Evaluation of an Electronic Platform to Record Lifestyle Habits in Subjects at Risk of Developing Type 2 Diabetes in a Middle-Income Population

Objectives

Lifestyle is the main focus of Type 2 diabetes (T2D) prevention strategies. mHealth-based therapy has proved positive results for T2D prevention in high-income settings, but little is known about its effectiveness in low- and middle-income populations where the burden of T2D is substantial. We sought to identify barriers, feasibility, usability, and effectiveness of an electronic platform “Vida Sana”, to record lifestyle habits in subjects at risk of developing type 2 diabetes in a middle-income setting.

Methods

This was a 3-month prospective interventional study of subjects at risk of T2D (prediabetes and body mass index (BMI) between 24 kg/m2 and 40 kg/m2.) Feasibility was assessed by study retention. Usability was evaluated with the System Usability Scale (SUS). Effectiveness measures included changes in weight, body composition, BMI, anthropometric measures, glycated hemoglobin (HbA1c), and fasting blood glucose from baseline to 3-month visit. Linear regression models were used to account for covariates.

Results

The feasibility of Vida Sana was 42.8% (n = 33 subjects), and the usability was 48.7% ± 14.2. The barriers reported for not using the platform were difficulty for access to the platform (36.3%), lack of time to record their habits (34.0%) lack of interest to record their habits (18.18%), and lack of resources (11.3%) (computer or internet). The platform was effective for lowering glucose in fasting (−3.1 mg/dL vs −0.11 ± 8.08; P = 0.038) and at 2 hr (−16.9 mg/dL vs 2.5 ± 26.1; P = 0.045), body fat % (−1.3 (−2.2 – −0.7) s −1.02 (−1.9 - −0.3); P = 0.024), and waist circumference (−3.2 ± 5.1 cm vs −1.7 ± 5.0; P = 0.023) independent their age, sex, treatment and education attainment.

Conclusions

The use of an electronic platform was effective to improve glycemic and anthropometric parameters in a population at risk of developing diabetes. Improving accessibility and ease of navigation could be objectives to improve the acceptance of mobile applications in a middle-income population.

Funding Sources

Miguel Aleman Medical Research Award.

Recent advances in managing/understanding the metabolic syndrome

The metabolic syndrome (MetS) concept gathers in a single entity a set of metabolic abnormalities that have in common a close relationship with ectopic deposit of lipids, insulin resistance, and chronic low-grade inflammation. It is a valuable teaching tool to help health professionals to understand and integrate the consequences of lipotoxicity and the adverse metabolic consequences of insulin resistance. Also, it is useful to identify subjects with a high risk for having incident type 2 diabetes. Systems biology studies have gained a prominent role in understanding the interaction between adipose tissue dysfunction, insulin action, and the MetS traits and co-morbidities (that is, non-alcoholic steatohepatitis, or NASH). This approach may allow the identification of new therapeutic targets (that is, de novo lipogenesis inhibitors for NASH). Treatment targets on MetS are the adoption of a healthy lifestyle, weight loss, and the control of the co-morbidities (hyperglycemia, dyslipidemia, arterial hypertension, among others). The long-term goals are the prevention of type 2 diabetes, cardiovascular events, and other MetS-related outcomes. In the last few decades, new drugs derived from the identification of innovative treatment targets have come on the market. These drugs have positive effects on more than one MetS component (that is, hyperglycemia and weight control). New potential treatment targets are under study.

METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes

OBJECTIVE

We developed a novel non-insulin-based fasting score to evaluate insulin sensitivity validated against the euglycemic-hyperinsulinemic clamp (EHC). We also evaluated its correlation with ectopic fact accumulation and its capacity to predict incident type 2 diabetes mellitus (T2D).

DESIGN AND METHODS

The discovery sample was composed by 125 subjects (57 without and 68 with T2D) that underwent an EHC. We defined METS-IR as Ln((2*G₀)+TG₀)*BMI)/(Ln(HDL-c)) (G₀: fasting glucose, TG₀: fasting triglycerides, BMI: body mass index, HDL-c: high-density lipoprotein cholesterol), and compared its diagnostic performance against the M-value adjusted by fat-free mass (MFFM) obtained by an EHC. METS-IR was validated in a sample with EHC data, a sample with modified frequently sampled intravenous glucose tolerance test (FSIVGTT) data and a large cohort against HOMA-IR. We evaluated the correlation of the score with intrahepatic and intrapancreatic fat measured using magnetic resonance spectroscopy. Subsequently, we evaluated its ability to predict incident T2D cases in a prospective validation cohort of 6144 subjects.

RESULTS

METS-IR demonstrated the better correlation with the MFFM (ρ = -0.622, P < 0.001) and diagnostic performance to detect impaired insulin sensitivity compared to both EHC (AUC: 0.84, 95% CI: 0.78-0.90) and the SI index obtained from the FSIVGTT (AUC: 0.67, 95% CI: 0.53-0.81). METS-IR significantly correlated with intravisceral, intrahepatic and intrapancreatic fat and fasting insulin levels (P < 0.001). After a two-year follow-up, subjects with METS-IR in the highest quartile (>50.39) had the highest adjusted risk to develop T2D (HR: 3.91, 95% CI: 2.25-6.81). Furthermore, subjects with incident T2D had higher baseline METS-IR compared to healthy controls (50.2 ± 10.2 vs 44.7 ± 9.2, P < 0.001).

CONCLUSION

METS-IR is a novel score to evaluate cardiometabolic risk in healthy and at-risk subjects and a promising tool for screening of insulin sensitivity.