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Zhang L, Cheng X, Yang Y, Li X, Yuan Y. Optimal dosage and modality of exercise on glycemic control in people with prediabetes: a systematic review and network meta-analysis. Front Endocrinol (Lausanne) 2025; 16:1560676. [PMID: 40357204 PMCID: PMC12066256 DOI: 10.3389/fendo.2025.1560676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 03/31/2025] [Indexed: 05/15/2025] Open
Abstract
Aims This study aims to assess the effects of different exercise types and their specific doses on glycemic control among individuals with prediabetes. Methods Multiple databases were subjected to a comprehensive search for randomized controlled trials (RCTs) published until 15 July 2024. The study protocol was prospectively registered with PROSPERO (CRD42024573186). The exercise interventions analyzed included aerobic exercise (AE), resistance training (RT), and combined aerobic-resistance training (AE+RT). Outcomes were quantified using standardized mean difference (SMD) with 95% credible intervals (CrIs), employing the confidence in network meta-analysis (CINeMA) framework for network meta-analysis to confirm the outcome reliability. Results According to the network meta-analysis, irrespective of dose, AE+RT led to the largest decrease in fasting blood glucose (FBG) (-0.44, [-0.62 to -0.26]). AE alone resulted in the largest reductions in 2-hour post-meal blood glucose (2hPG) (-0.71, [-0.97 to -0.45]) and glycosylated hemoglobin A1c (HbA1c) (-0.30, [-0.37 to -0.22]). Dose-response (DR) analysis identified optimal doses for each exercise type: 880 metabolic equivalent of task minutes per week (METs-min/week) for both AE and RT and 800 METs-min/week for AE+RT to reduce FBG. The optimal dose for 2hPG improvement via AE was 1,100 METs-min/week, and for HbA1c reduction via RT, it was 870 METs-min/week. Conclusions Given the variety of impaired glucose regulation (IGR), we recommend that people with prediabetes engage in RT at 1,100 METs-min/week to improve 2hPG and at 870 METs-min/week to reduce HbA1c. For FBG control, a dose of 800 METs-min/week is optimal for all exercise modalities. These evidence-based recommendations provide practical guidance for designing personalized exercise prescriptions to manage prediabetes.
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Affiliation(s)
- Lin Zhang
- Department of Rehabilitation, Jintang First People’s Hospital, Chengdu, China
| | - Xing Cheng
- College of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei, China
| | - Xue Li
- The Rehabilitation Medicine Center, People’s Hospital of Deyang City, Deyang, China
| | - Yuan Yuan
- Department of Sport and Exercise Sciences, Kunsan National University, Gunsan-Si, Republic of Korea
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Andrade CAS, Lovas S, Mahrouseh N, Chamouni G, Shahin B, Mustafa EOA, Muhlis ANA, Njuguna DW, Israel FEA, Gammoh N, Chandrika N, Atuhaire NC, Ashkar I, Chatterjee A, Charles R, Alzuhaily H, Almusfy A, Díaz Benavides D, Alshakhshir FK, Varga O. Primary Prevention of Type 2 Diabetes Mellitus in the European Union: A Systematic Review of Interventional Studies. Nutrients 2025; 17:1053. [PMID: 40292470 PMCID: PMC11945428 DOI: 10.3390/nu17061053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 03/11/2025] [Accepted: 03/15/2025] [Indexed: 04/30/2025] Open
Abstract
Interventions for primary prevention are crucial in tackling type 2 diabetes (T2D) by offering a structured approach to implementing lifestyle modifications, such as community-based programs. The aim of this study was to demonstrate the effectiveness of primary prevention interventions in preventing or delaying the onset of T2D in the 28 EU member states (EU-28). The present systematic review is registered on PROSPERO (CRD42020219994), and it followed the PRISMA guidelines. Eligibility criteria comprised original interventional studies reporting incidence of T2D in member states of the EU-28. A total of 23,437 records were initially retrieved, of which 16 met the eligibility criteria for inclusion. These interventional studies, published between 2003 and 2021, provided data from Spain, the UK, Finland, the Netherlands, and Denmark. Thirteen studies were of low quality, two were moderate, and one was high-quality. Three studies focused solely on dietary interventions, twelve studies combined diet, physical activity, and lifestyle counseling, and one study applied repeated health checks with personalized feedback and lifestyle advice. Overall, 10 studies reported a significant reduction in T2D incidence exclusively among high-risk individuals following the interventions with HR: 0.4 (95% CI: 0.3-0.7) to 0.75 (95% CI: 0.58-0.96). Only a few studies reported that primary lifestyle interventions decreased T2D risk, thus limiting generalizability. While lifestyle improvements were noted on high-risk groups, significant risk reduction among healthy individuals was not observed. Multicomponent interventions combining dietary modifications, physical activity, and personalized lifestyle counseling were the most effective in reducing the incidence of T2D among high-risk populations in the EU-28.
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Affiliation(s)
- Carlos Alexandre Soares Andrade
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Szabolcs Lovas
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Ghenwa Chamouni
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Balqees Shahin
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Eltayeb Omaima Awad Mustafa
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Abdu Nafan Aisul Muhlis
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Diana Wangeshi Njuguna
- Medical Surgical Department, School of Nursing, Dedan Kimathi University of Technology, Nyeri 10143, Kenya;
| | - Frederico Epalanga Albano Israel
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Nasser Gammoh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Niyati Chandrika
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Nkunzi Conetta Atuhaire
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Israa Ashkar
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain;
| | - Anoushka Chatterjee
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Rita Charles
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Hasan Alzuhaily
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Alaa Almusfy
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Daniela Díaz Benavides
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - F. K. Alshakhshir
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (C.A.S.A.); (S.L.); (G.C.); (B.S.); (E.O.A.M.); (A.N.A.M.); (F.E.A.I.); (N.G.); (N.C.); (N.C.A.); (A.C.); (R.C.); (H.A.); (A.A.); (D.D.B.)
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Moura FA, Kamanu FK, Wiviott SD, Giugliano RP, Udler MS, Florez JC, Ellinor PT, Sabatine MS, Ruff CT, Marston NA. Type 2 diabetes genetic risk and incident diabetes across diabetes risk enhancers. Diabetes Obes Metab 2025; 27:1287-1295. [PMID: 39696834 DOI: 10.1111/dom.16123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 11/22/2024] [Accepted: 11/25/2024] [Indexed: 12/20/2024]
Abstract
AIMS To evaluate the predictive value of a contemporary type 2 diabetes (T2D) polygenic score (PGS) in detecting incident diabetes across a range of diabetes risk factors. MATERIALS AND METHODS We analysed participants in the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial (ClinicalTrials.gov, number NCT0176463), which compared the efficacy of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab versus placebo in lowering cardiovascular outcomes in participants with stable atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg/dL (1.8 mmol/L) or higher who were receiving statin therapy. Genetic risk was characterized using a previously validated T2D PGS based on ~1.2 million single-nucleotide polymorphisms. PGS was analysed continuously and categorically as high (top 20% of the PGS) and low to intermediate (lower 80% of the PGS). The effect of evolocumab on incident diabetes in patients without diabetes at baseline was also assessed. HbA1c was measured at baseline and every 24 weeks thereafter, while FPG was measured at baseline, week 12, week 24 and every 24 weeks thereafter. Potential cases of incident diabetes were adjudicated centrally. Hazards ratios (HRs) for incident diabetes were adjusted for baseline characteristics and ancestry. RESULTS Among 9388 participants, the mean age was 63 ± 9 years and 22.7% were women, with median HbA1c 39 mmol/mol (36 mmol/mol - 41 mmol/mol; 5.7% [5.4%-5.9%]) and mean body mass index (BMI) 28.7 ± 5 kg/m2. Diabetes developed in 690 participants (7.3%) during 2.3 years of median follow-up. T2D PGS predicted incident T2D (HR per 1-SD 1.22, 95% CI 1.14-1.32, p < 0.001). The rates of incident T2D in the high and low to intermediate genetic risk categories were 12.1% versus 6.8%, respectively (HR 1.43 95% CI 1.20-1.70, p < 0.001). Notably, high T2D genetic risk had greater predictive strength among individuals with lower HbA1c (P-int = 0.0499) and lower BMI (P-int = 0.004). CONCLUSIONS The T2D polygenic score serves as an independent predictor of incident diabetes, particularly among individuals with lower distribution of traditional risk factors.
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Affiliation(s)
- Filipe A Moura
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Frederick K Kamanu
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen D Wiviott
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Miriam S Udler
- Center for Genomic Medicine and Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose C Florez
- Center for Genomic Medicine and Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas A Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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León-Samaniego GF, Romero Urréa HE, Espinoza-Carrasco F, Llimaico Noriega MDJ, Encalada Campos GE, Herrera P, Chavez-Cembellin A, Faytong-Haro M. Metabolic Syndrome Indicators and Cardiovascular/Endocrine Risks in Rural Ecuador: A Cross-Sectional Study. J Pers Med 2025; 15:78. [PMID: 40137394 PMCID: PMC11942871 DOI: 10.3390/jpm15030078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 02/12/2025] [Accepted: 02/14/2025] [Indexed: 03/27/2025] Open
Abstract
Background/Objectives: This study assessed the prevalence of metabolic syndrome (MetS) and its association with cardiovascular and endocrine diseases in a rural Ecuadorian parish population. Methods: This cross-sectional study included 200 participants. Descriptive statistics were computed for glucose, total cholesterol, and triglyceride levels. Logistic regression estimated the odds ratios (ORs) for the likelihood of cardiovascular (hypertension, coronary artery disease, stroke) and endocrine diseases (diabetes and other metabolic disorders) in relation to MetS biomarkers. Results: The study included 200 participants, with average glucose (123.09 mg/dL), cholesterol (229.58 mg/dL), and triglycerides (188.75 mg/dL) levels exceeding standard thresholds. Logistic regression analysis showed that glucose was the strongest predictor, increasing cardiovascular disease odds by 6.9% (OR = 1.069, p < 0.001) and endocrine disease odds by 11.8% (OR = 1.118, p < 0.001) after adjustment. Cholesterol and triglycerides also significantly contributed to the risk of both diseases. The models demonstrated a high predictive performance (AUC: 0.933 for cardiovascular disease and 0.993 for endocrine diseases). Conclusions: MetS was significantly associated with cardiovascular and endocrine disease risks in the rural population. Integrating personalized healthcare, such as tailored dietary counseling, culturally adapted interventions, and mobile health technologies, is crucial for improving the early detection and management of MetS in underserved communities.
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Affiliation(s)
- Guillermo Fernando León-Samaniego
- Facultad de Salud y Servicios Sociales, Universidad Estatal de Milagro, Milagro 091050, Ecuador; (H.E.R.U.); (F.E.-C.); (M.d.J.L.N.); (P.H.)
| | - Holguer Estuardo Romero Urréa
- Facultad de Salud y Servicios Sociales, Universidad Estatal de Milagro, Milagro 091050, Ecuador; (H.E.R.U.); (F.E.-C.); (M.d.J.L.N.); (P.H.)
| | - Freddy Espinoza-Carrasco
- Facultad de Salud y Servicios Sociales, Universidad Estatal de Milagro, Milagro 091050, Ecuador; (H.E.R.U.); (F.E.-C.); (M.d.J.L.N.); (P.H.)
| | - Mariana de Jesús Llimaico Noriega
- Facultad de Salud y Servicios Sociales, Universidad Estatal de Milagro, Milagro 091050, Ecuador; (H.E.R.U.); (F.E.-C.); (M.d.J.L.N.); (P.H.)
| | - Grecia Elizabeth Encalada Campos
- Facultad de Salud y Servicios Sociales, Universidad Estatal de Milagro, Milagro 091050, Ecuador; (H.E.R.U.); (F.E.-C.); (M.d.J.L.N.); (P.H.)
| | - Pedro Herrera
- Facultad de Salud y Servicios Sociales, Universidad Estatal de Milagro, Milagro 091050, Ecuador; (H.E.R.U.); (F.E.-C.); (M.d.J.L.N.); (P.H.)
| | | | - Marco Faytong-Haro
- Facultad de Ciencias de la Salud, Universidad Espíritu Santo, Samborondón 0901962, Ecuador;
- Facultad de Investigación, Universidad Estatal de Milagro, Milagro 091050, Ecuador
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Vetrani C, Verde L, Ambretti A, Muscogiuri G, Pagano AM, Lucania L, Colao A, Barrea L. Nutritional interventions in prison settings: a scoping review. Nutr Rev 2025; 83:397-404. [PMID: 38366579 DOI: 10.1093/nutrit/nuae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Mounting evidence has shown that incarceration can affect the health and well-being of individuals and increase the risk of noncommunicable diseases (NCDs). Diet quality is known to be one of the main determinants of risk of NCDs, and dietary changes are the first approach used in primary care to reduce the incidence of NCDs. OBJECTIVE This scoping review aimed to summarize the evidence for (1) the diet quality of inmates, and (2) the effect of nutritional intervention in prison systems. In addition, we aimed to describe limitations in the current literature and to suggest potential future research areas. METHOD A systematic search was performed in 2 databases (PubMed and Web of Science) using predefined search terms and covering the period May 2023 to June 2023. Additionally, reference lists from the retrieved studies were hand-searched to identify any additional relevant publications. The identified literature was screened based on defined search strategies, criteria, and research questions defined using the PICo (population or problem, interest, and context) framework. The review was conducted referring to the PRISMA-ScR and the PICo framework. RESULTS A total of 19 studies out of 63 initially identified records were included in this review (11 cross-sectional evaluations and 9 intervention-based studies). In almost all studies, assessment of the diet quality of menus showed the menus to be nutritionally adequate, except for having a higher-than-recommended intake of total energy, saturated fatty acids, sodium, cholesterol, and sugar. In addition, some studies reported a lower-than-recommended intake of fiber, magnesium, potassium, vitamins D, E, and A, and omega-3 fatty acids. Nutritional interventions were mainly planned in the form of workshops, seminars, and written material to deliver information on healthy dietary choices. Although no significant changes in inmates' dietary choices were observed in any of the studies, a high participation rate was detected. CONCLUSION Inmates might require additional prevention intervention to reduce their susceptibility to cardiometabolic diseases by virtue of their isolation from community facilities. Interventions should be tailored to the characteristics of prison settings and inmates to increase adherence to nutritional recommendations.
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Affiliation(s)
- Claudia Vetrani
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale Isola F2, Naples, Italy
| | - Ludovica Verde
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antinea Ambretti
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale Isola F2, Naples, Italy
| | - Giovanna Muscogiuri
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University of Naples "Federico II", Naples, Italy
- UNESCO Chair "Education for Health and Sustainable Development", University of Naples "Federico II", Naples, Italy
| | - Antonio Maria Pagano
- President S.I.M.S.Pe. Società Italiana di Medicina e Sanità Penitenziaria (Italian Society of Penitentiary Medicine and Healthcare), Viale Bruno Buozzi, ROMA, Italy
- Dipartimento delle Attività Territoriali, Direttore U.O. Tutela Salute Adulti e Minori, Area Penale, ASL SALERNO, Salerno, Italy
| | - Luciano Lucania
- Director S.I.M.S.Pe. Società Italiana di Medicina e Sanità Penitenziaria (Italian Society of Penitentiary Medicine and Healthcare), Viale Bruno Buozzi, ROMA, Italy
- Specialista Ambulatoriale in Chirurgia, Responsabile Istituto Penitenziario di Reggio Calabria Giuseppe Panzera, Street Carcere Nuovo, 15, Reggio Calabria, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University of Naples "Federico II", Naples, Italy
- UNESCO Chair "Education for Health and Sustainable Development", University of Naples "Federico II", Naples, Italy
| | - Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale Isola F2, Naples, Italy
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Bruno J, Walker JM, Nasserifar S, Upadhyay D, Ronning A, Vanegas SM, Popp CJ, Barua S, Alemán JO. Weight-neutral early time-restricted eating improves glycemic variation and time in range without changes in inflammatory markers. iScience 2024; 27:111501. [PMID: 39759025 PMCID: PMC11699278 DOI: 10.1016/j.isci.2024.111501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/27/2024] [Accepted: 11/26/2024] [Indexed: 01/07/2025] Open
Abstract
Early time-restricted eating (eTRE) is a dietary strategy that restricts caloric intake to the first 6-8 h of the day and can effect metabolic benefits independent of weight loss. However, the extent of these benefits is unknown. We conducted a randomized crossover feeding study to investigate the weight-independent effects of eTRE on glycemic variation, multiple time-in-range metrics, and levels of inflammatory markers. Ten adults with prediabetes were randomized to eTRE (8-h feeding window, 80% of calories consumed before 14:00 h) or usual feeding (50% of calories consumed after 16:00 h) for 1 week followed by crossover to the other schedule. Using continuous glucose monitoring, we showed that eTRE decreased glycemic variation (mean amplitude of glycemic excursion) and time in hyperglycemia greater than 140 mg/dL without affecting inflammatory markers (erythrocyte sedimentation rate and C-reactive protein). These data implicate eTRE as a candidate dietary intervention for the weight-independent management of dysglycemia in high-risk individuals.
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Affiliation(s)
- Joanne Bruno
- Laboratory of Translational Obesity Research, New York University Langone Health, New York, NY 10016, USA
- Holman Division of Endocrinology, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | | | - Shabnam Nasserifar
- Laboratory of Translational Obesity Research, New York University Langone Health, New York, NY 10016, USA
- Holman Division of Endocrinology, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Dhairya Upadhyay
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Andrea Ronning
- The Rockefeller University Hospital, New York, NY 10065, USA
| | - Sally M. Vanegas
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Collin J. Popp
- Department of Population Health, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY 10016, USA
| | - Souptik Barua
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - José O. Alemán
- Laboratory of Translational Obesity Research, New York University Langone Health, New York, NY 10016, USA
- Holman Division of Endocrinology, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
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7
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Damschroder LJ, Hamilton A, Farmer MM, Bean‐Mayberry B, Richardson C, Chanfreau C, Oberman RS, Lesser R, Lewis J, Raffa SD, Goldstein MG, Haskell S, Finley E, Moin T. Real-world impacts from a decade of Quality Enhancement Research Initiative-partnered projects to translate the Diabetes Prevention Program in the Veterans Health Administration. Health Serv Res 2024; 59 Suppl 2:e14349. [PMID: 38967218 PMCID: PMC11540559 DOI: 10.1111/1475-6773.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES To describe the impacts of four Veterans Health Administration (VA) Quality Enhancement Research Initiative (QUERI) projects implementing an evidence-based lifestyle intervention known as the Diabetes Prevention Program (DPP). DATA SOURCES AND STUDY SETTING 2012-2024 VA administrative and survey data. STUDY DESIGN This is a summary of findings and impacts from four effectiveness-implementation projects focused on in-person and/or online DPP across VA sites. DATA COLLECTION/EXTRACTION METHODS Patient demographics, participation data, and key findings and impacts were summarized across reports from the VA Diabetes-Mellitus Quality Enhancement Research Initiative (QUERI-DM) Diabetes Prevention Program (VA DPP) Trial, QUERI-DM Online DPP Trial, the Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) QUERI DPP Project, and EMPOWER 2.0 QUERI Program. PRINCIPAL FINDINGS Between 2012 and 2024, four VA QUERI studies enrolled 963 Veterans in DPP across 16 VA sites. All participants had overweight/obesity with one additional risk factor for type 2 diabetes (i.e., prediabetes, elevated risk score, or history of gestational diabetes) and 56% (N = 536) were women. In addition to enhancing the reach of and engagement in diabetes prevention services among Veterans, these projects resulted in three key impacts as follows: (1) informing the national redesign of VA MOVE! including recommendations to increase the number of MOVE! sessions and revise guidelines across 150+ VA sites, (2) enhancing the national evidence base to support online DPP delivery options with citations in national care guidelines outside VA, and (3) demonstrating the importance of gender-tailoring of preventive care services by and for women Veterans to enhance engagement in preventive services. CONCLUSIONS Over the past decade, the evolution of VA QUERI DPP projects increased the reach of and engagement in diabetes prevention services among Veterans, including women Veterans who have been harder to engage in lifestyle change programs in VA, and resulted in three key impacts informing type 2 diabetes and obesity prevention efforts within and outside of VA.
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Affiliation(s)
- Laura J. Damschroder
- Ann Arbor VA Medical Center for Clinical Management ResearchAnn ArborMichiganUSA
| | - Alison Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
- David Geffen School of Medicine at the University of California Los Angeles (UCLA)Los AngelesCaliforniaUSA
| | - Melissa M. Farmer
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
| | - Bevanne Bean‐Mayberry
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
- David Geffen School of Medicine at the University of California Los Angeles (UCLA)Los AngelesCaliforniaUSA
| | | | - Catherine Chanfreau
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
- VHA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare SystemSalt Lake CityUtahUSA
| | - Rebecca S. Oberman
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
| | - Rachel Lesser
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
| | - Jackie Lewis
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
| | - Sue D. Raffa
- VHA National Center for Health Promotion and Disease PreventionDurhamNorth CarolinaUSA
| | - Micheal G. Goldstein
- Warren Alpert Medical School at Brown UniversityProvidenceRhode IslandUSA
- VHA National Center for Health Promotion and Disease PreventionDurhamNorth CarolinaUSA
| | - Sally Haskell
- VHA Office of Women's HealthWashingtonDCUSA
- Yale School of MedicineNew HavenConnecticutUSA
| | - Erin Finley
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
- Long School of MedicineUniversity of Texas Health Science Center San AntonioSan AntonioTexasUSA
| | - Tannaz Moin
- VA Center for the Study of Healthcare Innovation, Implementation & PolicyLos AngelesCaliforniaUSA
- David Geffen School of Medicine at the University of California Los Angeles (UCLA)Los AngelesCaliforniaUSA
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8
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Opazo-Díaz E, Montes-de-Oca-García A, Galán-Mercant A, Marín-Galindo A, Corral-Pérez J, Ponce-González JG. Characteristics of High-Intensity Interval Training Influence Anthropometrics, Glycemic Control, and Cardiorespiratory Fitness in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 2024; 54:3127-3149. [PMID: 39358495 DOI: 10.1007/s40279-024-02114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Exercise is a non-pharmacological intervention for type 2 diabetes mellitus (T2DM), including moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT). Despite diverse exercise protocol variations, the impact of these variations in HIIT on T2DM anthropometrics, glycemic control, and cardiorespiratory fitness (CRF) remains unclear. OBJECTIVE The aim was to examine the influence of HIIT protocol characteristics on anthropometrics, glycemic control, and CRF in T2DM patients and compare it to control (without exercise) and MICT. METHODS This review is registered in PROSPERO (CRD42021281398) and follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search, employing "high-intensity interval training" and "diabetes mellitus" in PubMed and Web of Science databases, with a "randomized controlled trial" filter, spanned articles up to January 2023. RESULTS Of 190 records, 29 trials were included, categorized by HIIT interval duration, training volume, and intervention period. Long-duration, high-volume, and long-term HIIT yields superior outcomes compared to control conditions for body mass, waist circumference, fasting plasma glucose, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), glycosylated hemoglobin (%HbA1c), and CRF. The findings favored HIIT over MICT for body mass in long-duration, high-volume, and short-term intervals (mean difference [MD] - 3.45, - 3.13, and - 5.42, respectively, all p < 0.05) and for CRF in long and medium work intervals and high volume (MD 1.91, 2.55, and 2.43, respectively, all p < 0.05), as well as in medium and long-term intervention (MD 2.66 and 2.21, respectively, all p < 0.05). Regardless of specific HIIT characteristics, no differences were found in the HIIT versus MICT comparison for glycemic control. CONCLUSIONS Specific HIIT protocol characteristics influence changes in anthropometrics, glycemic control, and CRF compared to control groups. However, compared to MICT, only longer duration, higher volume, and short-term HIIT improved body mass, waist circumference, and CRF in individuals with T2DM.
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Affiliation(s)
- Edgardo Opazo-Díaz
- ExPhy Research Group, Department of Physical Education, University of Cadiz, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
- Exercise Physiology Lab, Physical Therapy Department, University of Chile, Santiago, Chile
| | - Adrián Montes-de-Oca-García
- ExPhy Research Group, Department of Physical Education, University of Cadiz, Puerto Real, Cádiz, Spain.
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Alejandro Galán-Mercant
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
- MOVE-IT Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, University of Cádiz, Cádiz, Spain
| | - Alberto Marín-Galindo
- ExPhy Research Group, Department of Physical Education, University of Cadiz, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Juan Corral-Pérez
- ExPhy Research Group, Department of Physical Education, University of Cadiz, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Jesús Gustavo Ponce-González
- ExPhy Research Group, Department of Physical Education, University of Cadiz, Puerto Real, Cádiz, Spain.
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
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9
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Kalwaney S, Cerceo E. Plant-Based Diets: A Vital Component of Graduate Medical Education Programs on Climate and Health. J Grad Med Educ 2024; 16:40-44. [PMID: 39677890 PMCID: PMC11644602 DOI: 10.4300/jgme-d-23-00913.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2024] Open
Affiliation(s)
- Shirley Kalwaney
- is Director, Graduate Medical Education, Inova Fairfax Medical Campus, Falls Church, Virginia, USA; and
| | - Elizabeth Cerceo
- is Associate Director, Internal Medicine Residency Program, and Associate Professor of Medicine, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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10
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Chavez-Alfaro MA, Mensink RP, Gravesteijn E, Joris PJ, Plat J. Effects of long-term almond consumption on markers for vascular function and cardiometabolic risk in men and women with prediabetes: results of a randomized, controlled cross-over trial. Eur J Nutr 2024; 64:7. [PMID: 39546040 DOI: 10.1007/s00394-024-03510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 10/06/2024] [Indexed: 11/17/2024]
Abstract
PURPOSE The aim of this study was to investigate the long-term effects of almond consumption on peripheral vascular function, ambulant blood pressure profiles (ABP), and serum/plasma markers reflecting endothelial dysfunction and inflammation in participants with overweight/obesity and prediabetes. METHODS Thirty-four participants completed this single-blinded, randomized, cross-over trial with 5-month intervention and control periods, separated by a 2-month wash-out. During the intervention period, participants consumed 50 g of whole almonds daily. At the end of each intervention period, peripheral vascular function was assessed by measuring the carotid-to-femoral and carotid-to-radial pulse wave velocities (PWVc-f and PWVc-r, respectively) and retinal microvascular calibers. Serum/plasma concentrations of soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha (TNFα), serum amyloid A protein (SAA) and high-sensitivity C-reactive protein (hs-CRP) and 24-hour ABP were also analyzed. RESULTS Almond consumption did not significantly affect arterial stiffness (PWVc-f and PWVc-r), while central retinal venular equivalent (CRVE) was minimally increased by 2 μm (P = 0.019). Central retinal arteriolar equivalent (CRAE), the arteriolar-to-venular ratio (AVR), and endothelial and inflammatory serum/plasma markers showed no significant changes after almond consumption. Almond consumption reduced systolic blood pressure (SBP; -3 mmHg 24-hour P = 0.035, -4 mmHg daytime P = 0.046, and - 4 mmHg during nighttime P = 0.029), SBP variability during 24-hour, daytime, and nighttime (P = 0.005, P = 0.019, and P = 0.003, respectively), and diastolic blood pressure variability during nighttime (P ≤ 0.001). CONCLUSION Almond consumption did not affect arterial stiffness, retinal microvasculature calibers, or serum and plasma markers for endothelial dysfunction and inflammation in participants with prediabetics, while BP and BP variability were improved. CLINICAL TRIAL REGISTRATION This clinical trial was registered in February 2018 as NCT03419702.
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Affiliation(s)
- Marco A Chavez-Alfaro
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Elske Gravesteijn
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Peter J Joris
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
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11
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Sethi B, Seshadri K, Deshmukh V, Ag U, Baruah M, Phatak S, Ghosal S, Chittawar S, Aggarwal K, Hs B, Sada P. Harnessing Digital Initiatives for Improved Health Outcomes in Diabetes Management: An Observational Patient Program. Cureus 2024; 16:e73093. [PMID: 39650992 PMCID: PMC11621240 DOI: 10.7759/cureus.73093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2024] [Indexed: 12/11/2024] Open
Abstract
INTRODUCTION Patients with diabetes have easy access to a wide range of digital applications that may help with self-management and lower barriers; however, robust evidence of their effectiveness remains somewhat elusive. Zyla is a medical artificial intelligence (AI)-based personalized care management app that assists the treating physician in improving the standard of patient care by offering the patients comprehensive and individualized care. This preliminary evaluation of data collected through the Zyla app aims to understand the impact of diabetes disease outcomes among patients subscribed to this app. METHODS This was a retrospective, observational program conducted through the Zyla app in the calendar year 2020. The Zyla app's objective is to assist the treating physician in improving the standard of patient care by giving them the choice of assembling a personalized team (consisting of clinical nutritionists, physiotherapists, and counselors over a virtual platform) that can offer patients comprehensive and individualized care. Data on parameters like glycated hemoglobin (HbA1c), fasting blood sugar (FBS), post-prandial glucose (PPG), serum creatinine (SC), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were collected through the Zyla app. Clinical outcomes assessed were the change from baseline to last reported levels of the mentioned parameters and are reported using descriptive analysis. RESULTS The glycemic control parameters, HbA1c (change from baseline (CFB): -1.08), FBS (CFB: -15.93), and PPG levels (-18.42), were significantly lower (P<0.0001) at the last assessment compared with baseline. For the lipid profile, levels of TGs (P<0.0001) and TC (P = 0.0037) were significantly lower compared with baseline, while HDL-C levels were comparatively higher (CFB: 0.68) and LDL-C levels were lower (CFB:11.60), however non-significant. Serum creatinine was also lower compared to baseline (CFB: -0.25); however, the difference was not statistically significant. CONCLUSIONS A significant improvement in all glycemic parameters was seen with the use of the Zyla app along with numerical improvements in kidney function parameters and cholesterol status among patients. These preliminary findings warrant further rigorous studies to validate the impact of medical apps in the management of diabetics in India.
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Affiliation(s)
- Bipin Sethi
- Endocrinology, CARE Hospitals & Transplant Centre and CARE Hospitals, Outpatient Centre, Hyderabad, IND
| | | | | | - Unnikrishnan Ag
- Endocrinology, Chellaram Hospital - Diabetes Care and Multispeciality, Pune, IND
| | | | - Sanjeev Phatak
- Diabetes and Endocrinology, Vijayratna Diabetes Diagnosis & Treatment Centre, Ahmedabad, IND
| | - Samit Ghosal
- Endocrinology, Nightingale Hospital, Kolkata, IND
| | | | | | - Bharath Hs
- Medical Affairs, AstraZeneca Pharma India Ltd, Bangalore, IND
| | - Prashant Sada
- Medical Affairs, AstraZeneca Pharma India Ltd, Bangalore, IND
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12
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Aoki J, Khalid O, Kaya C, Nagymanyoki Z, Hussong J, Salama ME. Progression from Prediabetes to Diabetes in a Diverse U.S. Population: A Machine Learning Model. Diabetes Technol Ther 2024; 26:748-753. [PMID: 38621172 DOI: 10.1089/dia.2024.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Objective: To date, there are no widely implemented machine learning (ML) models that predict progression from prediabetes to diabetes. Addressing this knowledge gap would aid in identifying at-risk patients within this heterogeneous population who may benefit from targeted treatment and management in order to preserve glucose metabolism and prevent adverse outcomes. The objective of this study was to utilize readily available laboratory data to train and test the performance of ML-based predictive risk models for progression from prediabetes to diabetes. Methods: The study population was composed of laboratory information services data procured from a large U.S. outpatient laboratory network. The retrospective dataset was composed of 15,029 adults over a 5-year period with initial hemoglobin A1C (A1C) values between 5.0% and 6.4%. ML models were developed using random forest survival methods. The ground truth outcome was progression to A1C values indicative of diabetes (i.e., ≥6.5%) within 5 years. Results: The prediabetes risk classifier model accurately predicted A1C ≥6.5% within 5 years and achieved an area under the receiver-operator characteristic curve of 0.87. The most important predictors of progression from prediabetes to diabetes were initial A1C, initial serum glucose, A1C slope, serum glucose slope, initial HDL, HDL slope, age, and sex. Conclusions: Leveraging readily obtainable laboratory data, our ML risk classifier accurately predicts elevation in A1C associated with progression from prediabetes to diabetes. Although prospective studies are warranted, the results support the clinical utility of the model to improve timely recognition, risk stratification, and optimal management for patients with prediabetes.
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13
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Di Lorenzo G, Verde A, Scafuri L, Costabile F, Caputo V, Di Trolio R, Strianese O, Montanaro V, Crocetto F, Del Giudice F, Baio R, Tufano A, Verze P, Calabrese AN, Buonerba C. The Impact of Flavonoid Supplementation on Serum Oxidative Stress Levels Measured via D-ROMs Test in the General Population: The PREVES-FLAVON Retrospective Observational Study. Nutrients 2024; 16:3302. [PMID: 39408268 PMCID: PMC11478935 DOI: 10.3390/nu16193302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND Oxidative stress has emerged as a key contributor to numerous NCDs (non-communicable diseases), including cardiovascular diseases, cancer, and diabetes. This study aims to explore the potential of targeted interventions to mitigate oxidative stress as part of a primary prevention strategy. METHODS The study included 32 healthy participants (11 men, 21 women) aged 45-65 who completed both the initial and follow-up assessments of the Healthy Days Initiative, a community-based wellness program organized by the non-profit Associazione O.R.A. ETS. Through blood analysis, vital sign assessment, lifestyle questionnaires, and individualized recommendations, participants received guidance on improving their health and reducing disease risk. The initiative also offered the opportunity for participants to consume a flavonoid supplement containing quercitrin, rutin, and hesperidin, with the goal of reducing oxidative stress. Participants who opted for supplementation were instructed to take 1-2 tablets daily for two weeks. Data collected included demographic information, anthropometric measurements, vital signs, dietary and lifestyle habits, medical history, WHO-5 Well-Being Index scores, and blood parameters. RESULTS Significant reductions were observed in glucose levels (from 82 to 74.5 mg/dL), reactive oxygen metabolites (d-ROMs) (from 394.5 to 365.5 U.CARR), and systolic blood pressure (from 133 to 122 mmHg) after the two-week flavonoid intervention. Most participants (26/31) reported no side effects, and the majority (30/31) expressed a willingness to continue using a product combination of quercitrin, rutin, and hesperidin or a similar product long-term. CONCLUSIONS While limited in scope and duration, the PREVES-FLAVON study contributes valuable insights to the growing body of evidence suggesting that flavonoid supplementation may play a significant role in reducing risk factors associated with NCDs in primary prevention settings. By targeting novel risk factors such as oxidative stress, this intervention holds promise for mitigating the global burden of NCDs and promoting healthy aging.
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Affiliation(s)
- Giuseppe Di Lorenzo
- Oncology Unit, “Andrea Tortora” Hospital, ASL Salerno, 84016 Pagani, Italy; (G.D.L.); (A.V.); (F.C.); (O.S.); (A.N.C.)
- Associazione O.R.A. ETS-Oncology Research Assistance, 84134 Salerno, Italy;
- UniCamillus—Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Antonio Verde
- Oncology Unit, “Andrea Tortora” Hospital, ASL Salerno, 84016 Pagani, Italy; (G.D.L.); (A.V.); (F.C.); (O.S.); (A.N.C.)
- Associazione O.R.A. ETS-Oncology Research Assistance, 84134 Salerno, Italy;
| | - Luca Scafuri
- Oncology Unit, “Andrea Tortora” Hospital, ASL Salerno, 84016 Pagani, Italy; (G.D.L.); (A.V.); (F.C.); (O.S.); (A.N.C.)
- Associazione O.R.A. ETS-Oncology Research Assistance, 84134 Salerno, Italy;
| | - Ferdinando Costabile
- Oncology Unit, “Andrea Tortora” Hospital, ASL Salerno, 84016 Pagani, Italy; (G.D.L.); (A.V.); (F.C.); (O.S.); (A.N.C.)
| | - Vincenza Caputo
- Oncology Unit, “Luigi Curto” Hospital, ASL Salerno, 84035 Polla, Italy;
| | - Rossella Di Trolio
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione G. Pascale, 80131 Naples, Italy;
| | - Oriana Strianese
- Oncology Unit, “Andrea Tortora” Hospital, ASL Salerno, 84016 Pagani, Italy; (G.D.L.); (A.V.); (F.C.); (O.S.); (A.N.C.)
| | - Vittorino Montanaro
- Urology Department, “San Leonardo” Hospital—ASL Napoli 3 Sud., Castellammare di Stabia, 80053 Naples, Italy;
| | - Felice Crocetto
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80133 Naples, Italy;
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Raffaele Baio
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy;
| | - Antonio Tufano
- Unit of Urology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy;
| | - Paolo Verze
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Alessia Nunzia Calabrese
- Oncology Unit, “Andrea Tortora” Hospital, ASL Salerno, 84016 Pagani, Italy; (G.D.L.); (A.V.); (F.C.); (O.S.); (A.N.C.)
| | - Carlo Buonerba
- Associazione O.R.A. ETS-Oncology Research Assistance, 84134 Salerno, Italy;
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Fan B, Wu Y, Guo H, Yu F, Liu LE, Yu S, Wang J, Wang Y. Self-assembly of cascade nanoenzyme glucose oxidase encapsulated in copper benzenedicarboxylate for wearable sweat-glucose colorimetric sensors with smartphone readout. Anal Chim Acta 2024; 1316:342852. [PMID: 38969409 DOI: 10.1016/j.aca.2024.342852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND With the advent of personalized medical approaches, precise and tailored treatments are expected to become widely accepted for the prevention and treatment of diabetes. Paper-based colorimetric sensors that function in combination with smartphones have been rapidly developed in recent years because it does not require additional equipment and is inexpensive and easy to perform. In this study, we developed a portable, low-cost, and wearable sweat-glucose detection device for in situ detection. RESULTS The sensor adopted an integrated biomimetic nanoenzyme of glucose oxidase (GOx) encapsulated in copper 1, 4-benzenedicarboxylate (CuBDC) (GOx@CuBDC) through a biomimetic mineralization process. CuBDC exhibited a peroxide-like effect, cascade catalytic effect with the encapsulated GOx, and increased the enzyme stability. GOx@CuBDC and 3,3,5,5-tetramethylbenzidine were combined to form a hybrid membrane that achieved single-step paper-based glucose detection. SIGNIFICANCE AND NOVELTY This GOx@CuBDC-based colorimetric glucose sensor was used to quantitatively analyze the sweat-glucose concentration with smartphone readings. The sensor exhibited a good linear relationship over the concentration range of 40-900 μM and a limit of detection of 20.7 μM (S/N = 3). Moreover, the sensor performed well in situ monitoring and in evaluating variations based on the consumption of foods with different glycemic indices. Therefore, the fabricated wearable sweat-glucose sensors exhibited optimal practical application performance.
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Affiliation(s)
- Binghua Fan
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Yongjun Wu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China; The Key Laboratory of Nanomedicine and Health Inspection of Zhengzhou, Zhengzhou, Henan, 450001, China
| | - Hongchao Guo
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Fei Yu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Li-E Liu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Songcheng Yu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Jia Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Yilin Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China.
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Yovera-Aldana M, Mezones-Holguín E, Agüero-Zamora R, Damas-Casani L, Uriol-Llanos B, Espinoza-Morales F, Soto-Becerra P, Ticse-Aguirre R. External validation of Finnish diabetes risk score (FINDRISC) and Latin American FINDRISC for screening of undiagnosed dysglycemia: Analysis in a Peruvian hospital health care workers sample. PLoS One 2024; 19:e0299674. [PMID: 39110713 PMCID: PMC11305586 DOI: 10.1371/journal.pone.0299674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024] Open
Abstract
AIMS To evaluate the external validity of Finnish diabetes risk score (FINDRISC) and Latin American FINDRISC (LAFINDRISC) for undiagnosed dysglycemia in hospital health care workers. METHODS We carried out a cross-sectional study on health workers without a prior history of diabetes mellitus (DM). Undiagnosed dysglycemia (prediabetes or diabetes mellitus) was defined using fasting glucose and two-hour oral glucose tolerance test. LAFINDRISC is an adapted version of FINDRISC with different waist circumference cut-off points. We calculated the area under the receptor operational characteristic curve (AUROC) and explored the best cut-off point. RESULTS We included 549 participants in the analysis. The frequency of undiagnosed dysglycemia was 17.8%. The AUROC of LAFINDRISC and FINDRISC were 71.5% and 69.2%; p = 0.007, respectively. The optimal cut-off for undiagnosed dysglycemiaaccording to Index Youden was ≥ 11 in LAFINDRISC (Sensitivity: 78.6%; Specificity: 51.7%) and ≥12 in FINDRISC (Sensitivity: 70.4%; Specificity: 53.9%). CONCLUSION The discriminative capacity of both questionnaires is good for the diagnosis of dysglycemia in the healthcare personnel of the María Auxiliadora hospital. The LAFINDRISC presented a small statistical difference, nontheless clinically similar, since there was no difference by age or sex. Further studies in the general population are required to validate these results.
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Affiliation(s)
- Marlon Yovera-Aldana
- Grupo de Investigación en Neurociencias, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
| | - Edward Mezones-Holguín
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Perú
- Epi-gnosis Solutions, Piura, Peru
| | - Rosa Agüero-Zamora
- Facultad de Medicina, Universidad Nacional Federico Villarreal, Lima, Perú
| | | | | | | | - Percy Soto-Becerra
- Instituto de Evaluación en Tecnologías en Salud e Investigación (IETSI), Lima, Perú
- Universidad Continental, Huancayo, Peru
| | - Ray Ticse-Aguirre
- Universidad Continental, Huancayo, Peru
- Escuela de Posgrado, Universidad Peruana Cayetano Heredia, Lima, Perú
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16
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Laroussi S, Bouattour N, Daoud S, Moalla KS, Sakka S, Damak M, Farhat N, Mhiri C. Reversible dementia and seizures due to metformin-induced vitamin B12 deficiency. L'ENCEPHALE 2024; 50:474-477. [PMID: 38369428 DOI: 10.1016/j.encep.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Sirine Laroussi
- Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia; Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia.
| | - Nadia Bouattour
- Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia; Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Sawsan Daoud
- Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia; Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Khadija Sonda Moalla
- Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia; Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Salma Sakka
- Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia; Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Mariem Damak
- Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia; Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Nouha Farhat
- Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia; Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Chokri Mhiri
- Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia; Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
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17
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Abate TW, Genanew A, Gedamu H, Tegenaw A, Ayalew E, Berhie AY, Ergetie T, Shibesh BF. Unmasking the silent epidemic: a comprehensive systematic review and meta-analysis of undiagnosed diabetes in Ethiopian adults. Front Endocrinol (Lausanne) 2024; 15:1372046. [PMID: 39086906 PMCID: PMC11288971 DOI: 10.3389/fendo.2024.1372046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
Background Undiagnosed diabetes mellitus poses a significant global public health concern, exerting a substantial impact on the well-being of individuals, their families, and societies at large. Those individuals with undiagnosed diabetes miss opportunities to maintain quality of life and prevent diabetes-related complications. Even if there are ample primary studies on undiagnosed diabetes in Ethiopia, the results reveal conflicting results. Therefore, a comprehensive national picture of undiagnosed diabetes is essential for designing effective strategies at the national level. Methods This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for prevalence studies (PROSPERO ID: CRD42021266676). PubMed, Web of Science and the World Health Organization's Hinari portal were searched using a strategy developed in collaboration with Liberians. The inclusion criteria comprised studies reporting undiagnosed diabetes in Ethiopia. Two independent reviewers conducted a quality assessment using a 10-item appraisal tool. Meta-analysis and meta-regression were performed using a random-effects model. Result Twenty-five studies with 22,193 participants met the inclusion criteria. The pooled prevalence of undiagnosed diabetes among the Ethiopian adult population was 5.68% (95% CI: 4.53 - 6.83, I2 = 75.4). Factors significantly associated with undiagnosed diabetes include age, waist circumference, overweight, family history of diabetes, and a history of hypertension. Conclusion Our systematic review found a noteworthy prevalence of undiagnosed diabetes in Ethiopia. The majority of factors linked with undiagnosed diabetes in this review were modifiable. This underscores the importance of targeted factors and public health interventions to improve early detection and reduce the burden of undiagnosed diabetes and its complications in Ethiopia. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42021266676.
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Affiliation(s)
- Teshager Woldegiyorgis Abate
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
- Department of Adult Health Nursing, Scholl of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashenafi Genanew
- Department of Pharmacy, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Haileyesus Gedamu
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebu Tegenaw
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Emiru Ayalew
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alemeshet Yirga Berhie
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Temesgen Ergetie
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Belayneh Fentahun Shibesh
- Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
- Department of Public Health, Medical School of the University of Nicosia, Nicosia, Cyprus
- Nature, Climate and Health, United Nations University CRIS, Bruges, Belgium
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Saha P, Marouf Y, Pozzebon H, Guergachi A, Keshavjee K, Noaeen M, Shakeri Z. Predicting Time to Diabetes Diagnosis Using Random Survival Forests. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2024; 2024:1-4. [PMID: 40039467 DOI: 10.1109/embc53108.2024.10782210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2025]
Abstract
Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder with increasing population incidence. However, T2DM takes years to develop, allowing onset prediction and prevention to be a clinically effective treatment strategy. In this study we propose and assess a novel approach to diabetes prediction which integrates a specialized extension of the random forest algorithm known as random survival forest (RSF). Rather than predicting a binary outcome, this machine learning model incorporates survival analysis methodology to predict the time until a patient will receive a diabetes diagnosis if their current lifestyle is maintained. We trained a baseline model on 7,704 electronic medical records from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) with 14 biomarker and comorbidity features across different measurement dates. Although tuning parameters were purposefully chosen for quick training rather than for predictive performance, our model exceeded expectations with a concordance index of 0.84. Thus, RSF models have been shown to produce accurate timelines of diabetes onset trajectory, providing patients with quantifiable and relatable risks that are easy to understand. The results of our study have substantial implications for advancing machine learning in clinical decision support and patient outcome predictions, emphasizing the role of innovative models in improving predictive accuracy.
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19
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Mongkolsucharitkul P, Surawit A, Manosan T, Ophakas S, Suta S, Pinsawas B, Pongkunakorn T, Pumeiam S, Ratanasuwan W, Homsanit M, Charoencholvanich K, Udomphorn Y, Suktitipat B, Mayurasakorn K. Metabolic and genetic risk factors associated with pre-diabetes and type 2 diabetes in Thai healthcare employees: A long-term study from the Siriraj Health (SIH) cohort study. PLoS One 2024; 19:e0303085. [PMID: 38941315 PMCID: PMC11213315 DOI: 10.1371/journal.pone.0303085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/18/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The study of non-communicable diseases (NCDs) in a developing country like Thailand has rarely been conducted in long-term cohorts, especially among the working-age population. We aim to assess the prevalence and incidence of risk factors and their associations underlying NCDs, especially type-2 diabetes mellitus (T2DM) among healthcare workers enrolled in the Siriraj Health (SIH) study cohort. METHODS The SIH study was designed as a longitudinal cohort and conducted at Siriraj hospital, Thailand. A total of 5,011 participants (77% women) were recruited and follow-up. Physical examinations, blood biochemical analyses, family history assessments, behavior evaluations, and genetics factors were assessed. RESULTS The average age was 35.44±8.24 years and 51% of participants were overweight and obese. We observed that men were more likely to have a prevalence of T2DM and dyslipidemia (DLP) compared to women. Aging was significantly associated with pre-diabetes and T2DM (P<0.001). Additionally, aging, metabolic syndrome, and elevated triglycerides were associated with the development of pre-diabetes and T2DM. The minor T allele of the rs7903146(C/T) and rs4506565 (A/T) were associated with a high risk of developing pre-diabetes with odds ratios of 2.74 (95% confidence interval [CI]: 0.32-23.3) and 2.71 (95% CI: 0.32-23.07), respectively; however, these associations were statistically insignificant (P>0.05). CONCLUSION The findings of the SIH study provide a comprehensive understanding of the health status, risk factors, and genetic factors related to T2DM in a specific working population and highlight areas for further research and intervention to address the growing burden of T2DM and NCDs.
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Affiliation(s)
- Pichanun Mongkolsucharitkul
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apinya Surawit
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thamonwan Manosan
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suphawan Ophakas
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sophida Suta
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bonggochpass Pinsawas
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyaporn Pongkunakorn
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sureeporn Pumeiam
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Winai Ratanasuwan
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mayuree Homsanit
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Keerati Charoencholvanich
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yuthana Udomphorn
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bhoom Suktitipat
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Korapat Mayurasakorn
- Siriraj Population Health and Nutrition Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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20
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Găman MA, Srichawla BS, Chen YF, Roy P, Dhali A, Nahian A, Manan MR, Kipkorir V, Suteja RC, Simhachalam Kutikuppala LV, Găman AM, Diaconu CC. Overview of dyslipidemia and metabolic syndrome in myeloproliferative neoplasms. World J Clin Oncol 2024; 15:717-729. [PMID: 38946827 PMCID: PMC11212607 DOI: 10.5306/wjco.v15.i6.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/05/2024] [Accepted: 05/28/2024] [Indexed: 06/24/2024] Open
Abstract
Myeloproliferative neoplasms (MPNs) occur due to the abnormal proliferation of one or more terminal myeloid cell lines in peripheral blood. Subjects suffering from MPNs display a high burden of cardiovascular risk factors, and thrombotic events are often the cause of death in this population of patients. Herein, we provide a brief overview of dyslipidemia and metabolic syndrome and their epidemiology in MPNs and examine the common molecular mechanisms between dyslipidemia, metabolic syndrome, and MPNs, with a special focus on cardiovascular risk, atherosclerosis, and thrombotic events. Furthermore, we investigate the impact of dyslipidemia and metabolic syndrome on the occurrence and survival of thrombosis in MPN patients, as well as the management of dyslipidemia in MPNs, and the impact of MPN treatment on serum lipid concentrations, particularly as side/adverse effects reported in the context of clinical trials.
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Affiliation(s)
- Mihnea-Alexandru Găman
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest 022328, Romania
- Department of Cellular and Molecular Pathology, Stefan S Nicolau Institute of Virology, Romanian Academy, Bucharest 030304, Romania
| | - Bahadar Singh Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Yong-Feng Chen
- Department of Basic Medical Sciences, School of Medicine of Taizhou University, Taizhou University, Taizhou 318000, Zhejiang Province, China
| | - Poulami Roy
- Department of Medicine, North Bengal Medical College and Hospital, West Bengal 734012, India
| | - Arkadeep Dhali
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Ahmed Nahian
- Lecom at Seton Hill, Greensburg, PA 15601, United States
| | | | - Vincent Kipkorir
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi 00100, Kenya
| | | | | | - Amelia Maria Găman
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
- Clinic of Hematology, Filantropia City Hospital, Craiova 200143, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest 050474, Romania
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, Bucharest 105402, Romania
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21
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Salamah HM, Marey A, Abugdida M, Abualkhair KA, Elshenawy S, Elhassan WAF, Naguib MM, Malnev D, Durrani J, Bailey R, Tsyunchyk A, Ibrahim L, Zavgorodneva Z, Sherazi A. Efficacy and safety of glucagon-like peptide-1 receptor agonists on prediabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetol Metab Syndr 2024; 16:129. [PMID: 38877565 PMCID: PMC11177512 DOI: 10.1186/s13098-024-01371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Prediabetes is a condition preceding the development of diabetes and is associated with an increased risk of a number of complications. The primary mode of management is thought to be lifestyle modification. Pharmacological therapy, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), were not well addressed in the literature and were only evaluated in trials as secondary and exploratory outcomes with a limited sample size. Here, GLP-1RAs are evaluated as a comprehensive therapy approach for patients with prediabetes. METHODS A comprehensive search of Web of Science, SCOPUS, PubMed, and Cochrane was performed on May 5, 2023, to retrieve randomized controlled trials (RCTs) comparing the effect of GLP-1RAs to placebo and/or lifestyle modification on prediabetes reversion to normoglycemia, prevention of overt diabetes, glycemic control, anthropometric parameters, and lipid profiles. Review Manager (RevMan) version 5.4 was used. The quality of RCTs was assessed using the revised version of the Cochrane Risk of Bias Tool. GRADE was performed to evaluate the certainty of evidence. RESULTS Twelve trials involving 2903 patients in the GLP-1RAs group and 1413 in the control group were included in the meta-analysis. Low quality of evidence revealed that GLP-1RAs significantly increased the incidence of prediabetes reversion to the normoglycemic state [RR = 1.76, 95% CI (1.45, 2.13), P < 0.00001] and moderate quality of evidence showed that GLP-1RAs significantly prevented new-onset diabetes [RR = 0.28, 95% CI (0.19, 0.43), P < 0.00001]. Significant reductions in HbA1c, fasting plasma glucose, body weight, waist circumference, triglycerides, and LDL were observed in the GLP-1RAs arm (P < 0.05). However, higher incidences of gastrointestinal disorders were reported in the GLP-1RAs group (P < 0.05). CONCLUSIONS GLP-1RAs combined with lifestyle modification proved to be a more effective therapy for managing prediabetic patients than lifestyle modification alone, with a tolerable safety profile. Future guidelines should consider GLP-1RAs as an adjunct to lifestyle modification in the management of prediabetic patients to provide better management and improve treatment adherence.
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Affiliation(s)
| | - Ahmed Marey
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Salem Elshenawy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Dmitrii Malnev
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Jamrose Durrani
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Ronelle Bailey
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Anastasiia Tsyunchyk
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Lena Ibrahim
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Zhanna Zavgorodneva
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Andleeb Sherazi
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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Gupta A, Choudhary N, Gupta N. Prediabetes in children and adolescents: A ticking bomb! World J Clin Pediatr 2024; 13:92127. [PMID: 38947990 PMCID: PMC11212763 DOI: 10.5409/wjcp.v13.i2.92127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/12/2024] [Accepted: 04/25/2024] [Indexed: 06/07/2024] Open
Abstract
Prediabetes in children and adolescents is on the rise which has drawn significant attention over the past decade. It is an early warning sign of the underlying pathophysiological changes which in due course of time might compound into type II diabetes mellitus. The incidence of prediabetes in adolescents ranges from 4%-23% which is alarmingly high and requires active intervention from the system. We have discussed early identification of high-risk patients, prompt screening and active intervention to manage this growing problem.
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Affiliation(s)
- Anju Gupta
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Science, New Delhi 110076, India
| | - Nitin Choudhary
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Science, New Delhi 110076, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Science, New Delhi 110029, India
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23
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Powell LH, Daniels BT, Drees BM, Karavolos K, Lohse B, Masters KS, Nicklas JM, Ruder EH, Suzuki S, Trabold N, Zimmermann LJ. Enhancing Lifestyles in the Metabolic syndrome (ELM) multisite behavioral efficacy trial. Design and baseline cohort. Am Heart J 2024; 270:136-155. [PMID: 38215918 DOI: 10.1016/j.ahj.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Prevalence of metabolic syndrome (MetS) increased from one-quarter to one-third of the U.S. adult population over 8 years and is spreading to young adults and Asian and Hispanic Americans. Diagnosed when >3 out of 5 cardiometabolic risk factors are present, there is widespread agreement that its fundamental roots are in a lifestyle characterized by poor dietary quality and physical inactivity. Past lifestyle trials for MetS produce benefits that have limited sustainability, suggesting the need for new treatment approaches. METHODS This is the design and baseline cohort of the Enhancing Lifestyles in the Metabolic Syndrome (ELM) multi-site trial. The trial tests the hypothesis that a habit-based lifestyle treatment offered over 6 months, followed by 18 monthly maintenance contacts, can produce 4 new diet, physical activity, and mindfulness habits and, if so, sustained MetS remission. The design is an individually randomized, partially clustered group treatment trial of 618 participants with the MetS recruited from 5 sites in the U.S. and randomized to a small group lifestyle treatment or an enhanced standard of care education comparator. The primary outcome is MetS remission at 24 months. Secondary outcomes compare arms at 6, 15, and 24 months on MetS components, lifestyle targets, weight, body mass index, hemoglobin A1c, LDL cholesterol, medications, quality of life, psychosocial factors, and cost-effectiveness. RESULTS The cohort of 618 participants was recruited by screening 14,817 over 2.5 years (screening to enrollment ratio 24:1). Recruitment exceeded the target of 600 despite 2 COVID-19 pauses. The mean age was 55.5 years, 24.3% were male, 25.5% were a racial minority, 9.7% identified as Hispanic, and 83.0% were classified as obese (body mass index >30). The most common MetS components were abdominal obesity (97.7%) and elevated blood pressure or antihypertensive medication (86.2%). CONCLUSIONS The geographic, sociodemographic, and clinical diversity of the cohort, combined with rigorous behavioral efficacy trial methods, will provide a conclusive answer to the question of whether this habit-based lifestyle program can produce sustained 24-month remission of the MetS and thereby help to curb a significant and growing public health problem.
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Chaudhry M, Kumar M, Singhal V, Srinivasan B. Metabolic health tracking using Ultrahuman M1 continuous glucose monitoring platform in non- and pre-diabetic Indians: a multi-armed observational study. Sci Rep 2024; 14:6490. [PMID: 38499685 PMCID: PMC10948749 DOI: 10.1038/s41598-024-56933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
Continuous glucose monitoring (CGM) device adoption in non- and pre-diabetics for preventive healthcare has uncovered a paucity of benchmarking data on glycemic control and insulin resistance for the high-risk Indian/South Asian demographic. Furthermore, the correlational efficacy between digital applications-derived health scores and glycemic indices lacks clear supportive evidence. In this study, we acquired glycemic variability (GV) using the Ultrahuman (UH) M1 CGM, and activity metrics via the Fitbit wearable for Indians/South Asians with normal glucose control (non-diabetics) and those with pre-diabetes (N = 53 non-diabetics, 52 pre-diabetics) for 14 days. We examined whether CGM metrics could differentiate between the two groups, assessed the relationship of the UH metabolic score (MetSc) with clinical biomarkers of dysglycemia (OGTT, HbA1c) and insulin resistance (HOMA-IR); and tested which GV metrics maximally correlated with inflammation (Hs-CRP), stress (cortisol), sleep, step count and heart rate. We found significant inter-group differences for mean glucose levels, restricted time in range (70-110 mg/dL), and GV-by-SD, all of which improved across days. Inflammation was strongly linked with specific GV metrics in pre-diabetics, while sleep and activity correlated modestly in non-diabetics. Finally, MetSc displayed strong inverse relationships with insulin resistance and dysglycemia markers. These findings present initial guidance GV data of non- and pre-diabetic Indians and indicate that digitally-derived metabolic scores can positively influence glucose management.
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Affiliation(s)
- Monik Chaudhry
- Ultrahuman Healthcare Private Limited, No. 799, V K Paradise Sector2, HSR Layout Bengaluru, Bangalore, Karnataka, 560102, India
| | - Mohit Kumar
- Ultrahuman Healthcare Private Limited, No. 799, V K Paradise Sector2, HSR Layout Bengaluru, Bangalore, Karnataka, 560102, India
| | - Vatsal Singhal
- Ultrahuman Healthcare Private Limited, No. 799, V K Paradise Sector2, HSR Layout Bengaluru, Bangalore, Karnataka, 560102, India
| | - Bhuvan Srinivasan
- Ultrahuman Healthcare Private Limited, No. 799, V K Paradise Sector2, HSR Layout Bengaluru, Bangalore, Karnataka, 560102, India.
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Gal AM, Iatcu CO, Popa AD, Arhire LI, Mihalache L, Gherasim A, Nita O, Soimaru RM, Gheorghita R, Graur M, Covasa M. Understanding the Interplay of Dietary Intake and Eating Behavior in Type 2 Diabetes. Nutrients 2024; 16:771. [PMID: 38542683 PMCID: PMC10975878 DOI: 10.3390/nu16060771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 11/12/2024] Open
Abstract
Diet and eating behavior both play a crucial role in the prevention and management of type 2 diabetes mellitus (T2DM). The main objective of this study was to investigate the relationship between dietary intake and eating behavior in a population of patients with T2DM. A cross-sectional study was performed using 416 patients with T2DM and their dietary intake and eating behavior were assessed with validated questionnaires. Women scored significantly higher than men for emotional and restrained eating (p < 0.001). Correlation analyses showed that emotional eaters consumed significantly more calories (r = 0.120, p = 0.014) and fat (r = 0.101, p = 0.039), as well as non-alcoholic beverages for women (r = 0.193, p = 0.003) and alcohol for men (r = 0.154, p = 0.038). Also, individuals who ate based on external cues consumed significantly more calories (r = 0.188, p < 0.001) and fat (r = 0.139, p = 0.005). These results demonstrate that eating behavior influences dietary intake. Understanding this relationship could optimize diabetes management and allow for more individualized nutritional guidance.
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Affiliation(s)
- Ana Maria Gal
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Camelia Oana Iatcu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Alina Delia Popa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Lidia Iuliana Arhire
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Laura Mihalache
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Andreea Gherasim
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Otilia Nita
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Raluca Meda Soimaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Roxana Gheorghita
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Mariana Graur
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Mihai Covasa
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
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Reddy KR, Freeman AM. Lifestyle Medicine: An Antidote to Cardiovascular Diseases. Am J Lifestyle Med 2024; 18:216-232. [PMID: 38559785 PMCID: PMC10979734 DOI: 10.1177/15598276221130684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.
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Affiliation(s)
- Koushik R. Reddy
- Division of Cardiology, Department of Medicine, James A. Haley VA Medical Center and University of South Florida, Tampa, FL, USA (KRR); and Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA (AMF)
| | - Andrew M. Freeman
- Division of Cardiology, Department of Medicine, James A. Haley VA Medical Center and University of South Florida, Tampa, FL, USA (KRR); and Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA (AMF)
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Slade D, Carr K, Karimi M, Stewart MW. Improving care practices of the patient with type 2 diabetes in community health centers. J Am Assoc Nurse Pract 2024; 36:128-135. [PMID: 38011633 DOI: 10.1097/jxx.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Diabetes ranks seventh in morbidity and mortality in the United States. In addition, more than 25 million Americans living with diabetes depend on community health centers (CHCs) for primary care. LOCAL PROBLEM Preimplementation data in a group of CHCs indicated poor adherence to standards of care practices as recommended by the American Diabetes Association (ADA) with quarterly A1c (33.1%), annual serum laboratory tests (66.6%), and annual urine microalbumin (26.5%). METHODS Using a pre- and postimplementation comparison method, a NP-led practice improvement project was conducted in a group of CHCs, which sought to (1) identify adherence to ADA care standards; (2) determine whether an intervention could affect adherence to ADA standards; and (3) compare pre- and postimplementation occurrences of hemoglobin A1c greater than 7.1% and greater than 9%. INTERVENTION Intervention composed of an educational component, standing orders to facilitate care practice changes, and electronic health record utilization changes. RESULTS Postimplementation data reveal statistically significant improvements in quarterly hemoglobin A1c (93.6%), annual serum laboratory tests (96.5%), and annual urine microalbumin screening (85.5%). CONCLUSIONS Improvements in translation to care for standardized guidelines facilitate improvements in health outcomes for patients. This project demonstrated improvements that can decrease the morbidity and mortality experienced by persons living with diabetes and being seen within a CHC. In addition, this project demonstrated that advanced practice nurses have the training and occupy a unique position within health care to spearhead initiatives for translation of evidence into care practices.
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Affiliation(s)
- Deloris Slade
- University of MS Medical Center, School of Nursing, Jackson, Mississippi
| | - Kayla Carr
- Mississippi State University, Mississippi
| | - Masoumeh Karimi
- University of MS Medical Center, School of Nursing, Jackson, Mississippi
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Gulanski BI, Goulet JL, Radhakrishnan K, Ko J, Li Y, Rajeevan N, Lee KM, Heberer K, Lynch JA, Streja E, Mutalik P, Cheung KH, Concato J, Shih MC, Lee JS, Aslan M. Metformin prescription for U.S. veterans with prediabetes, 2010-2019. J Investig Med 2024; 72:139-150. [PMID: 37668313 DOI: 10.1177/10815589231201141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Affecting an estimated 88 million Americans, prediabetes increases the risk for developing type 2 diabetes mellitus (T2DM), and independently, cardiovascular disease, retinopathy, nephropathy, and neuropathy. Nevertheless, little is known about the use of metformin for diabetes prevention among patients in the Veterans Health Administration, the largest integrated healthcare system in the U.S. This is a retrospective observational cohort study of the proportion of Veterans with incident prediabetes who were prescribed metformin at the Veterans Health Administration from October 2010 to September 2019. Among 1,059,605 Veterans with incident prediabetes, 12,009 (1.1%) were prescribed metformin during an average 3.4 years of observation after diagnosis. Metformin prescribing was marginally higher (1.6%) among those with body mass index (BMI) ≥35 kg/m2, age <60 years, HbA1c≥6.0%, or those with a history of gestational diabetes, all subgroups at a higher risk for progression to T2DM. In a multivariable model, metformin was more likely to be prescribed for those with BMI ≥35 kg/m2 incidence rate ratio [IRR] 2.6 [95% confidence intervals (CI): 2.1-3.3], female sex IRR, 2.4 [95% CI: 1.8-3.3], HbA1c≥6% IRR, 1.93 [95% CI: 1.5-2.4], age <60 years IRR, 1.7 [95% CI: 1.3-2.3], hypertriglyceridemia IRR, 1.5 [95% CI: 1.2-1.9], hypertension IRR, 1.5 [95% CI: 1.1-2.1], Major Depressive Disorder IRR, 1.5 [95% CI: 1.1-2.0], or schizophrenia IRR, 2.1 [95% CI: 1.2-3.8]. Over 20% of Veterans with prediabetes attended a comprehensive structured lifestyle modification clinic or program. Among Veterans with prediabetes, metformin was prescribed to 1.1% overall, a proportion that marginally increased to 1.6% in the subset of individuals at highest risk for progression to T2DM.
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Affiliation(s)
- Barbara I Gulanski
- Department of Medicine, Endocrinology, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Endocrinology, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph L Goulet
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- Pain, Research, Informatics, Multi-morbidities and Education Center (PRIME), West Haven, CT, USA
| | - Krishnan Radhakrishnan
- National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | - John Ko
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Yuli Li
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Nallakkandi Rajeevan
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kyung Min Lee
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Kent Heberer
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie A Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elani Streja
- Department of Medicine, Nephrology, Hypertension and Transplant, University of California-Irvine School of Medicine, Long Beach, CA, USA
| | - Pradeep Mutalik
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kei-Hoi Cheung
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - John Concato
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Mei-Chiung Shih
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer S Lee
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mihaela Aslan
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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Zha L, MacLeod S, Love T, Fortuna RJ, Zhang YV. Longitudinal impact of COVID-19 pandemic on the utilization of hemoglobin A1c testing in outpatients. Clin Chim Acta 2024; 552:117686. [PMID: 38042461 DOI: 10.1016/j.cca.2023.117686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, concerns arose about disparate access to health care and laboratory testing. There is limited information about the pandemic's impact on the frequency of diabetic laboratory testing across demographic subgroups (e.g., sex, age over 65 y, and race). METHODS This retrospective study examined outpatient hemoglobin A1c (HbA1c) testing in a large academic medical center in Upstate New York between March 2019 and March 2021. Multivariate Poisson regression models were used to evaluate the pandemic's effects on HbA1c utilization. RESULTS Over 190,000 HbA1c results from predominately white (76.1 %) and older (mean age, 60.6 y) outpatients were analyzed. Compared to pre-pandemic time period, the average number of HbA1c tests per patient during COVID time period experienced a small, though significant, drop (1.3 to 1.2; p < 0.001) on aggregate and in outpatients, males, females, and seniors. The modest reduction was not significant by race except for the white seniors (p < 0.001). However, the testing frequency remained within recommendations from the American Diabetes Association for monitoring prediabetic patients and patients with stable glycemic control. CONCLUSION Given the propensity for healthcare disruptions to widen disparities, it is reassuring that we did not observe a worsening of disparities in rates of HbA1c testing during the COVID-19 pandemic.
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Affiliation(s)
- Li Zha
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States; Present Address: Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, United States
| | - Sara MacLeod
- Division of Endocrinology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Boulevard, CU 420630, Rochester, NY, United States
| | - Robert J Fortuna
- Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States
| | - Y Victoria Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States.
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Lim JJ, Sequeira-Bisson IR, Yip WCY, Lu LW, Miles-Chan JL, Poppitt SD. Intra-pancreatic fat is associated with high circulating glucagon and GLP-1 concentrations following whey protein ingestion in overweight women with impaired fasting glucose: A randomised controlled trial. Diabetes Res Clin Pract 2024; 207:111084. [PMID: 38154534 DOI: 10.1016/j.diabres.2023.111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/13/2023] [Accepted: 12/25/2023] [Indexed: 12/30/2023]
Abstract
AIM Intra-pancreatic fat deposition (IPFD) while hypothesised to impair beta-cell function, its impact on alpha-cells remains unclear. We evaluated the association between IPFD and markers of pancreatic cells function using whey protein. METHODS Twenty overweight women with impaired fasting glucose (IFG) and low or high IPFD (<4.66% vs ≥4.66%) consumed 3 beverage treatments: 0 g (water control), 12.5 g (low-dose) and 50.0 g (high-dose) whey protein, after an overnight fast, in randomised order. Blood glucose, insulin, C-peptide, glucagon, gastric-inhibitory polypeptide (GIP), glucagon-like peptide-1 (GLP-1) and amylin were analysed postprandially over 4 h. Incremental area-under-the-curve (iAUC), incremental maximum concentration (iCmax), and time to maximum concentration (Tmax) for these were compared between IPFD groups using repeated measures linear mixed models, also controlled for age (pcov). RESULTS iAUC and iCmax glucose and insulin while similar between the two IPFD groups, high IPFD and ageing contributed to higher postprandial glucagon (iAUC: p = 0.012; pcov = 0.004; iCmax: p = 0.069; pcov = 0.021) and GLP-1 (iAUC: p = 0.006; pcov = 0.064; iCmax: p = 0.011; pcov = 0.122) concentrations. CONCLUSION In our cohort, there was no evidence that IPFD impaired protein-induced insulin secretion. Conversely, IPFD may be associated with increased protein-induced glucagon secretion, a novel observation which warrants further investigation into its relevance in the pathogenesis of dysglycaemia and type-2 diabetes.
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Affiliation(s)
- Jia Jiet Lim
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand; Riddet Institute, Palmerston North, New Zealand; High Value Nutrition, National Science Challenge, Auckland, New Zealand.
| | - Ivana R Sequeira-Bisson
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand; Riddet Institute, Palmerston North, New Zealand; High Value Nutrition, National Science Challenge, Auckland, New Zealand
| | - Wilson C Y Yip
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand; High Value Nutrition, National Science Challenge, Auckland, New Zealand
| | - Louise W Lu
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand; High Value Nutrition, National Science Challenge, Auckland, New Zealand
| | - Jennifer L Miles-Chan
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand; Riddet Institute, Palmerston North, New Zealand; High Value Nutrition, National Science Challenge, Auckland, New Zealand
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand; Riddet Institute, Palmerston North, New Zealand; High Value Nutrition, National Science Challenge, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand
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Chen Y, Lundeen EA, Koyama AK, Kompaniyets L, Andes LJ, Benoit SR, Imperatore G, Rolka DB. Prevalence of Testing for Diabetes Among US Adults With Overweight or Obesity, 2016-2019. Prev Chronic Dis 2023; 20:E116. [PMID: 38154119 PMCID: PMC10756652 DOI: 10.5888/pcd20.230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Introduction Screening for prediabetes and type 2 diabetes may allow earlier detection, diagnosis, and treatment. The US Preventive Services Task Force recommends screening every 3 years for abnormal blood glucose among adults aged 40 to 70 years with overweight or obesity. Using IQVIA Ambulatory Electronic Medical Records, we estimated the proportion of adults aged 40 to 70 years with overweight or obesity who received blood glucose testing within 3 years from baseline in 2016. Methods We identified 1,338,509 adults aged 40 to 70 years with overweight or obesity in 2016 and without pre-existing diabetes. We included adults whose records were present in the data set for at least 2 years before their index body mass index (BMI) in 2016 and 3 years after the index BMI (2017-2019), during which we examined the occurrence of blood glucose testing. We calculated the unadjusted and adjusted prevalence of receiving blood glucose testing. Results The unadjusted prevalence of receiving blood glucose testing was 33.4% when it was defined as having a hemoglobin A1c or fasting plasma glucose measure. The unadjusted prevalence was 74.3% when we expanded the definition of testing to include random plasma glucose and unspecified glucose measures. Adults with obesity were more likely to receive the test than those with overweight. Men (vs women) and adults aged 50 to 59 years (vs other age groups) had higher testing rates. Conclusion Our findings could inform clinical and public health promotion efforts to improve screening for blood glucose levels among adults with overweight or obesity.
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Affiliation(s)
- Yu Chen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341
| | - Elizabeth A Lundeen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alain K Koyama
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen R Benoit
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah B Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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Wang Y, Liu B, Han H, Hu Y, Zhu L, Rimm EB, Hu FB, Sun Q. Associations between plant-based dietary patterns and risks of type 2 diabetes, cardiovascular disease, cancer, and mortality - a systematic review and meta-analysis. Nutr J 2023; 22:46. [PMID: 37789346 PMCID: PMC10548756 DOI: 10.1186/s12937-023-00877-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Plant-based dietary patterns are gaining more attention due to their potential in reducing the risk of developing major chronic diseases, including type 2 diabetes (T2D), cardiovascular disease (CVD), cancer, and mortality, while an up-to-date comprehensive quantitative review is lacking. This study aimed to summarize the existing prospective observational evidence on associations between adherence to plant-based dietary patterns and chronic disease outcomes. METHODS We conducted a systematic review and meta-analysis of evidence across prospective observational studies. The data sources used were PubMed and MEDLINE, Embase, Web of Science, and screening of references. We included all prospective observational studies that evaluated the association between adherence to plant-based dietary patterns and incidence of T2D, CVD, cancer, and mortality among adults (≥ 18 years). RESULTS A total of 76 publications were identified, including 2,230,443 participants with 60,718 cases of incident T2D, 157,335 CVD cases, 57,759 cancer cases, and 174,435 deaths. An inverse association was observed between higher adherence to a plant-based dietary pattern and risks of T2D (RR, 0.82 [95% CI: 0.77-0.86]), CVD (0.90 [0.85-0.94]), cancer (0.91 [0.87-0.96]), and all-cause mortality (0.84 [0.78-0.92]) with moderate to high heterogeneity across studies (I2 ranged: 47.8-95.4%). The inverse associations with T2D, CVD and cancer were strengthened when healthy plant-based foods, such as vegetables, fruits, whole grains, and legumes, were emphasized in the definition of plant-based dietary patterns (T2D: 0.79 [0.72-0.87]; CVD: 0.85 [0.80-0.92]; cancer: 0.86 [0.80-0.92]; I2 ranged: 53.1-84.1%). Association for mortality was largely similar when the analyses were restricted to healthy plant-based diets (0.86 [0.80-0.92], I2 = 91.9%). In contrast, unhealthy plant-based diets were positively associated with these disease outcomes. Among four studies that examined changes in dietary patterns, increased adherence to plant-based dietary patterns was associated with a significantly reduced risk of T2D (0.83 [0.71-0.96]; I2 = 71.5%) and a marginally lower risk of mortality (0.95 [0.91-1.00]; I2 = 0%). CONCLUSIONS Better adherence to plant-based dietary patterns, especially those emphasizing healthy plant-based foods, is beneficial for lowering the risks of major chronic conditions, including T2D, CVD, cancer, as well as premature deaths. REGISTRATION OF REVIEW PROTOCOL This review was registered at the PROSPERO International Prospective Register of Systematic Reviews ( https://www.crd.york.ac.uk/PROSPERO/ ) with the registration number CRD42022290202.
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Affiliation(s)
- Yeli Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Binkai Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Han Han
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yang Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Lu Zhu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Huckfeldt PJ, Yu JC, O'Leary PK, Harada ASM, Pajewski NM, Frenier C, Espeland MA, Peters A, Bancks MP, Seabury SA, Goldman DP. Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes. JAMA Intern Med 2023; 183:1071-1079. [PMID: 37578773 PMCID: PMC10425863 DOI: 10.1001/jamainternmed.2023.3283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/29/2023] [Indexed: 08/15/2023]
Abstract
Importance An intensive lifestyle intervention (ILI) has been shown to improve diabetes management and physical function. These benefits could lead to better labor market outcomes, but this has not been previously studied. Objective To estimate the association of an ILI for weight loss in type 2 diabetes with employment, earnings, and disability benefit receipt during and after the intervention. Design, Setting, and Participants This cohort study included participants with type 2 diabetes and overweight or obesity and compared an ILI with a control condition of diabetes support and education. Data for the original trial were accrued from August 22, 2001, to September 14, 2012. Trial data were linked with Social Security Administration records to investigate whether, relative to the control group, the ILI was associated with improvements in labor market outcomes during and after the intervention period. Difference-in-differences models estimating relative changes in employment, earnings, and disability benefit receipt between the ILI and control groups were used, accounting for prerandomization differences in outcomes for linked participants. Outcome data were analyzed from July 13, 2020, to May 17, 2023. Exposure The ILI consisted of sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists on a weekly basis in the first 6 months, decreasing to a monthly basis by the fourth year, designed to achieve and maintain at least 7% weight loss. The control group received group-based diabetes education sessions 3 times annually during the first 4 years, with 1 annual session thereafter. Main Outcomes and Measures Employment and receipt of federal disability benefits (Supplemental Security Income and Social Security Disability Insurance), earnings, and disability benefit payments from 1994 through 2018. Results A total of 3091 trial participants were linked with Social Security Administration data (60.1% of 5145 participants initially randomized and 97.0% of 3188 of participants consenting to linkage). Among the 3091 with fully linked data, 1836 (59.4%) were women, and mean (SD) age was 58.4 (6.5) years. Baseline clinical and demographic characteristics were similar between linked participants in the ILI and control groups. Employment increased by 2.9 (95% CI, 0.3-5.5) percentage points for the ILI group relative to controls (P = .03) with no significant relative change in disability benefit receipt (-0.9 [95% CI, -2.1 to 0.3] percentage points; P = .13). Conclusions and Relevance The findings of this cohort study suggest that an ILI to prevent the progression and complications of type 2 diabetes was associated with higher levels of employment. Labor market productivity should be considered when evaluating interventions to manage chronic diseases.
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Affiliation(s)
- Peter J Huckfeldt
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Jeffrey C Yu
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles
- Alexion Pharmaceuticals, Ltd, Boston, Massachusetts
| | - Paul K O'Leary
- Office of Retirement and Disability Policy, Social Security Administration
| | - Ann S M Harada
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Chris Frenier
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
- Yale University School of Public Health, New Haven, Connecticut
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anne Peters
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Seth A Seabury
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles
| | - Dana P Goldman
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Sol Price School of Public Policy, University of Southern California, Los Angeles
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Lee BW, Ahn KJ, Cho HC, Lee EY, Min K, Dahaoui A, Jeong JS, Lim HJ, Jang HC. Safety and Clinical Outcomes of Insulin Degludec in Korean Patients with Diabetes in Real-World Practices: A Prospective, Observational Study. Diabetes Ther 2023; 14:1659-1672. [PMID: 37468685 PMCID: PMC10499774 DOI: 10.1007/s13300-023-01448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION To investigate the safety and effectiveness of insulin degludec (IDeg) in a real-world population of Korean patients with diabetes requiring insulin therapy. METHODS This was a multicenter, prospective, single-arm, open-label, non-interventional study. Patients aged ≥ 12 months and treated with previous glucose-lowering medications were eligible to switch to IDeg. The primary endpoint was the incidence of adverse events (AEs), and the secondary endpoints were changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial glucose (PPG), and target HbA1c < 7.0%. RESULTS In total, 3225 and 2450 patients were included in the safety analysis set (SAS) and effectiveness analysis set (EAS), respectively. The mean baseline HbA1c and duration of diabetes were 9.4% and 13.0 years, respectively. Adverse events were reported in 740 patients (22.9%); the majority were mild and resolved. Significant improvements were observed in HbA1c, FPG, and PPG at week 26 (all p < 0.0001). The target of HbA1c < 7% was achieved in 22.2% of patients at week 26. CONCLUSION In real-world clinical practice, 26 weeks of IDeg treatment resulted in significant reductions in glycemic parameters with a low incidence of AEs in Korean patients with diabetes. No new safety signals were observed. CLINICAL TRIALS REGISTRY AND REGISTRATION NUMBER This trial is registered under ClinicalTrials.gov (NCT02779413) and the universal trial number is [U1111-1176-2287].
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Affiliation(s)
- Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ho Chan Cho
- Department of Clinical Endocrinology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - KyungWan Min
- Department of Endocrinology and Metabolism, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Amine Dahaoui
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Jin Sook Jeong
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Hyo Jin Lim
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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Panigrahi A, Mohanty S. Efficacy and safety of HIMABERB® Berberine on glycemic control in patients with prediabetes: double-blind, placebo-controlled, and randomized pilot trial. BMC Endocr Disord 2023; 23:190. [PMID: 37679692 PMCID: PMC10483788 DOI: 10.1186/s12902-023-01442-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Prediabetes and diabetes involve alterations in glucose homeostasis, including increased fasting blood glucose and impaired glucose tolerance. Berberine has been identified as a potential regulator of glucose homeostasis with implications on the management of type 2 diabetes mellitus (DM). Given a paucity of data on berberine in prediabetes, evaluation of its effect in individuals with prediabetes may prove clinically valuable. OBJECTIVE The present pilot study aimed to investigate the effect of daily oral berberine on markers of glycemic control and insulin resistance among individuals with prediabetes. METHODS A randomized, double-blinded, placebo-controlled trial was conducted for 12 weeks among 34 individuals with prediabetes as defined by the American Diabetes Association (fasting plasma glucose (FPG) between 5.6 and 6.9 mmol/L, glycosylated hemoglobin (HbA1c) between 5.7% and 6.4%, or 2-hour 75-gram oral glucose tolerance test (2 h-OGTT) between 7.8 and 11.1 mmol/L). HIMABERB® 500 mg was given three times daily to the treatment group, and placebo was administered three times daily to the control group. Glycemic control markers and physical parameters were evaluated for both groups on days 0, 28, 56, and 84. The glycemic control markers assessed included FPG, fasting insulin (FI), 2 h-OGTT, HbA1c, and homeostatic model assessment-insulin resistance (HOMA-IR). The observed outcomes were analyzed using independent t-test statistics to determine the significance of differences over time after treatment initiation and between treatment and control groups. RESULTS Significant decreases in all markers of glycemic control were observed in the treatment group at intermediate time points and the endpoint of the study compared to baseline levels and to the control group. For the treatment group, FPG decreased from 6.75 ± 0.23 mmol/L to 5.33 ± 0.28 mmol/L, FI from 9.81 ± 0.36 to 7.88 ± 0.52 mmol/L, 2 h-OGTT from 10.44 ± 0.52 to 8.12 ± 0.40 mmol/L, HbA1c from 6.40% ± 0.20-5.43% ± 0.21%, and HOMA-IR from 3.61 ± 0.31 to 2.41 ± 0.14. The decreases in glycemic control markers compared to the control group were clinically and statistically significant (p<10- 5). No severe adverse effects, kidney or liver toxicity were detected. CONCLUSION After 12 weeks, berberine (HIMABERB®) intervention in individuals with prediabetes significantly reduced glycemic control markers, with mean FPG and 2 h-OTGG being reduced to below prediabetic thresholds, supporting the investigation of the use of HIMABERB® for delaying progression to diabetes mellitus. TRIAL REGISTRATION http://ctri.nic.in (CTRI/2021/12/038751) (20/12/2021).
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Affiliation(s)
- Antarmayee Panigrahi
- Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneshwar, 751030, Odisha, India.
| | - Susant Mohanty
- Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneshwar, 751030, Odisha, India
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Nabila S, Choi J, Kim JE, Hahn S, Hwang IK, Kim TI, Park HK, Choi JY. Bidirectional associations between periodontal disease and systemic diseases: a nationwide population-based study in Korea. Sci Rep 2023; 13:14078. [PMID: 37640779 PMCID: PMC10462734 DOI: 10.1038/s41598-023-41009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
To evaluate the associations of periodontal disease (PD) with systemic diseases, including diabetes mellitus (DM) and cardiovascular disease (CVD), as well as the reciprocal association. The CVD included the cases of coronary heart disease and heart failure. A prospective study was conducted from 2007 to 2019 using linked data from three databases in Korea. Three separate study groups were formed to individually determine the risks of PD (n = 10,533), DM (n = 14,523) and CVD (n = 14,315). All diseases were confirmed based on physicians' diagnoses using medical records and self-reports. Cox proportional hazard regression was applied with 95% confidence intervals (CIs) to obtain hazard ratios (HRs). PD was significantly associated with an elevated risk of DM (HR [95% CI]: 1.22 [1.07-1.39]) after full adjustment for age, sex, lifestyle factors, body mass index, dental behaviour and CVD. PD was also found to increase the risk of CVD (1.27 [1.03-1.57]), whereas CVD increased the risk of PD (1.20 [1.09-1.32]) after full adjustment for other covariates including DM. This study found a bidirectional association between PD and CVD, as well as a positive association of PD with DM.
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Affiliation(s)
- Salma Nabila
- Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea
- BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Korea
| | - Jaesung Choi
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ji-Eun Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea
- BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Korea
| | - Seokyung Hahn
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - In-Kyung Hwang
- Department of Periodontology, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul, Korea
| | - Tae-Il Kim
- Department of Periodontology, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul, Korea
| | - Hee-Kyung Park
- Department of Oral Medicine and Oral Diagnosis, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, 101 Daehak-ro, Jongno-gu, Seoul, 110-749, Korea.
| | - Ji-Yeob Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea.
- BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea.
- Cancer Research Institute, Seoul National University, Seoul, Korea.
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Arhab A, Junod N, Rossel JB, Giet O, Sittarame F, Beer S, Sofra D, Durrer D, Delgado H, Castellsague M, Laimer M, Puder JJ. Effectiveness of a real-life program (DIAfit) to promote physical activity in patients with type 2 diabetes: a pragmatic cluster randomized clinical trial. Front Endocrinol (Lausanne) 2023; 14:1155217. [PMID: 37484961 PMCID: PMC10359883 DOI: 10.3389/fendo.2023.1155217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The aim of this study was to evaluate the effectiveness of a real-life clinical physical activity program (DIAfit) on improving physical fitness, body composition, and cardiometabolic health in an unselected population with type 2 diabetes mellitus, and to compare the effects of two variants a different exercise frequencies on the same outcomes. Research design and methods This was a cluster randomized-controlled assessor-blind trial conducted in 11 clinical centres in Switzerland. All participants in the clinical program with type 2 diabetes were eligible and were randomized to either standard (3 sessions/week for 12 weeks) or alternative (1 session/week for the first four weeks, then 2 sessions/week for the rest of 16 weeks) physical activity program each consisting of 36 sessions of combined aerobic and resistance exercise. Allocation was concealed by a central office unrelated to the study. The primary outcome was aerobic fitness. Secondary outcome measures included: body composition, BMI, HbA1c, muscle strength, walking speed, balance, flexibility, blood pressure, lipid profile. Results All 185 patients with type 2 diabetes (mean age 59.7 +-10.2 years, 48% women) agreed to participate and were randomized in two groups: a standard group (n=88) and an alternative group (n=97)). There was an 11% increase in aerobic fitness after the program (12.5 Watts; 95% CI 6.76 to 18.25; p<0.001). Significant improvements in physical fitness, body composition, and cardiometabolic parameters were observed at the end of the DIAfit program (improvements between 2-29%) except for lean body mass, triglycerides and cholesterol. No differences were observed between both programs, except for a larger weight reduction of -0.97kg (95% CI -0.04 to -1.91; p=0.04) in the standard program. Conclusions Both frequency variants of the nation-wide DIAfit program had beneficial effects on physical fitness, HbA1c, body composition, and blood pressure in type 2 diabetes patients and differences were negligible. Clinical trial registration clinicaltrials.gov, identifier NCT01289587.
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Affiliation(s)
- Amar Arhab
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
| | - Nicolas Junod
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
- La Lignière Clinic, Department of Medicine, Cardiovascular and Metabolic Rehabilitation Service, Gland, Switzerland
- Lavaux Hospital, Cully, Switzerland
| | - Jean-Benoit Rossel
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
| | - Olivier Giet
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
- Socio-medical Centre, Sierre, Switzerland
| | - Frederic Sittarame
- Cardiac Rehabilitation and Heart Failure Unity, Cardiology Service, Department of Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Sandra Beer
- Private Practice for Diabetes and Endocrinology, Lausanne, Switzerland
| | - Daniela Sofra
- Private Practice for Diabetes and Endocrinology, Lausanne, Switzerland
| | - Dominique Durrer
- European Association for the Study of Obesity (EASO), Collaborating Centre for Obesity Management (COMs), Vevey, Switzerland
| | - Humberto Delgado
- La Lignière Clinic, Department of Medicine, Cardiovascular and Metabolic Rehabilitation Service, Gland, Switzerland
| | | | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital Bern University Hospital, Bern, Switzerland
| | - Jardena J. Puder
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
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Liu X, Johnson SB, Lynch KF, Cordan K, Pate R, Butterworth MD, Lernmark Å, Hagopian WA, Rewers MJ, McIndoe RA, Toppari J, Ziegler AG, Akolkar B, Krischer JP, Yang J. Physical Activity and the Development of Islet Autoimmunity and Type 1 Diabetes in 5- to 15-Year-Old Children Followed in the TEDDY Study. Diabetes Care 2023; 46:1409-1416. [PMID: 37141102 PMCID: PMC10300517 DOI: 10.2337/dc23-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study investigated physical activity and its association with the development of islet autoimmunity and type 1 diabetes in genetically at-risk children aged 5-15 years. RESEARCH DESIGN AND METHODS As part of the longitudinal Environmental Determinants of Diabetes in the Young (TEDDY) study, annual assessment of activity using accelerometry was conducted from age 5 years. Time-to-event analyses using Cox proportional hazard models were used to assess the association between time spent in moderate to vigorous physical activity per day and the appearance of one or several autoantibodies and progression to type 1 diabetes in three risk groups: 1) 3,869 islet autoantibody (IA)-negative children, of whom 157 became single IA positive; 2) 302 single IA-positive children, of whom 73 became multiple IA positive; and 3) 294 multiple IA-positive children, of whom 148 developed type 1 diabetes. RESULTS No significant association was found in risk group 1 or risk group 2. A significant association was seen in risk group 3 (hazard ratio 0.920 [95% CI 0.856, 0.988] per 10-min increase; P = 0.021), particularly when glutamate decarboxylase autoantibody was the first autoantibody (hazard ratio 0.883 [95% CI 0.783, 0.996] per 10-min increase; P = 0.043). CONCLUSIONS More daily minutes spent in moderate to vigorous physical activity was associated with a reduced risk of progression to type 1 diabetes in children aged 5-15 years who had developed multiple IAs.
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Affiliation(s)
- Xiang Liu
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Suzanne Bennett Johnson
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL
| | - Kristian F. Lynch
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Kerry Cordan
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Russell Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Martha D. Butterworth
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | | | - Marian J. Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| | - Richard A. McIndoe
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Anette-G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Jeffrey P. Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
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Boyer W, Toth L, Brenton M, Augé R, Churilla J, Fitzhugh E. The role of resistance training in influencing insulin resistance among adults living with obesity/overweight without diabetes: A systematic review and meta-analysis. Obes Res Clin Pract 2023; 17:279-287. [PMID: 37331899 DOI: 10.1016/j.orcp.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023]
Abstract
The purpose of this study was to systematically examine the independent effect of resistance training (RT) on markers of insulin resistance (IR) (fasting insulin and HOMA-IR) among individuals with overweight/obesity without diabetes. PubMed, SPORTdiscus, SCOPUS, Prospero, and clinicaltrials.gov were searched through December 19, 2022. Article screening was conducted in three phases: title screen (n = 5020), abstract screen (n = 202), and full text screen (n = 73). A total of 27 studies with 402 individual data points were used for the meta-analysis. Comprehensive Meta-Analysis software version 3.0 was used to interpret pre- and post-IR measurements with a random-effects model. Exploratory sub-analyses were conducted on studies for only females, only males, and age (< 40 and ≥ 40 years). RT had a significant effect on fasting insulin (- 1.03, 95 % CI - 1.03, - 0.75 p < 0.001) and HOMA-IR (- 1.05, 95 % CI - 1.33, - 0.76, p < 0.001). Sub-analyses revealed that males had a more pronounced effect compared to females and those < 40 years of age had a more pronounced effect compared to those ≥ 40 years. The results of this meta-analysis illustrate that RT plays an independent role in improving IR among adults with overweight/obesity. RT should continue to be recommended as part of preventive measures among these populations. Future studies examining the effect of RT on IR should consider dose centered on the current U.S. physical activity guidelines.
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Affiliation(s)
- William Boyer
- California Baptist University, Department of Kinesiology, 8432 Magnolia Ave., Riverside, CA 92504, United States of America.
| | - Lindsay Toth
- University of North Florida, Department of Clinical and Applied Movement Sciences, 1 UNF Dr., Jacksonville, FL 32224, United States of America
| | - Madison Brenton
- California Baptist University, Department of Kinesiology, 8432 Magnolia Ave., Riverside, CA 92504, United States of America
| | - Robert Augé
- University of Tennessee, Department of Plant Sciences, 2505 E J. Chapman Dr., Knoxville, TN 37919, United States of America
| | - James Churilla
- University of North Florida, Department of Clinical and Applied Movement Sciences, 1 UNF Dr., Jacksonville, FL 32224, United States of America
| | - Eugene Fitzhugh
- University of Tennessee, Department of Kinesiology, Recreation and Sports Studies, 1914 Andy Holt Ave, Knoxville, TN 37996, United States of America
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Dabhi KN, Gohil NV, Tanveer N, Hussein S, Pingili S, Makkena VK, Jaramillo AP, Awosusi BL, Ayyub J, Nath TS. Assessing the Link Between Statins and Insulin Intolerance: A Systematic Review. Cureus 2023; 15:e42029. [PMID: 37465091 PMCID: PMC10351747 DOI: 10.7759/cureus.42029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023] Open
Abstract
There has been mixed and inconclusive evidence regarding the relationship between statin usage and insulin intolerance. This systematic review aims to comprehensively explore the link between the use of statins and insulin intolerance. We systematically searched MEDLINE, PubMed, PubMed Central (PMC), and Google Scholar databases for online English articles with full text. We excluded conference proceedings, editorials, commentaries, preclinical studies, abstracts, and preprints. The search across databases initially identified 667 articles. After eliminating duplicates and analyzing the remaining articles based on the inclusion and exclusion criteria, 11 articles were selected. The included studies had a total of 46,728,889 participants. The findings suggest that the use of statins is associated with a decrease in insulin sensitivity and insulin resistance. This systematic review provides evidence that the use of statins may have an adverse effect on insulin sensitivity and increase insulin resistance. These findings may have important clinical implications for individuals on statin therapy, especially those at risk of developing diabetes.
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Affiliation(s)
- Karan Nareshbhai Dabhi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Namra V Gohil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Nida Tanveer
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sally Hussein
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shravya Pingili
- Internal Medicine, Kakatiya Medical College, Hyderabad, IND
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vijaya Krishna Makkena
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Osmania Medical College, Hyderabad, IND
| | - Arturo P Jaramillo
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Babatope L Awosusi
- Pathology and Laboratory Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Javaria Ayyub
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tuheen Sankar Nath
- Surgical Oncology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Pamidi S, Benedetti A, Tasali E. One hour post-load glucose levels among patients with obstructive sleep apnea and normal glucose tolerance. J Diabetes Complications 2023; 37:108551. [PMID: 37478674 DOI: 10.1016/j.jdiacomp.2023.108551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Sushmita Pamidi
- Department of Medicine, Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Andrea Benedetti
- Department of Medicine, Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Canada
| | - Esra Tasali
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
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Ismail CAN. Issues and challenges in diabetic neuropathy management: A narrative review. World J Diabetes 2023; 14:741-757. [PMID: 37383599 PMCID: PMC10294062 DOI: 10.4239/wjd.v14.i6.741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 04/11/2023] [Indexed: 06/14/2023] Open
Abstract
Diabetic neuropathy (DN) is a devastating disorder with an increasing prevalence globally. This epidemic can pose a critical burden on individuals and com-munities, subsequently affecting the productivity and economic output of a country. With more people living a sedentary lifestyle, the incidence of DN is escalating worldwide. Many researchers have relentlessly worked on ways to combat this devastating disease. Their efforts have given rise to a number of commercially available therapies that can alleviate the symptoms of DN. Unfortunately, most of these therapies are only partially effective. Worse still, some are associated with unfavorable side effects. This narrative review aims to highlight current issues and challenges in the management of DN, especially from the perspective of molecular mechanisms that lead to its progression, with the hope of providing future direction in the management of DN. To improve the approaches to diabetic management, the suggested resolutions in the literature are also discussed in this review. This review will provide an in-depth understanding of the causative mechanisms of DN, apart from the insights to improve the quality and strategic approaches to DN management.
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Affiliation(s)
- Che Aishah Nazariah Ismail
- Department of Physiology, School of Medical Sciences, University Sains Malaysia Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
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Barthow C, Krebs J, McKinlay E. A multiple case study of pre-diabetes care undertaken by general practice in Aotearoa/New Zealand: de-incentivised and de-prioritised work. BMC PRIMARY CARE 2023; 24:109. [PMID: 37120507 PMCID: PMC10147904 DOI: 10.1186/s12875-023-02053-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/02/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND In Aotearoa/New Zealand (NZ) general practices diagnose and manage pre-diabetes. This work is important as it has the potential to delay or prevent the onset of Type 2 Diabetes (T2DM), reduce NZ's health inequities, and the burden that T2DM places on health care services. However, no study has previously examined how this work routinely occurs in NZ. METHODS Two case studies of practices serving ethnically and socio-economically diverse populations, followed by cross-case analysis. RESULTS The NZ health care context including funding mechanisms, reporting targets, and the disease centred focus of care, acted together to dis-incentivise and de-prioritise pre-diabetes care in general practices. The social determinants of health differentially influenced patients' ability to engage with and respond to pre-diabetes care, significantly impacting this work. Differing perspectives about the significance of pre-diabetes and gaps in systematic screening practices were identified. Interventions used were inconsistent and lacked comprehensive ongoing support. CONCLUSIONS Complex multi-layered factors impact on pre-diabetes care, and many of the barriers cannot be addressed at the general practice level. The practice serving the most disadvantaged population who concurrently have higher rates of pre-diabetes/T2DM were more adversely affected by the barriers identified.
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Affiliation(s)
- Christine Barthow
- Department of Medicine, University of Otago, PO Box 7343, Wellington, Wellington South, 6242, New Zealand.
| | - Jeremy Krebs
- Department of Medicine, University of Otago, PO Box 7343, Wellington, Wellington South, 6242, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington, Wellington South, 6242, New Zealand
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Liu J, Wang L, Cui X, Shen Q, Wu D, Yang M, Dong Y, Liu Y, Chen H, Yang Z, Liu Y, Zhu M, Ma H, Jin G, Qian Y. Polygenic Risk Score, Lifestyles, and Type 2 Diabetes Risk: A Prospective Chinese Cohort Study. Nutrients 2023; 15:2144. [PMID: 37432247 DOI: 10.3390/nu15092144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 07/12/2023] Open
Abstract
The aim of this study was to generate a polygenic risk score (PRS) for type 2 diabetes (T2D) and test whether it could be used in identifying high-risk individuals for lifestyle intervention in a Chinese cohort. We genotyped 80 genetic variants among 5024 participants without non-communicable diseases at baseline in the Wuxi Non-Communicable Diseases cohort (Wuxi NCDs cohort). During the follow-up period of 14 years, 440 cases of T2D were newly diagnosed. Using Cox regression, we found that the PRS of 46 SNPs identified by the East Asians was relevant to the future T2D. Participants with a high PRS (top quintile) had a two-fold higher risk of T2D than the bottom quintile (hazard ratio: 2.06, 95% confidence interval: 1.42-2.97). Lifestyle factors were considered, including cigarette smoking, alcohol consumption, physical exercise, diet, body mass index (BMI), and waist circumference (WC). Among high-PRS individuals, the 10-year incidence of T2D slumped from 6.77% to 3.28% for participants having ideal lifestyles (4-6 healthy lifestyle factors) compared with poor lifestyles (0-2 healthy lifestyle factors). When integrating the high PRS, the 10-year T2D risk of low-clinical-risk individuals exceeded that of high-clinical-risk individuals with a low PRS (3.34% vs. 2.91%). These findings suggest that the PRS of 46 SNPs could be used in identifying high-risk individuals and improve the risk stratification defined by traditional clinical risk factors for T2D. Healthy lifestyles can reduce the risk of a high PRS, which indicates the potential utility in early screening and precise prevention.
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Affiliation(s)
- Jia Liu
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Lu Wang
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Xuan Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Qian Shen
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Dun Wu
- College of Arts and Science, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Man Yang
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Yunqiu Dong
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Yongchao Liu
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Hai Chen
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Zhijie Yang
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Yaqi Liu
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
| | - Meng Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Hongxia Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Guangfu Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yun Qian
- Department of Chronic Non-Communicable Disease Control, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University (Wuxi Center for Disease Control and Prevention), Wuxi 214023, China
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Graham SA, Auster-Gussman LA, Lockwood KG, Branch OH. Weight Loss in a Digital Diabetes Prevention Program for People in Health Professional Shortage and Rural Areas. Popul Health Manag 2023. [PMID: 37115532 DOI: 10.1089/pop.2022.0278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Individuals with prediabetes living in hard-to-reach and underserved areas experience barriers to accessing traditional in-person preventive health services. The National Diabetes Prevention Program (DPP) is a preventive health care program designed to reduce the risk of developing type 2 diabetes. Although there have been increasing numbers of remote DPPs accessible, there are little data on the clinical outcomes of digital DPPs for members living in hard-to-reach and underserved areas. This study assessed whether living in a designated Health Professional Shortage Area (HPSA) and a rural versus urban area impacted the weight loss of N = 7266 members of a fully digital program called Lark DPP. Secondary analyses included between-group comparisons of program retention and member characteristics, demographics, and socioeconomics. Percent weight loss did not differ by HPSA (P = 0.16) or rural/urban status (P = 0.15), despite greater potential barriers for members residing in HPSAs (eg, highest starting body mass index, lowest income, lowest education). Mean percent weight loss for members residing in an HPSA and rural area was mean (M) = 4.75%, standard error (SE) = 0.09; for members in a non-HPSA, rural area M = 4.96%, SE = 0.16; for members in an HPSA, urban area M = 4.55%, SE = 0.13; and for members in a non-HPSA, urban area M = 4.77%, SE = 0.13. Members of a fully digital DPP achieved weight loss that did not differ by HPSA or urban/rural designation. Fully digital programs offer a solution to reduce the risk of type 2 diabetes in areas where residents may not otherwise have access to diabetes prevention services.
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Sauder KA, Glueck DH, Harrall KK, D'Agostino R, Dolan LM, Lane AD, Liese AD, Lustigova E, Malik FS, Marcovina S, Mayer‐Davis E, Mottl A, Pihoker C, Reynolds K, Shah AS, Urbina EM, Wagenknecht LE, Daniels SR, Dabelea D. Exploring Racial and Ethnic Differences in Arterial Stiffness Among Youth and Young Adults With Type 1 Diabetes. J Am Heart Assoc 2023; 12:e028529. [PMID: 36994741 PMCID: PMC10122883 DOI: 10.1161/jaha.122.028529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/06/2023] [Indexed: 03/31/2023]
Abstract
Background We examined arterial stiffness in individuals with type 1 diabetes, and explored whether differences between Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) individuals were attributable to modifiable clinical and social factors. Methods and Results Participants (n=1162; 22% Hispanic, 18% NHB, and 60% NHW) completed 2 to 3 research visits from ≈10 months to ≈11 years post type 1 diabetes diagnosis (mean ages of ≈9 to ≈20 years, respectively) providing data on socioeconomic factors, type 1 diabetes characteristics, cardiovascular risk factors, health behaviors, quality of clinical care, and perception of clinical care. Arterial stiffness (carotid-femoral pulse wave velocity [PWV], m/s) was measured at ≈20 years of age. We analyzed differences in PWV by race and ethnicity, then explored the individual and combined impact of the clinical and social factors on these differences. PWV did not differ between Hispanic (adjusted mean 6.18 [SE 0.12]) and NHW (6.04 [0.11]) participants after adjustment for cardiovascular risks (P=0.06) and socioeconomic factors (P=0.12), or between Hispanic and NHB participants (6.36 [0.12]) after adjustment for all factors (P=0.08). PWV was higher in NHB versus NHW participants in all models (all P<0.001). Adjustment for modifiable factors reduced the difference in PWV by 15% for Hispanic versus NHW participants; by 25% for Hispanic versus NHB; and by 21% for NHB versus NHW. Conclusions Cardiovascular and socioeconomic factors explain one-quarter of the racial and ethnic differences in PWV of young people with type 1 diabetes, but NHB individuals still experienced greater PWV. Exploration of pervasive inequities potentially driving these persistent differences is needed.
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Affiliation(s)
- Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Deborah H. Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Kylie K. Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Ralph D'Agostino
- Biostatistics and Data SciencesWake Forest University School of MedicineWinston‐SalemNC
| | - Lawrence M. Dolan
- Pediatrics, Cincinnati Children’s Hospital Medical Center Department of Pediatrics & The University of CincinnatiCincinnatiOH
| | - Abbi D. Lane
- Exercise ScienceUniversity of South Carolina Arnold School of Public HealthColumbiaSC
| | - Angela D. Liese
- Epidemiology and BiostatisticsUniversity of South Carolina Arnold School of Public HealthColumbiaSC
| | - Eva Lustigova
- Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | | | | | | | - Amy Mottl
- MedicineUniversity of North Carolina at Chapel HillChapel HillNC
| | | | - Kristi Reynolds
- Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Amy S. Shah
- Pediatrics, Cincinnati Children’s Hospital Medical Center Department of Pediatrics & The University of CincinnatiCincinnatiOH
| | - Elaine M. Urbina
- Pediatrics, Cincinnati Children’s Hospital Medical Center Department of Pediatrics & The University of CincinnatiCincinnatiOH
| | | | - Stephen R. Daniels
- PediatricsPediatrics, University of Colorado Anschutz Medical CampusAuroraCO
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterUniversity of Colorado Anschutz Medical CampusAuroraCO
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Coomans de Brachène A, Scoubeau C, Musuaya AE, Costa-Junior JM, Castela A, Carpentier J, Faoro V, Klass M, Cnop M, Eizirik DL. Exercise as a non-pharmacological intervention to protect pancreatic beta cells in individuals with type 1 and type 2 diabetes. Diabetologia 2023; 66:450-460. [PMID: 36401627 PMCID: PMC9676790 DOI: 10.1007/s00125-022-05837-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022]
Abstract
AIMS/HYPOTHESIS Diabetes is characterised by progressive loss of functional pancreatic beta cells. None of the therapeutic agents used to treat diabetes arrest this process; preventing beta cell loss remains a major unmet need. We have previously shown that serum from eight young healthy male participants who exercised for 8 weeks protected human islets and insulin-producing EndoC-βH1 cells from apoptosis induced by proinflammatory cytokines or the endoplasmic reticulum (ER) stressor thapsigargin. Whether this protective effect is influenced by sex, age, training modality, ancestry or diabetes is unknown. METHODS We enrolled 82 individuals, male or female, non-diabetic or diabetic, from different origins, in different supervised training protocols for 8-12 weeks (including training at home during the COVID-19 pandemic). EndoC-βH1 cells were treated with 'exercised' serum or with the exerkine clusterin to ascertain cytoprotection from ER stress. RESULTS The exercise interventions were effective and improved [Formula: see text] values in both younger and older, non-obese and obese, non-diabetic and diabetic participants. Serum obtained after training conferred significant beta cell protection (28% to 35% protection after 4 and 8 weeks of training, respectively) from severe ER stress-induced apoptosis. Cytoprotection was not affected by the type of exercise training or participant age, sex, BMI or ancestry, and persisted for up to 2 months after the end of the training programme. Serum from exercised participants with type 1 or type 2 diabetes was similarly protective. Clusterin reproduced the beneficial effects of exercised sera. CONCLUSIONS/INTERPRETATION These data uncover the unexpected potential to preserve beta cell health by exercise training, opening a new avenue to prevent or slow diabetes progression through humoral muscle-beta cell crosstalk.
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Affiliation(s)
| | - Corentin Scoubeau
- Laboratory for Biometry and Exercise Nutrition, Université Libre de Bruxelles, Brussels, Belgium
| | - Anyïshai E Musuaya
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
| | - Jose Maria Costa-Junior
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
| | - Angela Castela
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Carpentier
- Laboratory for Biometry and Exercise Nutrition, Université Libre de Bruxelles, Brussels, Belgium
| | - Vitalie Faoro
- Cardiopulmonary Exercise Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Malgorzata Klass
- Laboratory for Biometry and Exercise Nutrition, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Applied Biology and Research Unit in Applied Neurophysiology, Université Libre de Bruxelles, Brussels, Belgium
| | - Miriam Cnop
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
- Division of Endocrinology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Decio L Eizirik
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
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Vázquez-Ruiz Z, Martínez-González MÁ, Vitelli-Storelli F, Bes-Rastrollo M, Basterra-Gortari FJ, Toledo E. Effect of Dietary Phenolic Compounds on Incidence of Type 2 Diabetes in the "Seguimiento Universidad de Navarra" (SUN) Cohort. Antioxidants (Basel) 2023; 12:antiox12020507. [PMID: 36830064 PMCID: PMC9952475 DOI: 10.3390/antiox12020507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
The global incidence of type 2 diabetes (T2D) has been steadily increasing in recent decades. The Mediterranean dietary pattern has shown a preventive effect on the risk of T2D. Evaluating the association between bioactive compounds such as phenolic compounds (PC) in a Mediterranean cohort could help to better understand the mechanisms implicated in this protection. We evaluated the association between dietary intake of PC and the risk of T2D in a relatively young cohort of 17,821 Spanish participants initially free of T2D, through the University of Navarra Follow-up Project ("Seguimiento Universidad de Navarra" or SUN cohort) after 10 years of median follow-up using time-dependent Cox models. Intake of PC was estimated at baseline and repeatedly at 10-year follow-up using a 136-item validated food frequency and the Phenol-Explorer database. The incidence of T2D was identified by a biennial follow-up, and only medically confirmed cases were included. During 224,751 person-years of follow-up, 186 cases of T2D were confirmed. A suboptimal intake of stilbenes was independently associated with a higher risk of T2D in subjects over 50 years (HR: 1.75, 95% CI: 1.06-2.90, p value < 0.05) after adjusting for potential confounders. Our results suggest that a moderate-high intake of stilbenes can decrease the risk of developing T2D in subjects over 50 years in our cohort.
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Affiliation(s)
- Zenaida Vázquez-Ruiz
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Facundo Vitelli-Storelli
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, 24004 León, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Francisco Javier Basterra-Gortari
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
- Correspondence:
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Cheney AM, McCarthy WJ, Pozar M, Reaves C, Ortiz G, Lopez D, Saldivar PA, Gelberg L. "Ancestral recipes": a mixed-methods analysis of MyPlate-based recipe dissemination for Latinos in rural communities. BMC Public Health 2023; 23:216. [PMID: 36721121 PMCID: PMC9889948 DOI: 10.1186/s12889-022-14804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/05/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Latinx population experiences some of the highest rates of chronic disease, including obesity and type II diabetes. Such conditions may be especially burdensome in rural Latinx communities that often face barriers to accessing disease prevention resources and public health programs. METHODS Diverse stakeholders (i.e., patients, community members, system of healthcare clinics, community food bank) tailored an existing cookbook, based on the U.S. Department of Agriculture MyPlate healthy eating and dietary guidelines, for local ingredients, health literacy, and language for rural Latinx and Indigenous Latin Americans. The cookbook recipes were disseminated widely via virtual cooking demonstrations, food distribution events, and social media. Pre- and posttest surveys were used to assess changes in diabetes knowledge measured by the 24-item American Diabetes Association Diabetic Knowledge Questionnaire and confidence in dietary behavior change over time measured by 4 questions of the 17-item Mediterranean Diet Index. A mixed effects, repeated measures analysis was conducted with gender ID, age range and educational attainment included as covariates and assessment interval as the predictor (pretest vs posttest) and change in confidence about adhering to four specific components of the Mediterranean diet. Focus groups elicited information on participants' motivation and ability to use the recipes and eat healthy foods following the virtual cooking demonstration participation. RESULTS A total of 20 virtual cooking demonstrations were conducted and 60 participants completed a pretest survey and 54 a posttest survey, a subsample (n = 19) participated in one of three focus groups. Most participants were female, identified as Latinx/Hispanic, were between the ages of 40-49, and spoke Spanish. 17% identified as Indigenous Latin American specifically as Purépecha, an indigenous group from Michoacán, Mexico. Survey and focus group findings indicated at posttest an increase in diabetes knowledge among participants with no prior diagnosis of chronic health conditions and more confidence in limiting sugary beverages and refined wheat pasta/white rice among indigenous participants. Focus group discussions explicated the quantitative findings. CONCLUSION This study brought together patients and key stakeholders committed to addressing the social determinants of health and it mobilized the community to develop culturally vetted health education materials. The findings indicate the need for increased access to evidence-based nutrition education and to culturally appropriate food products that can be easily incorporated into daily food preparation.
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Affiliation(s)
- Ann Marie Cheney
- Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine, 900 University Ave, Riverside, CA, 92521, USA.
| | - William J McCarthy
- University of California Los Angeles Fielding School of Public Health, California, Los Angeles, USA
| | - María Pozar
- Conchita Servicios de la Comunidad, Madrid, Spain
| | | | - Gabriela Ortiz
- University of California Riverside College of Arts, Humanities, and Social Sciences, Riverside, California, USA
| | - Diana Lopez
- University of California Los Angeles David Geffen School of Medicine, California, Los Angeles, USA
| | - Perla A Saldivar
- Department of Social Medicine Population and Public Health, University of California Riverside School of Medicine, 900 University Ave, Riverside, CA, 92521, USA
| | - Lillian Gelberg
- University of California Los Angeles Fielding School of Public Health, California, Los Angeles, USA
- University of California Los Angeles David Geffen School of Medicine, California, Los Angeles, USA
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50
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Association of Fatty Liver Index with Incident Diabetes Risk in Patients Initiating Statin-Therapy: A 6-Year Retrospective Study. Diagnostics (Basel) 2023; 13:diagnostics13030503. [PMID: 36766607 PMCID: PMC9913972 DOI: 10.3390/diagnostics13030503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Statins are associated with new-onset type 2 diabetes (T2D), mainly in patients with metabolic syndrome (MetS). The fatty liver index (FLI) is used as a prognostic score for the diagnosis of non-alcoholic fatty liver disease (NAFLD), which is common in patients with MetS. We aimed to investigate the association of FLI with new-onset T2D in patients initiating statin therapy. METHODS A retrospective observational study including 1241 individuals with dyslipidemia and followed up for ≥3 years. Patients with T2D and those receiving lipid-lowering treatment at the baseline visit were excluded. Models with clinical and laboratory parameters were used to assess the association of FLI with incident T2D. RESULTS Among the 882 eligible subjects, 11% developed T2D during the follow-up (6 years; IQR: 4-10 years). After adjusting for sex, age and MetS parameters, a multivariate analysis revealed that age (HR:1.05; 95%CI: 1.01-1.09, p < 0.05), fasting plasma glucose (HR: 1.09; 95%CI: 1.06-1.13, p < 0.001) and FLI (HR: 1.02; 95%CI: 1.01-1.04, p < 0.01) were independently associated with T2D risk. The subjects with probable NAFLD (FLI ≥ 60) had a three-fold increased T2D risk compared with the subjects with FLI < 60 (HR: 3.14; 95%CI: 1.50-6.59, p = 0.001). A ROC curve analysis showed that FLI had a significant, although poor, predictive value for assessing T2D risk (C-Statistic: 0.67; 95%CI: 0.58-0.77, p = 0.001). Higher FLI values were associated with reduced T2D-free survival (log-rank = 15.46, p < 0.001). CONCLUSIONS FLI is significantly and independently associated with new-onset T2D risk in patients initiating statin therapy.
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