A review of the effects of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors on lean body mass in humans

Weight loss is an important goal in the management of several chronic conditions, including type 2 diabetes mellitus, and pharmacological therapies that aid weight loss are appealing. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) are novel glucose-lowering therapies that have been shown to induce clinically significant reductions in body weight. However, this weight loss may not be attributed solely to fat mass (FM). Given the importance of skeletal muscle and lean body mass (LBM) on cardio-metabolic health and physical function, we reviewed the available literature reporting the effects of GLP-1RAs and SGLT2is on body composition. Results demonstrate that, in most circumstances, the weight loss associated with both therapies predominantly comprises a reduction in FM, although significant heterogeneity exists between studies. In over half of the studies identified, the proportion of LBM reduction ranged between 20% and 50% of total weight lost, which is consistent with diet-induced weight loss and bariatric surgery. No clear differences existed between GLP-1RAs and SGLT2is. Consequently, the loss of LBM and skeletal muscle associated with weight loss induced by GLP-1RAs and SGLT2is warrants attention. Strategies to preserve skeletal muscle and improve physical function, for example through structured exercise, are of great importance

Prediction of diabetic foot ulceration: The value of using microclimate sensor arrays

Background: Accurately predicting the risk of diabetic foot ulceration (DFU) could dramatically reduce the enormous burden of chronic wound management and amputation. Yet, current prognostic models are unable to precisely predict DFU events. Typically, efforts have focused on individual factors like temperature, pressure or shear rather than the overall foot microclimate. Method: A systematic review was conducted by searching PubMed reports with no restrictions on start date covering literature published until 20 February 2019 using relevant keywords, including temperature, pressure, shear and relative humidity. We review the use of these variables as predictors of DFU, highlighting gaps in our current understanding and suggesting which specific features should be combined to develop a real-time microclimate prognostic model. Results: Current prognostic models rely either solely on contralateral temperature, pressure or shear measurement; these parameters, however, rarely reach 50% specificity in relation to DFU. There is also considerable variation in methodological investigation, anatomical sensor configuration and resting time prior to temperature measurements (5-20 minutes). Few studies have considered relative humidity and mean skin resistance. Conclusions: Very limited evidence supports the use of single clinical parameters in predicting the risk of DFU. We suggest the microclimate as a whole should be considered to predict DFU more effectively and suggest nine specific features which appear to be implicated for further investigation. Technology supports real-time inshoe data collection and wireless transmission, providing a potentially rich source of data to better predict risk of DFU

Associations of objectively measured moderate-to-vigorous-intensity physical activity and sedentary time with all-cause mortality in a population of adults at high risk of type 2 diabetes mellitus

The relationships of physical activity and sedentary time with all-cause mortality in those at high risk of type 2 diabetes mellitus (T2DM) are unexplored. To address this gap in knowledge,we examined the associations of objectively measured moderate-to-vigorous-intensity physical activity (MVPA) and sedentary time with all-cause mortality in a population of adults at high risk of T2DM. In 2010–2011, 712 adults (Leicestershire, U.K.), identified as being at high risk of T2DM, consented to be followed up for mortality.MVPA and sedentary time were assessed by accelerometer; those with valid data (≥10 hours of wear-time/day with ≥4 days of data) were included. Cox proportional hazards regression models, adjusted for potential confounders, were used to investigate the independent associations of MVPA and sedentary time with all-cause mortality. 683 participants (250 females (36.6%)) were included and during a mean follow-up period of 5.7 years, 26 deaths were registered. Every 10% increase in MVPA time/day was associated with a 5% lower risk of all-cause mortality [Hazard Ratio (HR): 0.95 (95% Confidence Interval (95% CI): 0.91, 0.98); p=0.004]; indicating that for the average adult in this cohort undertaking approximately 27.5 minutes of MVPA/day, this benefit would be associated with only 2.75 additional minutes of MVPA/day. Conversely, sedentary time showed no association with all-cause mortality [HR (every 10-minute increase in sedentary time/day): 0.99 (95% CI: 0.95, 1.03); p=0.589]. These data support the importance of MVPA in adults at high risk of T2DM. The association between sedentary time and mortality in this population needs further investigation

Association between lifestyle factors and the incidence of multimorbidity in an older English population.

Background: Evidence on the role of lifestyle factors in relation to multimorbidity, especially in elderly populations, is scarce. We assessed the association between five lifestyle factors and incident multimorbidity (presence of ≥2 chronic conditions) in an English cohort aged ≥50 years. Methods: We used data from wave 4, 5 and 6 of the English Longitudinal Study of Ageing. Data on smoking, alcohol consumption, physical activity, fruit and vegetable consumption and BMI were extracted and combined to generate a sum of unhealthy lifestyle factors for each individual. We examined whether these lifestyle factors individually or in combination predicted during the subsequent wave. We used marginal structural Cox proportional hazard models, adjusted for both time-constant and time-varying factors. Results: A total of 5,476 participants contributed 232,749 person-months of follow-up during which 1,156 cases of incident multimorbidity were recorded. Physical inactivity increased the risk of multimorbidity by 33% (adjusted Hazard Ratio (aHR) 1.33, 95% CI 1.03-1.73). The risk was about two-three times higher when inactivity was combined with obesity (aHR 2.87, 95% CI 1.55-5.31) or smoking (aHR 2.35, 95% CI 1.36-4.08) and about four times when combined with both (aHR 3.98, 95% CI 1.02-17.00). Any combination of 2, 3 and 4 or more unhealthy lifestyle factors significantly increased the multimorbidity hazard, compared to none, from 42% to 114%. Conclusion: This study provides evidence of a temporal association between combinations of different unhealthy lifestyle factors with multimorbidity. Population level interventions should include reinforcing positive lifestyle changes in the population to reduce the risk of developing multimorbidity

Psoriasis and Psyche - What`s New? What is Clinically Relevant?

Physical activity and age-sex standardised prevalence of multimorbidity over time in the restricted sample (DOCX 16 kb

Image processing using Android device - gas-meter value recognition

Diplomová práce se zabývá návrhem zpracování obrazu v systému Android. Volbou vývojového prostředí a jeho implementací. Pracovní postup řešení problematiky zahrnuje vytvoření aplikace a grafického uživatelského rozhraní. Text zahrnuje popis funkcionality aplikace, komunikace s fotoaparátem, uložení a načítání dat. Dále popisuje použité algoritmy a metody zpracování obrazu pro detekci hodnot plynoměru.This thesis describes the design of the image processing for Android system, consisting of the choice of the development environment and its implementation. Workflow solution to the problem involves development of the Androidapplication and it’s graphical user interface. The text includes description of the application functionality, communicationwith a camera, storing and retrieving data. It also describes used algorithms and image processing methods used for detecting values from the counter of the gas meter.

Fitness moderates glycemic responses to sitting and light activity breaks

Purpose: Regular engagement in sedentary behaviours can lead to major public health consequences. This study aimed to experimentally determine whether cardio-respiratory fitness modifies postprandial glycemia during prolonged sitting and investigated the potentially blunting influence this may have upon the benefits of interrupting postprandial sitting time with light activity breaks. Methods: Thirty–four adult volunteers (18female; 16male; mean±SD age: 40±9 years, BMI: 24.5±3 kg/m2) undertook two 7·5 hour experimental conditions in a randomized order: 1) Prolonged sitting; 2) Sitting interspersed with 5 minute light walking bouts every 30minutes. Blood samples were obtained while fasting and throughout the postprandial period following ingestion of two identical meals. Incremental Area Under the Curve (iAUC) was calculated for glucose and insulin throughout each experimental condition. Maximal exercise testing quantified VO2 peak as a measure of cardiorespiratory fitness (CRF) prior to experimental conditions. A repeated measures ANOVA investigated whether VO2 peak modified iAUC data between conditions. This trial is registered with ClinicalTrials.gov (Reg no.NCT0493309). Results: Interrupting prolonged sitting time with light walking breaks reduced blood glucose iAUC from 3.89 ± 0.7 to 2·51 ± 0.7 mmol·L-1·h (p = 0.015) and insulin iAUC from 241 ± 46 to 156 ± 24 mU·L-1·h (p = 0.013) after adjustment for VO2 peak and sex. A significant interaction between treatment response and VO2 peak was observed for glucose (p = 0.035), but not insulin (p = 0.062), whereby the treatment effect reduced with higher levels of fitness. Average blood glucose iAUC responses for a man at the 25th centile of CRF (42.5 mL∙kg-1∙min-1) within our cohort went from 5.80 to 2.98 mmol·L-1·h during the prolonged sitting and light walking breaks conditions respectively, whereas average responses for a man at the 75th centile of CRF (60.5 mL∙kg-1∙min-1) went from 1.99 to 1.78 mmol·L-1·h. Similar trends were observed for women. Conclusions: Individuals with low levels of CRF gained the most metabolic benefit from breaking prolonged sitting with regular bouts of light walking. Future interventions aimed at alleviating the deleterious impacts of sedentary behavior may be optimized by tailoring to cardio-respiratory fitness levels within the general population

Non-exercise equations to estimate fitness in white European and South Asian men

© 2015 American College of Sports Medicine PURPOSE: Cardiorespiratory fitness is a strong, independent predictor of health, whether it is measured in an exercise test or estimated in an equation. The purpose of this study was to develop and validate equations to estimate fitness in middle-aged white European and South Asian men. METHODS: Multiple linear regression models (n=168, including 83 white European and 85 South Asian men) were created using variables that are thought to be important in predicting fitness (VO2 max, mL⋅kg⋅min): age (years); BMI (kg·m); resting heart rate (beats⋅min); smoking status (0=never smoked, 1=ex or current smoker); physical activity expressed as quintiles (0=quintile 1, 1=quintile 2, 2=quintile 3, 3=quintile 4, 4=quintile 5), categories of moderate- to vigorous-intensity physical activity (0=150-225 min⋅wk, 3=>225-300 min⋅wk, 4=>300 min⋅wk), or minutes of moderate- to vigorous-intensity physical activity (min⋅wk); and, ethnicity (0=South Asian, 1=white). The leave-one-out-cross-validation procedure was used to assess the generalizability and the bootstrap and jackknife resampling techniques were used to estimate the variance and bias of the models. RESULTS: Around 70% of the variance in fitness was explained in models with an ethnicity variable, such as: VO2 max = 77.409 - (age*0.374) – (BMI*0.906) – (ex or current smoker*1.976) + (physical activity quintile coefficient) – (resting heart rate*0.066) + (white ethnicity*8.032), where physical activity quintile 1 is 1, 2 is 1.127, 3 is 1.869, 4 is 3.793, and 5 is 3.029. Only around 50% of the variance was explained in models without an ethnicity variable. All models with an ethnicity variable were generalizable and had low variance and bias. CONCLUSION: These data demonstrate the importance of incorporating ethnicity in non-exercise equations to estimate cardiorespiratory fitness in multi-ethnic populations

A cluster randomised controlled trial to investigate the effectiveness and cost effectiveness of the 'Girls Active' intervention: a study protocol

Background: Despite the health benefits of physical activity, data from the UK suggest that a large proportion of adolescents do not meet the recommended levels of moderate-to-vigorous physical activity (MVPA). This is particularly evident in girls, who are less active than boys across all ages and may display a faster rate of decline in physical activity throughout adolescence. The ‘Girls Active’ intervention has been designed by the Youth Sport Trust to target the lower participation rates observed in adolescent girls. ‘Girls Active’ uses peer leadership and marketing to empower girls to influence decision making in their school, develop as role models and promote physical activity to other girls. Schools are provided with training and resources to review their physical activity, sport and PE provision, culture and practices to ensure they are relevant and attractive to adolescent girls. Methods/Design: This study is a two-arm cluster randomised controlled trial (RCT) aiming to recruit 20 secondary schools. Clusters will be randomised at the school level (stratified by school size and proportion of Black and Minority Ethnic (BME) pupils) to receive either the ‘Girls Active’ intervention or carry on with usual practice (1:1). The 20 secondary schools will be recruited from state secondary schools within the Midlands area. We aim to recruit 80 girls aged 11 –14 years in each school. Data will be collected at three time points; baseline and seven and 14 months after baseline. Our primary aim is to investigate whether ‘Girls Active’ leads to higher objectively measured (GENEActiv) moderate-to-vigorous physical activity in adolescent girls at 14 months after baseline assessment compared to the control group. Secondary outcomes include other objectively measured physical activity variables, adiposity, physical activity-related psychological factors and the cost-effectiveness of the ‘Girls Active’ intervention. A thorough process evaluation will be conducted during the course of the intervention delivery. Discussion: The findings of this study will provide valuable information on whether this type of school-based approach to increasing physical activity in adolescent girls is both effective and cost-effective in the U

Association between SGLT2 inhibitor treatment and diabetic ketoacidosis and mortality in people with type 2 diabetes admitted to hospital with COVID-19

   Objective  To determine the association between prescription of SGLT2 inhibitors and diabetic ketoacidosis (DKA) incidence or mortality in people with type 2 diabetes hospitalized with COVID-19.  Research Design and Methods  This was a retrospective cohort study based on secondary analysis of data from a large nationwide audit from a network of 40 centres in United Kingdom with data collection up to December 2020 that was originally designed to describe risk factors associated with adverse outcomes among people with diabetes who were admitted to hospital with COVID-19.. The primary outcome for this analysis was DKA on or during hospital admission. The secondary outcome was mortality. Crude, age-sex adjusted and multivariable logistic regression models, were used to generate odds ratios and 95% confidence intervals for people prescribed SGLT2 inhibitor compared to those not prescribed SGLT2 inhibitor.   Results  The original national audit included 3067 people with type 2 diabetes who were admitted to hospital with COVID-19, of whom 230 (7.5%) were prescribed SGLT2 inhibitors prior to hospital admission. Mean (SD) age of the overall cohort was 72 years, 62.3% were men and 34.9% were prescribed insulin. Overall, 2.8% of the total population had DKA and 35.6% people died. The adjusted odds of DKA were not significantly different between those prescribed SGLT2 inhibitors and those not (OR 0.56, 0.16-1.97). The adjusted odds of mortality associated with SGLT2 inhibitors were similar in the total study population (OR 1.13, 0.78-1.63 ), in the sub-group prescribed insulin (OR 1.02, 0.59-1.77), and in the sub-group that developed DKA (OR 0.21, 0.01-8.76).  Conclusions We demonstrate a low risk of DKA and high mortality rate in people with type 2 diabetes admitted to hospital with COVID-19 and limited power but no evidence of increased risk of DKA or in-hospital mortality associated with prescription of SGLT2 inhibitors. </p