The effect of a lifestyle intervention on type 2 diabetes pathophysiology and remission: the Stevenshof pilot study

Although lifestyle interventions can lead to diabetes remission, it is unclear to what extent type 2 diabetes (T2D) remission alters or improves the underlying pathophysiology of the disease. Here, we assess the effects of a lifestyle intervention on T2D reversal or remission and the effects on the underlying pathology. In a Dutch primary care setting, 15 adults with an average T2D duration of 13.4 years who were (pharmacologically) treated for T2D received a diabetes subtyping ("diabetyping") lifestyle intervention (DLI) for six months, aiming for T2D remission. T2D subtype was determined based on an OGTT. Insulin and sulphonylurea (SU) derivative treatment could be terminated for all participants. Body weight, waist/hip ratio, triglyceride levels, HbA1c, fasting, and 2h glucose were significantly improved after three and six months of intervention. Remission and reversal were achieved in two and three participants, respectively. Indices of insulin resistance and beta cell capacity improved, but never reached healthy values, resulting in unchanged T2D subtypes. Our study implies that achieving diabetes remission in individuals with a longer T2D duration is possible, but underlying pathology is only minimally affected, possibly due to an impaired beta cell function. Thus, even when T2D remission is achieved, patients need to continue adhering to lifestyle therapy.Diabetes mellitus: pathophysiological changes and therap

A novel personalized systems nutrition program improves dietary patterns, lifestyle behaviors and health-related outcomes: results from the habit study

Personalized nutrition may be more effective in changing lifestyle behaviors compared to population-based guidelines. This single-arm exploratory study evaluated the impact of a 10-week personalized systems nutrition (PSN) program on lifestyle behavior and health outcomes. Healthy men and women (n = 82) completed the trial. Individuals were grouped into seven diet types, for which phenotypic, genotypic and behavioral data were used to generate personalized recommendations. Behavior change guidance was also provided. The intervention reduced the intake of calories (−256.2 kcal; p < 0.0001), carbohydrates (−22.1 g; p < 0.0039), sugar (−13.0 g; p < 0.0001), total fat (−17.3 g; p < 0.0001), saturated fat (−5.9 g; p = 0.0003) and PUFA (−2.5 g; p = 0.0065). Additionally, BMI (−0.6 kg/m2; p < 0.0001), body fat (−1.2%; p = 0.0192) and hip circumference (−5.8 cm; p < 0.0001) were decreased after the intervention. In the subgroup with the lowest phenotypic flexibility, a measure of the body’s ability to adapt to environmental stressors, LDL (−0.44 mmol/L; p = 0.002) and total cholesterol (−0.49 mmol/L; p < 0.0001) were reduced after the intervention. This study shows that a PSN program in a workforce improves lifestyle habits and reduces body weight, BMI and other health-related outcomes. Health improvement was most pronounced in the compromised phenotypic flexibility subgroup, which indicates that a PSN program may be effective in targeting behavior change in health-compromised target groups

Initial heating in cold cars

During the initial minutes after entering a cold car, people feel uncomfortably cold. Six different warming systems were investigated in a small car in order to find out how to improve the feeling of comfort using 16 volunteers. The methods were: no additional warming next to a standard heating system in the car (1), heat pad in the back (2), heat pad on sun shield (3) heat pad on steering wheel (4) infra-red heating directed to the head (5) infra-red heater directed towards the hands (6). Body core and skin temperatures were measured as well as thermal comfort and thermal sensation of the hands, head and body. All heating conditions increased ambient car temperature above the control condition. Steer (4) and IR hand heating (6) were beneficial for the thermal sensation of the hand. Thermal sensation of the head was rated highest in the IR head condition (5). The chair condition (2) also scored quite well on heat thermal sensation, but mainly after the first 5 min. Overall thermal sensation was rated highest in the chair condition (2). The control (1) and sun shield (3) conditions were rated lowest, mainly after the first 5 min. Subjects indicated they hardly noticed the sun shield heating. Subjects felt most comfortable in the chair (2) and IR head condition (5). Regression analyses indicated that thermal comfort is related quite well to thermal sensation, especially of the total body. Thermal comfort and thermal sensation are poorly predicted by core and skin temperatures. It can be concluded that chair and IR head heating are most beneficial for overall thermal sensation and comfort, the latter working on a shorter term than the former. This result is relatively independent of differences in body temperatures

ePartners : quick scan of future application domains

De eerste fase van het ‘ePartner that cares’ project heeft laten zien dat het mogelijk is om ePartners in het domein van de gezondheidszorg te ontwerpen, voor verschillende gebruikers, gezondheidsproblemen en -gebieden. Maar de toekomst van het ePartner raamwerk blijft niet beperkt tot de gezondheidszorg. Actoren in andere domeinen kunnen ook hun voordeel doen met de ondersteuning op maat, om daar optredende problemen op te lossen. Om deze mogelijkheden te verkennen zijn de volgende onderzoeksvragen geformuleerd: 1 Wat zijn de generieke en domeinspecifieke aspecten van ePartner functies en ontwikkelmethoden die tot nu toe zijn vastgelegd, en 2 hoe kunnen we domeinafhankelijkheid minimaliseren om ePartners flexibel in te zetten in verschillende domeinen, binnen en buiten de gezondheidszorg (zoals mobiliteit en educatie)? ---- Om deze vragen te beantwoorden zijn generieke en domeinspecifieke aspecten van de modellen en methoden die tot nu toe gebruikt zijn beschreven, met name het ePartner concept (kernfuncties), de ePartner ontwikkelmethoden (situated Cognitive Engineering en Intervention Mapping) en de resultaten die tot nu toe behaald zijn in het project. ituated Cognitive Engineering maakt het mogelijk om systematisch use cases, user requirements, claims en design patterns voor ePartners te documenteren. De verwachte directe impact van ‘ePartners that care’ (gedragsverandering (naar een gezondere levensstijl), gezonder leven, (langer) zelfstandig leven) is domeinafhankelijk en moet geherformuleerd worden voor andere domeinen. De indirecte impact (bijvoorbeeld vertrouwen (in eigen kunnen), toenemende motivatie, kennis en inzicht, in controle zijn), is domeinonafhankelijk. ---- Daarnaast is een overzicht (quick scan) gemaakt van veelbelovende gebieden voor ePartners binnen en buiten het gezondheidszorgdomein, door middel van interviews met TNO experts en co-financiers (Yulius, Inmote and Cofely). De gebieden zijn georganiseerd rond de maatschappelijke thema’s van TNO: Defensie en Veiligheid, Gezond leven, Energie, Informatiemaatschappij en Mobiliteit. Voor alle thema’s zijn algemene maatschappelijke en marktontwikkelingen beschreven, maar ook de ePartner ontwikkelingsstatus, kennispositie, kennishiaten en drempels voor implementatie. Om valorisatie van ePartners te versnellen, moeten zaken als privacy en ethiek, hardware, software, implementatie en een solide business case worden beschouwd. Ten slotte wordt een overzicht gegeven van huidige en veelbelovende ePartner projecten, gecategoriseerd rond de toepassingsgebieden Gezondheid, Leven en Reizen, Veilig, Werken en Leren, en Informatie. ---- Alle informatie in dit rapport kan dienen als inspiratie voor de ontwikkeling van ePartners in nieuwe domeinen of voor nieuwe doelgroepen, die voldoen aan de geïdentificeerde kernfuncties, om nieuwe ePartner use cases, requirements, claims en design patterns te creëren

Effects of a 13-week personalized lifestyle intervention based on the diabetes subtype for people with newly diagnosed type 2 diabetes

A type 2 diabetes mellitus (T2DM) subtyping method that determines the T2DM phenotype based on an extended oral glucose tolerance test is proposed. It assigns participants to one of seven subtypes according to their β-cell function and the presence of hepatic and/or muscle insulin resistance. The effectiveness of this subtyping approach and subsequent personalized lifestyle treatment in ameliorating T2DM was assessed in a primary care setting. Sixty participants, newly diagnosed with (pre)diabetes type 2 and not taking diabetes medication, completed the intervention. Retrospectively collected data of 60 people with T2DM from usual care were used as controls. Bodyweight (p < 0.01) and HbA1c (p < 0.01) were significantly reduced after 13 weeks in the intervention group, but not in the usual care group. The intervention group achieved 75.0% diabetes remission after 13 weeks (fasting glucose ≤ 6.9 mmol/L and HbA1c < 6.5% (48 mmol/mol)); for the usual care group, this was 22.0%. Lasting (two years) remission was especially achieved in subgroups with isolated hepatic insulin resistance. Our study shows that a personalized diagnosis and lifestyle intervention for T2DM in a primary care setting may be more effective in improving T2DM-related parameters than usual care, with long-term effects seen especially in subgroups with hepatic insulin resistance.</p