the DPP. This relationship persisted after adjustment for measures of adiposity and was consistent regardless of whether a participant was treated with placebo, intensive lifestyle intervention or metformin.
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Affiliation(s)
- Geoffrey A. Walford
- Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, MA, USA
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Yong Ma
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Costas A. Christophi
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Ronald B. Goldberg
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
- Division of Endocrinology, Diabetes, and Metabolism, University of Miami Miller School of Medicine, Miami, FA, USA
| | - Petr Jarolim
- Division of Clinical Laboratories, Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Edward Horton
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
- Joslin Diabetes Center, Boston, MA, USA
| | - Kieren J. Mather
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
- Division of Endocrinology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth Barrett-Connor
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
- Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Jaclyn Davis
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, MA, USA
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Jose C. Florez
- Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, MA, USA
- Diabetes Prevention Program Data Coordinating Center, The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Thomas J. Wang
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Florez H, Temprosa MG, Orchard TJ, Mather KJ, Marcovina SM, Barrett-Connor E, Horton E, Saudek C, Pi-Sunyer XF, Ratner RE, Goldberg RB. Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance. Diabetes Obes Metab 2014; 16:326-33. [PMID: 24118860 PMCID: PMC3943638 DOI: 10.1111/dom.12220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 12/28/2022]
Abstract
AIMS To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence. METHODS We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2 years. RESULTS In an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3-2.3), 1.7 (1.2-2.3) and 2.0 (1.3-3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk. CONCLUSIONS MetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.
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Affiliation(s)
- Hermes Florez
- Geriatric Research, Education, and Clinical Center, Miami Veterans Affairs Healthcare System and Divisions of Epidemiology, Geriatric Medicine & Endocrinology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kieren J Mather
- Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana
| | - Santica M Marcovina
- Northwest Lipid Research Labs, University of Washington, Seattle, Washington
| | - Elizabeth Barrett-Connor
- Department of Family and Preventive Medicine, University of California, San Digeo, La Jolla, California
| | | | | | - Xavier F Pi-Sunyer
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, St. Luke’s Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Ronald B Goldberg
- Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL
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Sacks FM, Hermans MP, Fioretto P, Valensi P, Davis T, Horton E, Wanner C, Al-Rubeaan K, Aronson R, Barzon I, Bishop L, Bonora E, Bunnag P, Chuang LM, Deerochanawong C, Goldenberg R, Harshfield B, Hernández C, Herzlinger-Botein S, Itoh H, Jia W, Jiang YD, Kadowaki T, Laranjo N, Leiter L, Miwa T, Odawara M, Ohashi K, Ohno A, Pan C, Pan J, Pedro-Botet J, Reiner Z, Rotella CM, Simo R, Tanaka M, Tedeschi-Reiner E, Twum-Barima D, Zoppini G, Carey VJ. Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus: a global case-control study in 13 countries. Circulation 2013; 129:999-1008. [PMID: 24352521 DOI: 10.1161/circulationaha.113.002529] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Microvascular renal and retinal diseases are common major complications of type 2 diabetes mellitus. The relation between plasma lipids and microvascular disease is not well established. METHODS AND RESULTS The case subjects were 2535 patients with type 2 diabetes mellitus with an average duration of 14 years, 1891 of whom had kidney disease and 1218 with retinopathy. The case subjects were matched for diabetes mellitus duration, age, sex, and low-density lipoprotein cholesterol to 3683 control subjects with type 2 diabetes mellitus who did not have kidney disease or retinopathy. The study was conducted in 24 sites in 13 countries. The primary analysis included kidney disease and retinopathy cases. Matched analysis was performed by use of site-specific conditional logistic regression in multivariable models that adjusted for hemoglobin A1c, hypertension, and statin treatment. Mean low-density lipoprotein cholesterol concentration was 2.3 mmol/L. The microvascular disease odds ratio increased by a factor of 1.16 (95% confidence interval, 1.11-1.22) for every 0.5 mmol/L (≈1 quintile) increase in triglycerides or decreased by a factor of 0.92 (0.88-0.96) for every 0.2 mmol/L (≈1 quintile) increase in high-density lipoprotein cholesterol. For kidney disease, the odds ratio increased by 1.23 (1.16-1.31) with triglycerides and decreased by 0.86 (0.82-0.91) with high-density lipoprotein cholesterol. Retinopathy was associated with triglycerides and high-density lipoprotein cholesterol in matched analysis but not significantly after additional adjustment. CONCLUSIONS Diabetic kidney disease is associated worldwide with higher levels of plasma triglycerides and lower levels of high-density lipoprotein cholesterol among patients with good control of low-density lipoprotein cholesterol. Retinopathy was less robustly associated with these lipids. These results strengthen the rationale for studying dyslipidemia treatment to prevent diabetic microvascular disease.
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Affiliation(s)
- Frank M Sacks
- Nutrition Department, Harvard School of Public Health, Boston, MA (F.M.S., L.B.); Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium (M.P.H.); Department of Medicine, University of Padova, Padova, Italy (P.F., I.B.); Department of Endocrinology Diabetology Nutrition, Jean Verdier Hospital, AP-HP, Le Centre de Recherché en Nutrition Humaine d'Ille de France, Paris Nord University, Bondy, France (P.V.); University of Western Australia, Crawley, Australia (T.D.); Harvard Medical School, Joslin Diabetes Center, Boston, MA (E.H., S.H.-B.); University of Würzburg, Würzburg, Germany (C.W.); College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia (K.A.-R.); LMC Diabetes and Endocrinology, Toronto, Ontario, Canada (R.A.); Department of Medicine, Section of Endocrinology, University of Verona, Verona, Italy (E.B., G.Z.); Ramathibodi Hospital, Bangkok, Thailand (P.B.); Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (L.-M.C., Y.-D.J.); Rangsit School of Medicine, Rajavithi Hospital, Bangkok, Thailand (C.D.); North York General Hospital and LMC Diabetes and Endocrinology Centres, Toronto, Ontario, Canada (R.G.); Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA (B.H., N.L., V.J.C.); CIBERDEM and Vall d'Hebron Research Institute, Barcelona, Spain (C.H., R.S.); Keio University School of Medicine, Tokyo, Japan (H.I., M.T.); Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiaotong University, Affiliated Sixth People's Hospital, Shanghai, China (W.J.); Department of Diabetes and Metabolic Diseases, The University of Tokyo, Tokyo, Japan (T.K.); University of Toronto, Toronto, Ontario, Canada (L.L.); Tokyo Medical University, Tokyo, Japan (T.M., M.O.); Department of General Internal Medicine, National Cancer Center Hospital, Tokyo, Japan (K.O.); Tokyo Medical University Hachioji Medical Center, Tokyo, Japan (A.O.); Beijing 301 Mili
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Horton E, Mitchell K, Johnson-Warrington V, Apps L, Young H, Singh S, Singh S. S24 A self-management programme of activity, coping and education (SPACE) for COPD: A randomised non-inferiority trial in a pulmonary rehabilitation population: Abstract S24 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Goldberg R, Temprosa M, Otvos J, Brunzell J, Marcovina S, Mather K, Arakaki R, Watson K, Horton E, Barrett-Connor E. Lifestyle and metformin treatment favorably influence lipoprotein subfraction distribution in the Diabetes Prevention Program. J Clin Endocrinol Metab 2013; 98:3989-98. [PMID: 23979954 PMCID: PMC3790618 DOI: 10.1210/jc.2013-1452] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022]
Abstract
CONTEXT Although intensive lifestyle change (ILS) and metformin reduce diabetes incidence in subjects with impaired glucose tolerance (IGT), their effects on lipoprotein subfractions have not been studied. OBJECTIVE The objective of the study was to characterize the effects of ILS and metformin vs placebo interventions on lipoprotein subfractions in the Diabetes Prevention Program. DESIGN This was a randomized clinical trial, testing the effects of ILS, metformin, and placebo on diabetes development in subjects with IGT. PARTICIPANTS Selected individuals with IGT randomized in the Diabetes Prevention Program participated in the study. INTERVENTIONS Interventions included randomization to metformin 850 mg or placebo twice daily or ILS aimed at a 7% weight loss using a low-fat diet with increased physical activity. MAIN OUTCOME MEASURES Lipoprotein subfraction size, density, and concentration measured by magnetic resonance and density gradient ultracentrifugation at baseline and 1 year were measured. RESULTS ILS decreased large and buoyant very low-density lipoprotein, small and dense low-density lipoprotein (LDL), and small high-density lipoprotein (HDL) and raised large HDL. Metformin modestly reduced small and dense LDL and raised small and large HDL. Change in insulin resistance largely accounted for the intervention-associated decreases in large very low-density lipoprotein, whereas changes in body mass index (BMI) and adiponectin were strongly associated with changes in LDL. Baseline and a change in adiponectin were related to change in large HDL, and BMI change associated with small HDL change. The effect of metformin to increase small HDL was independent of adiponectin, BMI, and insulin resistance. CONCLUSION ILS and metformin treatment have favorable effects on lipoprotein subfractions that are primarily mediated by intervention-related changes in insulin resistance, BMI, and adiponectin. Interventions that slow the development of diabetes may also retard the progression of atherosclerosis.
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Affiliation(s)
- R Goldberg
- MD, c/o The Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Boulevard, Suite 750, Rockville, Maryland 20852.
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Nauck M, Horton E, Andjelkovic M, Ampudia-Blasco FJ, Parusel CT, Boldrin M, Balena R. Taspoglutide, a once-weekly glucagon-like peptide 1 analogue, vs. insulin glargine titrated to target in patients with Type 2 diabetes: an open-label randomized trial. Diabet Med 2013; 30:109-13. [PMID: 22937895 DOI: 10.1111/dme.12003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To compare the efficacy and safety of once-weekly taspoglutide with insulin glargine in patients with advanced Type 2 diabetes failing metformin and sulphonylurea combination therapy. METHODS This open-label, parallel-group, multi-centre trial randomized 1049 patients continuing metformin 1:1:1 to taspoglutide 10 mg once weekly, taspoglutide 20 mg once weekly or insulin glargine once daily with forced titration to fasting plasma glucose ≤ 6.1 mmol/l. Sulphonylureas were discontinued before randomization. The primary endpoint was change in HbA(1c) after 24 weeks. RESULTS After 24 weeks, least-square mean changes from baseline in HbA(1c) in patients receiving taspoglutide 10 mg [-8 mmol/mol (se 1)] [-0.77% (se 0.05)] or taspoglutide 20 mg [-11 mmol/mol (se 1)] [-0.98% (se 0.05)] were non-inferior to insulin glargine [-9 mmol/mol (se 1)] [-0.84% (se 0.05)]; treatment difference of 0.07% (95% CI -0.06 to 0.21) and -0.14% (95% CI -0.28 to -0.01), for taspoglutide 10 and 20 mg, respectively, vs. insulin glargine. Taspoglutide was associated with more adverse events (mainly gastrointestinal) and significantly less hypoglycaemia than insulin glargine. CONCLUSIONS Compared with insulin glargine, taspoglutide provided non-inferior HbA(1c) reductions associated with less hypoglycaemia, but more gastrointestinal adverse events.
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Affiliation(s)
- M Nauck
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
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Florez JC, Jablonski KA, McAteer JB, Franks PW, Mason CC, Mather K, Horton E, Goldberg R, Dabelea D, Kahn SE, Arakaki RF, Shuldiner AR, Knowler WC. Effects of genetic variants previously associated with fasting glucose and insulin in the Diabetes Prevention Program. PLoS One 2012; 7:e44424. [PMID: 22984506 PMCID: PMC3439414 DOI: 10.1371/journal.pone.0044424] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 08/03/2012] [Indexed: 11/19/2022] Open
Abstract
Common genetic variants have been recently associated with fasting glucose and insulin levels in white populations. Whether these associations replicate in pre-diabetes is not known. We extended these findings to the Diabetes Prevention Program, a clinical trial in which participants at high risk for diabetes were randomized to placebo, lifestyle modification or metformin for diabetes prevention. We genotyped previously reported polymorphisms (or their proxies) in/near G6PC2, MTNR1B, GCK, DGKB, GCKR, ADCY5, MADD, CRY2, ADRA2A, FADS1, PROX1, SLC2A2, GLIS3, C2CD4B, IGF1, and IRS1 in 3,548 Diabetes Prevention Program participants. We analyzed variants for association with baseline glycemic traits, incident diabetes and their interaction with response to metformin or lifestyle intervention. We replicated associations with fasting glucose at MTNR1B (P<0.001), G6PC2 (P = 0.002) and GCKR (P = 0.001). We noted impaired β-cell function in carriers of glucose-raising alleles at MTNR1B (P<0.001), and an increase in the insulinogenic index for the glucose-raising allele at G6PC2 (P<0.001). The association of MTNR1B with fasting glucose and impaired β-cell function persisted at 1 year despite adjustment for the baseline trait, indicating a sustained deleterious effect at this locus. We also replicated the association of MADD with fasting proinsulin levels (P<0.001). We detected no significant impact of these variants on diabetes incidence or interaction with preventive interventions. The association of several polymorphisms with quantitative glycemic traits is replicated in a cohort of high-risk persons. These variants do not have a detectable impact on diabetes incidence or response to metformin or lifestyle modification in the Diabetes Prevention Program.
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Affiliation(s)
- Jose C. Florez
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (DPPRG); (JCF)
| | - Kathleen A. Jablonski
- The Biostatistics Center, George Washington University, Rockville, Maryland, United States of America
| | - Jarred B. McAteer
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Paul W. Franks
- Lund University Diabetes Center, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Clinton C. Mason
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, United States of America
| | - Kieren Mather
- Division of Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Edward Horton
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Joslin Diabetes Center, Boston, Massachusetts, United States of America
| | - Ronald Goldberg
- Lipid Disorders Clinic, Division of Endocrinology, Diabetes, and Metabolism, and the Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Dana Dabelea
- Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, United States of America
| | - Steven E. Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, United States of America
| | - Richard F. Arakaki
- Department of Medicine Clinical Research, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Alan R. Shuldiner
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, United States of America
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Florez JC, Jablonski KA, Taylor A, Mather K, Horton E, White NH, Barrett-Connor E, Knowler WC, Shuldiner AR, Pollin TI. The C allele of ATM rs11212617 does not associate with metformin response in the Diabetes Prevention Program. Diabetes Care 2012; 35:1864-7. [PMID: 22751958 PMCID: PMC3425006 DOI: 10.2337/dc11-2301] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The C allele at the rs11212617 polymorphism in the ataxia-telangiectasia-mutated (ATM) gene has been associated with greater clinical response to metformin in people with type 2 diabetes. We tested whether this variant modified the effect of metformin in the Diabetes Prevention Program (DPP), in which metformin reduced diabetes incidence by 31% in volunteers with impaired glucose tolerance. RESEARCH DESIGN AND METHODS We genotyped rs11212617 in 2,994 DPP participants and analyzed its effects on diabetes incidence and related traits. RESULTS Contrary to expectations, C carriers enjoyed no preventive advantage on metformin; their hazard ratio, compared with A carriers, was 1.17 ([95% CI 0.96-1.42], P = 0.13) under metformin. There were no significant differences by genotype in metformin's effects on insulin sensitivity, fasting glucose, glycated hemoglobin, or disposition index. CONCLUSIONS The reported association of rs11212617 with metformin response was not confirmed for diabetes prevention or for effects on relevant physiologic parameters in the DPP.
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Hoffmann B, Luttmann-Gibson H, Cohen A, Zanobetti A, de Souza C, Foley C, Suh HH, Coull BA, Schwartz J, Mittleman M, Stone P, Horton E, Gold DR. Opposing effects of particle pollution, ozone, and ambient temperature on arterial blood pressure. Environ Health Perspect 2012; 120:241-6. [PMID: 22020729 PMCID: PMC3279434 DOI: 10.1289/ehp.1103647] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 10/20/2011] [Indexed: 05/03/2023]
Abstract
BACKGROUND Diabetes increases the risk of hypertension and orthostatic hypotension and raises the risk of cardiovascular death during heat waves and high pollution episodes. OBJECTIVE We examined whether short-term exposures to air pollution (fine particles, ozone) and heat resulted in perturbation of arterial blood pressure (BP) in persons with type 2 diabetes mellitus (T2DM). METHODS We conducted a panel study in 70 subjects with T2DM, measuring BP by automated oscillometric sphygmomanometer and pulse wave analysis every 2 weeks on up to five occasions (355 repeated measures). Hourly central site measurements of fine particles, ozone, and meteorology were conducted. We applied linear mixed models with random participant intercepts to investigate the association of fine particles, ozone, and ambient temperature with systolic, diastolic, and mean arterial BP in a multipollutant model, controlling for season, meteorological variables, and subject characteristics. RESULTS An interquartile increase in ambient fine particle mass [particulate matter (PM) with an aerodynamic diameter of ≤ 2.5 μm (PM2.5)] and in the traffic component black carbon in the previous 5 days (3.54 and 0.25 μg/m3, respectively) predicted increases of 1.4 mmHg [95% confidence interval (CI): 0.0, 2.9 mmHg] and 2.2 mmHg (95% CI: 0.4, 4.0 mmHg) in systolic BP (SBP) at the population geometric mean, respectively. In contrast, an interquartile increase in the 5-day mean of ozone (13.3 ppb) was associated with a 5.2 mmHg (95% CI: -8.6, -1.8 mmHg) decrease in SBP. Higher temperatures were associated with a marginal decrease in BP. CONCLUSIONS In subjects with T2DM, PM was associated with increased BP, and ozone was associated with decreased BP. These effects may be clinically important in patients with already compromised autoregulatory function.
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Affiliation(s)
- Barbara Hoffmann
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
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Abstract
Countries of the Persian Gulf region--Bahrain, Iran, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates--have become increasingly modernized, resulting in a transformation of lifestyle based on technology, sedentary activity, lack of sunlight, and unhealthy dietary patterns. These factors have led to a higher prevalence not only of vitamin D undernutrition, but also chronic obesity, insulin resistance, prediabetes, and type 2 diabetes. This review explores the integrative physiologic effects of vitamin D with socioeconomic factors and propose a hypothesis-driven model for their contributions to obesity and diabetes in the Persian Gulf. Further research into these interactions may ultimately lead to novel preventive strategies and therapies for metabolic disorders in this geographic region.
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Affiliation(s)
- Jessica Fields
- Division of Endocrinology, Diabetes, and Bone Disease, Mount Sinai School of Medicine, New York, NY 10128, USA
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McMurray JJ, Holman RR, Haffner SM, Bethel MA, Holzhauer B, Hua TA, Belenkov Y, Boolell M, Buse JB, Buckley BM, Chacra AR, Chiang FT, Charbonnel B, Chow CC, Davies MJ, Deedwania P, Diem P, Einhorn D, Fonseca V, Fulcher GR, Gaciong Z, Gaztambide S, Giles T, Horton E, Ilkova H, Jenssen T, Kahn SE, Krum H, Laakso M, Leiter LA, Levitt NS, Mareev V, Martinez F, Masson C, Mazzone T, Meaney E, Nesto R, Pan C, Prager R, Raptis SA, Rutten GEHM, Sandstroem H, Schaper F, Scheen A, Schmitz O, Sinay I, Soska V, Stender S, Tamás G, Tognoni G, Tuomilehto J, Villamil AS, Vozár J, Califf RM. Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med 2010; 362:1477-90. [PMID: 20228403 DOI: 10.1056/nejmoa1001121] [Citation(s) in RCA: 428] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance. METHODS In this double-blind, randomized clinical trial with a 2-by-2 factorial design, we assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. We then followed the patients for a median of 5.0 years for the development of diabetes (6.5 years for vital status). We studied the effects of valsartan on the occurrence of three coprimary outcomes: the development of diabetes; an extended composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, arterial revascularization, or hospitalization for unstable angina; and a core composite outcome that excluded unstable angina and revascularization. RESULTS The cumulative incidence of diabetes was 33.1% in the valsartan group, as compared with 36.8% in the placebo group (hazard ratio in the valsartan group, 0.86; 95% confidence interval [CI], 0.80 to 0.92; P<0.001). Valsartan, as compared with placebo, did not significantly reduce the incidence of either the extended cardiovascular outcome (14.5% vs. 14.8%; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.43) or the core cardiovascular outcome (8.1% vs. 8.1%; hazard ratio, 0.99; 95% CI, 0.86 to 1.14; P=0.85). CONCLUSIONS Among patients with impaired glucose tolerance and cardiovascular disease or risk factors, the use of valsartan for 5 years, along with lifestyle modification, led to a relative reduction of 14% in the incidence of diabetes but did not reduce the rate of cardiovascular events. (ClinicalTrials.gov number, NCT00097786.)
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Holman RR, Haffner SM, McMurray JJ, Bethel MA, Holzhauer B, Hua TA, Belenkov Y, Boolell M, Buse JB, Buckley BM, Chacra AR, Chiang FT, Charbonnel B, Chow CC, Davies MJ, Deedwania P, Diem P, Einhorn D, Fonseca V, Fulcher GR, Gaciong Z, Gaztambide S, Giles T, Horton E, Ilkova H, Jenssen T, Kahn SE, Krum H, Laakso M, Leiter LA, Levitt NS, Mareev V, Martinez F, Masson C, Mazzone T, Meaney E, Nesto R, Pan C, Prager R, Raptis SA, Rutten GEHM, Sandstroem H, Schaper F, Scheen A, Schmitz O, Sinay I, Soska V, Stender S, Tamás G, Tognoni G, Tuomilehto J, Villamil AS, Vozár J, Califf RM. Effect of nateglinide on the incidence of diabetes and cardiovascular events. N Engl J Med 2010; 362:1463-76. [PMID: 20228402 DOI: 10.1056/nejmoa1001122] [Citation(s) in RCA: 323] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The ability of short-acting insulin secretagogues to reduce the risk of diabetes or cardiovascular events in people with impaired glucose tolerance is unknown. METHODS In a double-blind, randomized clinical trial, we assigned 9306 participants with impaired glucose tolerance and either cardiovascular disease or cardiovascular risk factors to receive nateglinide (up to 60 mg three times daily) or placebo, in a 2-by-2 factorial design with valsartan or placebo, in addition to participation in a lifestyle modification program. We followed the participants for a median of 5.0 years for incident diabetes (and a median of 6.5 years for vital status). We evaluated the effect of nateglinide on the occurrence of three coprimary outcomes: the development of diabetes; a core cardiovascular outcome that was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure; and an extended cardiovascular outcome that was a composite of the individual components of the core composite cardiovascular outcome, hospitalization for unstable angina, or arterial revascularization. RESULTS After adjustment for multiple testing, nateglinide, as compared with placebo, did not significantly reduce the cumulative incidence of diabetes (36% and 34%, respectively; hazard ratio, 1.07; 95% confidence interval [CI], 1.00 to 1.15; P=0.05), the core composite cardiovascular outcome (7.9% and 8.3%, respectively; hazard ratio, 0.94, 95% CI, 0.82 to 1.09; P=0.43), or the extended composite cardiovascular outcome (14.2% and 15.2%, respectively; hazard ratio, 0.93, 95% CI, 0.83 to 1.03; P=0.16). Nateglinide did, however, increase the risk of hypoglycemia. CONCLUSIONS Among persons with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors, assignment to nateglinide for 5 years did not reduce the incidence of diabetes or the coprimary composite cardiovascular outcomes. (ClinicalTrials.gov number, NCT00097786.)
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Krum H, McMurray JJV, Horton E, Gerlock T, Holzhauer B, Zuurman L, Haffner SM, Bethel MA, Holman RR, Califf RM. Baseline characteristics of the Nateglinide and Valsartan Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial population: comparison with other diabetes prevention trials. Cardiovasc Ther 2010; 28:124-32. [PMID: 20184589 DOI: 10.1111/j.1755-5922.2010.00146.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Nateglinide and Valsartan Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial is exploring two pharmacological strategies (nateglinide and valsartan, both alone and in combination) in the prevention of overt diabetes mellitus (DM) and the reduction of cardiovascular disease (CVD) in subjects at high risk for these events. In this analysis, we provide baseline characteristics of the randomized NAVIGATOR study population and contrast them with those from other trials of DM prevention. Key eligibility criteria include impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), a history of CVD (in patients aged > or =50 years), and > or =1 cardiovascular risk factor (in patients aged > or =55 years). Baseline demographic characteristics, laboratory findings, cardiovascular risk factors, CVD history, and medication use are described and compared with other trials of DM prevention. The full analysis set of subjects (N = 9306) showed a clustering of risk factors consistent with the metabolic syndrome: high rates of hypertension (77.5%), dyslipidemia (44.7%), increased waist circumference (101.0 cm), and high body mass index (BMI) (47.5% with BMI > or =30 kg/m(2)). A minority of patients had a history of CVD (24.3%); of these, 11.7% had a history of myocardial infarction and most of the remainder had evidence of coronary artery disease. Subjects also had elevated blood pressure (BP) (predominantly systolic) (139.7/82.6 mm Hg), increased serum low-density lipoproteins cholesterol levels (3.27 mmol/L), and borderline elevation of triglyceride levels (1.97 mmol/L). Demographic data, BP, and lipid profiles in NAVIGATOR were similar to those of previous DM prevention trials, which were also based largely on meeting criteria for IGT. Medication use at baseline among NAVIGATOR subjects, which frequently included aspirin, beta-blockers, calcium channel blockers, diuretics, and lipid-lowering agents, reflects enhanced CVD risk. However, little prescribing of renin-angiotensin-aldosterone system blockers was observed, likely due to protocol exclusion criteria. In conclusion, the NAVIGATOR study comprises prediabetic subjects who typically have concurrent BP and metabolic disturbances and an enhanced risk of CVD, and are thus at higher risk for cardiovascular events than subjects in previous DM prevention trials.
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Affiliation(s)
- Henry Krum
- Monash University/Alfred Hospital, Melbourne, Victoria 3004, Australia.
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Aschner P, Horton E, Leiter LA, Munro N, Skyler JS. Practical steps to improving the management of type 1 diabetes: recommendations from the Global Partnership for Effective Diabetes Management. Int J Clin Pract 2010; 64:305-15. [PMID: 20456170 PMCID: PMC2814087 DOI: 10.1111/j.1742-1241.2009.02296.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Diabetes Control and Complications Trial (DCCT) led to considerable improvements in the management of type 1 diabetes, with the wider adoption of intensive insulin therapy to reduce the risk of complications. However, a large gap between evidence and practice remains, as recently shown by the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, in which 30-year rates of microvascular complications in the 'real world' EDC patients were twice that of DCCT patients who received intensive insulin therapy. This gap may be attributed to the many challenges that patients and practitioners face in the day-to-day management of the disease. These barriers include reaching glycaemic goals, overcoming the reality and fear of hypoglycaemia, and appropriate insulin therapy and dose adjustment. As practitioners, the question remains: how do we help patients with type 1 diabetes manage glycaemia while overcoming barriers? In this article, the Global Partnership for Effective Diabetes Management provides practical recommendations to help improve the care of patients with type 1 diabetes.
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Affiliation(s)
- P Aschner
- Javeriana University School of Medicine, Bogota, Colombia
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Horton E, Cefalu WT, Haines ST, Siminerio LM. Multidisciplinary interventions: mapping new horizons in diabetes care. Diabetes Educ 2008; 34 Suppl 4:78S-89S. [PMID: 18664711 DOI: 10.1177/0145721708321s148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than 20 million people in the United States, or 7% of the population, have diabetes, with health care and work-related costs estimated to be $174 billion in 2007. Obesity constitutes one of the major driving factors behind this epidemic. Most drugs currently used to treat diabetes address the primary metabolic defects in type 2 diabetes mellitus, which are insulin resistance and pancreatic islet dysfunction. Incretin augmentation therapies, such as glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase IV inhibitors, restore glucose homeostasis by addressing some of the unmet needs in diabetes therapies related to alpha-cell dysfunction and chronic beta-cell dysfunction. This new group of drugs offers certain advantages because its use is characterized by a low incidence of hypoglycemia and the absence of weight gain. Moreover, the use of fixed-dose combinations of dipeptidyl peptidase IV inhibitors with other oral antidiabetic agents seems very attractive to patients because of their reduced pill intake and minimized financial burden, which may improve adherence. An efficient strategy to slow down the epidemic of diabetes must include these emerging therapies and regimens, coupled with intensive patient education that includes information on treatment benefits and adverse effects, medication costs, and medication regimen complexity.
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Affiliation(s)
- Edward Horton
- Vice President and Director of Clinical Research, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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Horton E, Cefalu WT, Haines ST, Siminerio LM. Multidisciplinary Interventions: Mapping New Horizons in Diabetes Care. The Diabetes Educator 2008. [DOI: 10.1177/0145721708321148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Perreault L, Ma Y, Dagogo-Jack S, Horton E, Marrero D, Crandall J, Barrett-Connor E. Sex differences in diabetes risk and the effect of intensive lifestyle modification in the Diabetes Prevention Program. Diabetes Care 2008; 31:1416-21. [PMID: 18356403 PMCID: PMC2453677 DOI: 10.2337/dc07-2390] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In participants of the Diabetes Prevention Program (DPP) randomized to intensive lifestyle modification (ILS), meeting ILS goals strongly correlated with prevention of diabetes in the group as a whole. Men met significantly more ILS goals than women but had a similar incidence of diabetes. Therefore, we explored sex differences in risk factors for diabetes and the effect of ILS on risk factors. RESEARCH DESIGN AND METHODS Baseline risk factors for diabetes and percent change in risk factors over the first year in men versus women were compared using Wilcoxon's rank-sum tests. RESULTS At baseline, men were older and had a larger waist circumference; higher fasting plasma glucose concentration, caloric intake, and blood pressure; and lower HDL cholesterol and corrected insulin response than women, who were less physically active and had a higher BMI (P < 0.01 for all comparisons). Over the first year of the DPP, no sex difference in risk factors for diabetes was observed for those who lost <3% body weight. Weight loss of 3-7% body weight yielded greater decreases in 2-h glucose (P < 0.01), insulin concentration (P < 0.04), and insulin resistance (P < 0.03) in men than in women. Weight loss of >7% body weight resulted in greater decreases in 2-h glucose (P < 0.01), triglyceride level (P < 0.01), and A1C (P < 0.03) in men than in women. CONCLUSIONS Weight loss >3% body weight yielded greater reduction in risk factors for diabetes in men than in women. Despite the more favorable effects of ILS in men, baseline risk factors were more numerous in men and likely obscured any sex difference in incident diabetes.
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Affiliation(s)
- Leigh Perreault
- University of Colorado Health Sciences Center, Aurora, Colorado, USA
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Varo N, Vicent D, Libby P, Nuzzo R, Calle-Pascual AL, Bernal MR, Fernández-Cruz A, Veves A, Jarolim P, Varo JJ, Goldfine A, Horton E, Schönbeck U. Elevated plasma levels of the atherogenic mediator soluble CD40 ligand in diabetic patients: a novel target of thiazolidinediones. Circulation 2003; 107:2664-9. [PMID: 12742991 DOI: 10.1161/01.cir.0000074043.46437.44] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Considerable evidence implicates the proinflammatory cytokine CD40 ligand (CD40L) in atherosclerosis and accumulating data link type 1 and 2 diabetes, conditions associated with accelerated atherosclerosis, to inflammation. This study therefore evaluated the hypothesis that diabetic patients have elevated plasma levels of soluble CD40L (sCD40L) and that treatment with the insulin-sensitizing thiazolidinediones lowers this index of inflammation. METHODS AND RESULTS Subjects with type 1 (n=49) or type 2 diabetes (n=48) had higher (P<0.001) sCD40L plasma levels (6.56+/-3.27 and 6.67+/-2.90 ng/mL, respectively) compared with age-matched control groups (1.40+/-2.21 and 1.32+/-2.68 ng/mL, respectively). Multiple regression analysis demonstrated a significant (P<0.001) association between plasma sCD40L and type 1 as well as type 2 diabetes, independent of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, body mass index, gender, C-reactive protein, and soluble intracellular adhesion molecule-1. Furthermore, in a pilot study, administration of troglitazone (12 weeks, 600 mg/day), but not placebo, to type 2 diabetics (n=68) significantly (P<0.001) diminished sCD40L plasma levels by 29%. The thiazolidinedione lowered plasma sCD40L in type 2 diabetic patients with long-standing disease (>3 years) with or without macrovascular complications (-34% and -29%, respectively) as well as in type 2 diabetic patients with more recent (<3 years) onset of the disease (-27%; all P<0.05). CONCLUSIONS This study provides new evidence that individuals with type 1 or 2 diabetes have a proinflammatory state as indicated by elevated levels of plasma sCD40L. Troglitazone treatment of type 2 diabetic patients diminishes sCD40L levels, suggesting a novel antiinflammatory mechanism for limiting diabetes-associated arterial disease.
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Affiliation(s)
- Nerea Varo
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, Mass 02115, USA
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Couriel D, Hicks K, Giralt S, Ippoliti C, Khouri I, de LM, Horton E, Cohen A, Hosing C, Donato M, Anderlini P, Molldrem J, Gajewski J, Champlin R. 102Phase III trial with infliximab/methylprednisolone (MP) vs MP for the treatment of acute GVHD: Preliminary findings. Biol Blood Marrow Transplant 2003. [DOI: 10.1016/s1083-8791(03)80103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Epidemiologic, animal, clinical, and metabolic studies demonstrate the independent roles of physical activity and nutrition in the prevention and treatment of several chronic diseases. Fewer data are available to describe the synergistic effects of exercise and diet, and questions remain as to whether and how these two lifestyle factors work together to promote health and prevent disease. This paper briefly reviews many of the known effects of physical activity and nutrition on the prevention and treatment of coronary heart disease, non-insulin-dependent diabetes mellitus, obesity, and osteoporosis as well as how exercise and diet may work together. A discussion of how to increase physical activity levels and how to improve dietary intake also is included. Finally, current exercise and dietary recommendations are summarized, as are directions for future research.
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Affiliation(s)
- S N Blair
- Cooper Institute for Aerobics Research, Dallas, TX, USA
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Horton E. A provider to managed care. Behav Healthc Tomorrow 1995; 4:22, 75. [PMID: 10156798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Ruderman N, Horton E, Kemmer F, Berger M. The lost symposium. Diabetes and exercise 1990. Diabetes Care 1993; 16:959-60. [PMID: 8325223 DOI: 10.2337/diacare.16.6.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
RESEARCH OPPORTUNITIES— Critical scientific and practical questions are whether it is possible to prevent NIDDM and whether early treatment of diabetes is effective. There are three potential strategies that may retard the development of prevention of NIDDM and which are also of importance in the early treatment of NIDDM—control of obesity, preservation of insulin action, and preservation of insulin secretion. The panel stressed the impact of exercise both on the control of obesity and the preservation of insulin action. A structured exercise program such as that conducted in the Zuni community can be made available to an entire community. The importance of community involvement in establishing and sustaining such programs, and the importance of using sound principles of effective behavior modification were recognized.
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Douglas PS, Clarkson TB, Flowers NC, Hajjar KA, Horton E, Klocke FJ, LaRosa J, Shively C. Exercise and atherosclerotic heart disease in women. Med Sci Sports Exerc 1992; 24:S266-76. [PMID: 1625552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Goodyear LJ, Brahman M, Horton E, Knutson S, Horton ES. 316. Med Sci Sports Exerc 1987. [DOI: 10.1249/00005768-198704001-00316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Buckspan R, Hoxworth B, Cersosimo E, Devlin J, Horton E, Abumrad N. alpha-Ketoisocaproate is superior to leucine in sparing glucose utilization in humans. Am J Physiol 1986; 251:E648-53. [PMID: 3538898 DOI: 10.1152/ajpendo.1986.251.6.e648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The present study was designed to examine the glucose-sparing effect of leucine and its keto acid alpha-ketoisocaproate (KIC) in vivo. Two groups of overnight-fasted normal volunteers were studied. In the first group, eight subjects received an intravenous infusion of leucine and six subjects received KIC (2.3 mumol X kg-1 X min-1) for 3 h; on another occasion, all subjects received saline and acted as their own controls. In the second group, 11 subjects received an infusion of 1 mU X kg-1 X min-1 for 3 h with a variable glucose infusion to maintain euglycemia. On another occasion, five subjects received an additional infusion of leucine and six subjects received KIC each at 2.3 mumol X kg-1 X min-1 for 3 h. The amount of exogenous glucose required to maintain euglycemia (M, mg X kg-1 X min-1) was used as an index of total body glucose utilization. Forearm exchange of leucine, KIC, glucose, and lactate was determined in both groups. Both leucine and KIC infusions alone decreased glucose uptake (42 and 40%) and increased lactate release (37 and 116%, respectively). Hyperinsulinemia (6-fold basal) and euglycemia resulted in a fivefold increase in glucose uptake across the human forearm. The amount of exogenous glucose required to maintain euglycemia averaged 7.4 +/- 0.5 mg X kg-1 X min-1. The combination of leucine and insulin infusions did not alter the stimulated forearm glucose uptake nor did it change M (7.25 +/- 0.6 mg X kg-1 X min-1, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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Agris PF, Playl T, Goldman L, Horton E, Woolverton D, Setzer D, Rodi C. Processing of tRNA is accomplished by a high-molecular-weight enzyme complex. Recent Results Cancer Res 1983; 84:237-54. [PMID: 6844694 DOI: 10.1007/978-3-642-81947-6_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
An enzyme complex is a multifunctional catalytic unit that efficiently associates substrates with functionally related enzymes. The enzyme complex provides for the cellular regulation of enzymatic activities by physical interaction of the proteins with each other and by prior alteration of one enzyme's substrate by a related enzyme. Such regulatory abilities may go awry in neoplasia. Components of the protein biosynthetic machinery, such as aminoacyl-tRNA synthetases, have been thought to exist freely in the cytoplasm. However, high-molecular-weight enzyme complexes with aminoacyl-tRNA synthetase activities have been found in mammalian cells. We have been the first to report that the mammalian cell enzymes responsible for modification of tRNA occur in enzyme complexes (molecular weight 900000 daltons) associated with aminoacyl-tRNA synthetases and that the activities of these enzymes differ in normal and leukemic cells. Thus the enzymes responsible for the methylation of tRNA occur in enzyme complexes that provide efficient maturation of tRNA and possible regulation of protein synthesis. In FLC cells a unique enzyme complex composed of tRNA-methyltransferase and aminoacyl-tRNA synthetase activities has also been shown to contain a specific ribonuclease activity and a cysteine-tRNA sulfurtransferase activity. Sulfurtransferase activity has been characterized and optimized for its tRNA and cysteine substrates and mercaptoethanol and cation cofactors. Abnormal activity of this enzyme during neoplasia could result in improper acylation of tRNA and/or infidelity of coding by tRNA. Specific RNase is important in the sizing of percursor tRNA into mature tRNA. Results showed that this sizing was dependent upon the presence of the enzyme complex and the length of the incubation time. Many of the 20 aminoacyl-tRNA synthetases are also found in the complex. Electron microscopy has verified the subunit nature of the complex, seen previously by density gradient centrifugation and gel filtration. Three subunits, each of 300 000 daltons, comprise a complex approximately 200 A in diameter.
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