Psychodynamic mechanism and weight reduction in obesity group therapy – first observations with different attachment styles

Objectives: Successful long-term results are extremely rare in non-surgical obesity treatment. Interactional difficulties with the attending physicians and the limited compliance of obese patients are a frequently described dilemma in repeated psychotherapeutic group treatment attempts. The type of relationship initiation and the attachment behavior probably play a central role in this connection but have not yet been systematically investigated

Metformin extended-release versus immediate-release:An international, randomized, double-blind, head-to-head trial in pharmacotherapy-naïve patients with type 2 diabetes

This international, randomized, double-blind trial (NCT01864174) compared the efficacy and safety of metformin extended-release (XR) and immediate-release (IR) in patients with type 2 diabetes. After a 4-week placebo lead-in, pharmacotherapy-naïve adults with glycated haemoglobin (HbA1c) at 7.0% to 9.2% were randomized (1:1) to receive once-daily metformin XR 2000mg or twice-daily metformin IR 1000mg for 24weeks. The primary endpoint was change in HbA1c after 24weeks. Secondary endpoints were change in fasting plasma glucose (FPG), mean daily glucose (MDG) and patients (%) with HbA1c <7.0% after 24weeks. Overall, 539 patients were randomized (metformin XR, N=268; metformin IR, N=271). Adjusted mean changes in HbA1c, FPG, MDG and patients (%) with HbA1c <7.0% after 24weeks were similar for XR and IR: -0.93% vs -0.96%; -21.1 vs -20.6mg/dL (-1.2 vs -1.1mmol/L); -24.7 vs -27.1mg/dL (-1.4 vs -1.5mmol/L); and 70.9% vs 72.0%, respectively. Adverse events were similar between groups and consistent with previous studies. Overall, metformin XR demonstrated efficacy and safety similar to that of metformin IR over 24weeks, with the advantage of once-daily dosing

Effects of long-term soluble vs. insoluble dietary fiber intake on high-fat diet-induced obesity in C57BL/6J mice

Although most of the proposed beneficial effects of fiber consumption have been attributed to viscous and gel-forming properties of soluble fiber, it is mainly insoluble cereal fiber and whole grains that are strongly associated with reduced diabetes risk in prospective cohort studies, indicating that other unknown mechanisms are likely to be involved. We performed a long-term study investigating potential protective effects of adding soluble guar fiber (10% w/w) vs. insoluble cereal fiber (10% w/w) to an isoenergetic and macronutrient matched high-fat diet in obesity-prone C57BL/6J mice. After 45 weeks, mice fed soluble vs. insoluble fiber showed both significantly increased body weight (41.8±3.0 vs. 33.6±1.5 g, P=.03) and elevated markers of insulin resistance. In mice fed soluble fiber, energy loss via the feces was significantly lower and colonic fermentation with production of short chain fatty acids (SCFA) was markedly increased. Gene expression analysis in white adipose tissue showed significantly increased levels of the fatty acid target G-protein coupled receptor-40 in soluble fiber-fed mice. Liver gene expression in the insoluble fiber group showed a pattern consistent with increased fatty acid oxidation. The present results show that soluble vs insoluble dietary fiber added to a high-fat, Western-style diet differently affected body weight and estimates of insulin sensitivity in obesity-prone mice. Soluble fiber intake with increased SCFA production significantly contributed to digested energy, thereby potentially outweighing the well known short-term beneficial effects of soluble fiber consumption

New genetic loci implicated in fasting glucose homeostasis and their impact on type 2 diabetes risk

Levels of circulating glucose are tightly regulated. To identify new loci influencing glycemic traits, we performed meta-analyses of 21 genome-wide association studies informative for fasting glucose, fasting insulin and indices of beta-cell function (HOMA-B) and insulin resistance (HOMA-IR) in up to 46,186 nondiabetic participants. Follow-up of 25 loci in up to 76,558 additional subjects identified 16 loci associated with fasting glucose and HOMA-B and two loci associated with fasting insulin and HOMA-IR. These include nine loci newly associated with fasting glucose (in or near ADCY5, MADD, ADRA2A, CRY2, FADS1, GLIS3, SLC2A2, PROX1 and C2CD4B) and one influencing fasting insulin and HOMA-IR (near IGF1). We also demonstrated association of ADCY5, PROX1, GCK, GCKR and DGKB-TMEM195 with type 2 diabetes. Within these loci, likely biological candidate genes influence signal transduction, cell proliferation, development, glucose-sensing and circadian regulation. Our results demonstrate that genetic studies of glycemic traits can identify type 2 diabetes risk loci, as well as loci containing gene variants that are associated with a modest elevation in glucose levels but are not associated with overt diabetes

Glycaemic response after intake of a high energy, high protein, diabetes-specific formula in older malnourished or at risk of malnutrition type 2 diabetes patients

Background & aims: Several studies with diabetes-specific formulas (DSFs) for hyperglycaemic patients in need of nutritional support have been conducted in non-malnourished patients, mainly comparing products with varying macronutrient compositions. Here, the effect of a high energy, high protein DSF on postprandial responses was compared to a product with a similar macronutrient composition in malnourished or at risk of malnutrition patients with type 2 diabetes.Methods: In this randomised, double-blind cross-over study, 20 patients were included. After overnight fasting, patients consumed 200 mL of a DSF or standard supplement (control) (19.6 g protein, 31.2 g carbohydrates and 10.6 g fat), while continuing their anti-diabetic medication. The formulas differed in type of carbohydrates and presence of fibre. The postprandial glucose, insulin and glucagon responses were monitored over 4 h. Data were analysed with a Linear Mixed Model, and results of the modified ITT population (n = 19) are shown.Results: Postprandial glucose response as incremental area under the curve (iAUC), was lower after consumption of DSF compared with control (489.7 ± 268.5 (mean ± SD) vs 581.3 ± 273.9 mmol/L min, respectively; p = 0.008). Also, the incremental maximum concentration of glucose (iCmax) was lower for DSF vs control (3.5 ± 1.4 vs 4.0 ± 1.4 mmol/L; p = 0.007). Postprandial insulin and glucagon levels, expressed as iAUC or iCmax, were not significantly different between groups.Conclusions: Consumption of a high energy, high protein DSF by older malnourished or at risk of malnutrition type 2 diabetes patients resulted in a significantly lower glucose response compared to control. These data suggest that the use of a DSF is preferred for patients with diabetes in need of nutritional support

Einfluss der Fettleber auf den Glukosestoffwechsel nicht untersch&auml;tzen. Neue Ans&auml;tze f&uuml;r die Diagnose und Behandlung.

Die nicht alkoholische Fettleber gilt in Europa und den USA als die h&auml;ufigste Ursache f&uuml;r chronische Lebererkrankungen. Experten gehen davon aus, dass in Europa bis zu 30&thinsp;% der Bev&ouml;lkerung davon betroffen sind. Zu viel Fett in der Leber f&uuml;hrt dabei nicht nur zu einer chronischen Erkankung der Leber, es hat auch einen negativen Einfluss auf den Zuckerstoffwechsel und f&uuml;hrt beispielsweise zur Entwicklung eines Typ-2-Diabetes. Aus diesem Grund r&uuml;cken neue M&ouml;glichkeiten zur Therapie der Fettleber immer mehr in den Fokus. Dabei werden sowohl Ern&auml;hrungsumstellungen als auch medikament&ouml;se Ans&auml;tze ber&uuml;cksichtigt. Um den Zusammenhang zwischen Leber und Typ-2-Diabetes noch zielgerichteter zu untersuchen, baut das Deutsche Zentrum f&uuml;r Diabetesforschung einen Forschungsschwerpunkt zum Thema Fettleber auf

Predicting Factors for Metabolic Non-Response to a Complex Lifestyle Intervention—A Replication Analysis to a Randomized-Controlled Trial

BACKGROUND: T2DM heterogeneity affects responsiveness to lifestyle treatment. Beta-cell failure and nonalcoholic fatty liver disease (NAFLD) independently predict T2DM, but NAFLD inconsistently predicts metabolic response to lifestyle intervention. AIM: We attempt to replicate a prediction model deducted from the Tübinger Lifestyle Intervention Program by assessing similar metabolic factors to predict conversion to normal glucose regulation (NGR) in a comparable lifestyle intervention trial. METHODS: In the Optimal Fiber Trial (OptiFiT), 131 Caucasian participants with prediabetes completed a one-year lifestyle intervention program and received a fiber or placebo supplement. We compared baseline parameters for responders and non-responders, assessed correlations of major metabolic changes and conducted a logistic regression analysis for predictors of remission to NGR. RESULTS: NGR was achieved by 33 participants, respectively. At baseline, for the placebo group only, 1 h and 2 h glucose levels, glucose AUC and Cederholm index predicted conversion to NGR. HOMA-beta, HOMA-IR or liver fat indices did not differ between responders and non-responders of the placebo or the fiber group. Changes in waist circumference or fatty liver index correlated with changes in glycemia and insulin resistance, but not with changes in insulin secretion. Insulin-resistant NAFLD did not predict non-response. Differences in compliance did not explain the results. CONCLUSIONS: Higher post-challenge glucose levels strongly predicted the metabolic non-response to complex lifestyle intervention in our cohort. Depending on the specific intervention and the investigated cohort, fasting glucose levels and insulin sensitivity might contribute to the risk pattern. Beta-cell function did not improve in accordance with other metabolic improvements, qualifying as a potential risk factor for non-response. We could not replicate previous data suggesting that an insulin-resistant fatty liver is a specific risk factor for treatment failure. Replication studies are required

Loss of the antiangiogenic pigment epithelium-derived factor in patients with angiogenic eye disease

Retinal neovascularization characterizes proliferative diabetic retinopathy (PDR). Pigment epithelium-derived factor (PEDF) has been shown to be a major antiangiogenic growth factor in the mammalian eye. PEDF expression is suppressed by hypoxia, and changes in PEDF have been correlated to the development of retinal neovascularization in animal models of hypoxic eye disease. However, whether this concept of a reduced angiogenesis inhibitor holds true in humans is as yet unclear. In this study, we analyzed the in vivo regulation of PEDF in patients with and without hypoxic eye disease. We used immunoblots to measure PEDF in ocular fluids obtained from 64 nondiabetic and diabetic patients. In addition, immunohistochemistry of PEDF was carried out in specimens of normal human retinas and retinas with various degrees of diabetic retinopathy. The PEDF concentrations in patients with PDR (P < 0.001) or extensive nondiabetic retinal neovascularization caused by retinal-vein occlusion (P < 0.001) were lower than in control patients. Levels of PEDF were replenished in PDR patients with previous retinal scatter photocoagulation compared with PDR patients without previous photocoagulation (P = 0.01). Immunohistochemistry revealed an interstitial staining pattern as expected for a secreted protein, with an intense staining in retinas of patients without proliferative eye disease. However, in patients with PDR, little or no staining was detectable. Our data strongly support the concept that retinal angiogenesis is induced by loss of the major angiogenesis inhibitor in the eye, PEDF, in combination with an increased expression of angiogenic growth factors such as vascular endothelial growth factor. Our findings suggest that substitution of angiogenesis inhibitors may be an effective approach in the treatment of PDR