Early Identification of Type 2 Diabetes: Policy should be aligned with health systems strengthening

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Influence of the Duration of Diabetes on the Outcome of a Diabetes Self-Management Education Program

BackgroundDiabetes education and lifestyle modification are critical components in controlling blood glucose levels of people with type 2 diabetes. Until now, available data on the effectiveness of education with respect to the duration of diabetes are limited. We investigated whether adherence to lifestyle behavior modification prompted by diabetes education was influenced by the duration of diabetes.MethodsTwo hundred and twenty-five people with type 2 diabetes were recruited for an intensive, collaborative, group-based diabetes education program with annual reinforcement. We divided the patients into two groups based on the duration of their diabetes prior to the education program (≤1 year [≤1Y] vs. ≥3 years [≥3Y]). Dietary habits, physical activity, and the frequency of blood glucose self-monitoring were evaluated with a questionnaire prior to education and at the follow-up endpoint.ResultsThe mean follow-up period was 32.2 months. The mean hemoglobin A1c (A1C) value was significantly lower in the ≤1Y group. Self-care behaviors, measured by scores for dietary habits (P=0.004) and physical activity (P<0.001), were higher at the endpoint in the ≤1Y group than in the ≥3Y group. Logistic regression analysis revealed that a longer diabetes duration before education was significantly associated with mean A1C levels greater than or equal to 7.0% (53 mmol/mol).ConclusionDiabetes duration influenced the effectiveness of diabetes education on lifestyle behavior modification and glycemic control. More-intense, regular, and sustained reinforcement with encouragement may be required for individuals with longstanding type 2 diabetes

Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: a randomized, 24-week clinical trial

Abstract AIMS: To compare the effect of replacing diet beverages (DBs) with water or continuing to drink DBs in patients with type 2 diabetes during a 24-week weight loss program. The primary endpoint was the effect of intervention on weight over a 24-week period. The main secondary endpoints included anthropometric measurement and glucose and fat metabolism during the 24-week period. METHODS: A total of 81 overweight and obese women with type 2 diabetes, who usually consumed DBs in their diet, were asked to either substitute water for DBs or continue drinking DBs five times per week after lunch for 24 weeks (DBs group) during a weight loss program. RESULTS: Compared with the DBs group, the water group had a greater decrease in weight (water, -6.40 ± 2.42 kg; DBs, -5.25 ± 1.60 kg; P = .006), in BMI (water, -2.49 ± 0.92 kg/m2 ; DBs, -2.06 ± 0.62 kg/m2 ; P = .006), in FPG (water, -1.63 ± 0.54 mmol/L; DBs, -1.29 ± 0.48 mmol/L, P = .005), in fasting insulin (water, -5.71 ± 2.30 m lU/mL; DBs, -4.16 ± 1.74 m lU/mL, P = .011), in HOMA IR (water, -3.20 ± 1.17; DBs, -2.48 ± 0.99, P = 003) and in 2 hour postprandial glucose (water, -1.67 ± 0.62 mmol/L; DBs, -1.35 ± 0.39 mmol/L; P = 0.027) over the 24-week period. However, there was no significant time × group interaction for waist circumference, lipid profiles and HbA1c within both groups over the 24-week period. CONCLUSION: Replacement of DBs with water after the main meal in obese adult women with type 2 diabetes may lead to more weight reduction during a weight loss program

The Association of Unintentional Changes in Weight, Body Composition, and Homeostasis Model Assessment Index with Glycemic Progression in Non-Diabetic Healthy Subjects

BackgroundWe performed a retrospective longitudinal study on the effects of changes in weight, body composition, and homeostasis model assessment (HOMA) indices on glycemic progression in subjects without diabetes during a four-year follow-up period in a community cohort without intentional intervention.MethodsFrom 28,440 non-diabetic subjects who participated in a medical check-up program in 2004, data on anthropometric and metabolic parameters were obtained after four years in 2008. Body composition analyses were performed with a bioelectrical impedance analyzer. Skeletal muscle index (SMI, %) was calculated with lean mass/weight×100. Subjects were divided into three groups according to weight change status in four years: weight loss (≤-5.0%), stable weight (-5.0 to 5.0%), weight gain (≥5.0%). Progressors were defined as the subjects who progressed to impaired fasting glucose or diabetes.ResultsProgressors showed worse baseline metabolic profiles compared with non-progressors. In logistic regression analyses, the increase in changes of HOMA-insulin resistance (HOMA-IR) in four years presented higher odds ratios for glycemic progression compared with other changes during that period. Among the components of body composition, a change in waist-hip ratio was the strongest predictor, and SMI change in four years was a significant negative predictor for glycemic progression. Changes in HOMA β-cell function in four years was a negative predictor for glycemic progression.ConclusionIncreased interval changes in HOMA-IR, weight gain and waist-hip ratio was associated with glycemic progression during a four-year period without intentional intervention in non-diabetic Korean subjects

Lifestyle interventions for weight loss in adults with severe obesity: a systematic review

Severe obesity is an increasingly prevalent condition and is often associated with long-term comorbidities, reduced survival and higher healthcare costs. Non-surgical methods avoid the side effects, complications and costs of surgery, but it is unclear which non-surgical method is most effective. The objective of this article was to systematically review the effectiveness of lifestyle interventions compared to standard or minimal care for weight loss in adults with severe obesity. MEDLINE, EMBASE, CENTRAL, databases of on-going studies, reference lists of any relevant systematic reviews and the Cochrane Library database were searched from inception to February 2016 for relevant randomized controlled trials (RCTs). Inclusion criteria were participants with severe obesity (body mass index [BMI] > 40 kg/m(2) or BMI > 35 kg/m(2) with comorbidity) and interventions with a minimal duration of 12 weeks that were multi-component combinations of diet, exercise and behavioural therapy. Risk of bias was evaluated using the Cochrane risk of bias criteria. Meta-analysis was not possible because of methodological heterogeneity. Seventeen RCTs met the inclusion criteria. Weight change in kilograms of participants from baseline to follow-up was reported for 14 studies. Participants receiving the lifestyle intervention had a greater decrease in weight than participants in the control group for all studies (1.0-11.5 kg). Lifestyle interventions varied greatly between the studies. Overall lifestyle interventions with combined diet and exercise components achieved the greatest weight loss. Lifestyle interventions for weight loss in adults with severe obesity were found to result in increased weight loss when compared to minimal or standard care, especially those with combined diet and exercise components

Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes

WSTĘP. Celem pracy było określenie związku między długotrwałą poprawą wskaźników obwodowej wrażliwości na insulinę [wskaźnik zużycia glukozy (GDR, glucose disposal rate)], stężenia glukozy na czczo i wolnych kwasów tłuszczowych (FFA, free fatty acids) a towarzyszącymi zmianami wagi, masy i dystrybucji tkanki tłuszczowej w wyniku wprowadzenia modyfikacji stylu życia u otyłych chorych na cukrzycę typu 2. MATERIAŁ I METODY. Zmierzono GDR, stężenie glukozy na czczo i FFA metodą klamry normoglikemicznej, a także masę i dystrybucję tkanki tłuszczowej, tłuszcz narządowy, rozmiar adipocytów za pomocą absorpcjometrii podwójnej energii promieniowania rentgenowskiego, tomografii komputerowej i biopsji tkanki tłuszczowej u 26 mężczyzn i 32 kobiet w próbie Look-AHEAD przed stosowaniem rocznej diety i ćwiczeń fizycznych, ukierunkowanych na utratę masy ciała, oraz po ich stosowaniu. WYNIKI. Masa ciała i stężenie glukozy na czczo znacznie się zmniejszyły (p < 0,0001), bardziej znamiennie u mężczyzn niż u kobiet (odpowiednio: -12% do -8% i -16% do -7%; p < 0,05), podczas gdy FFA zredukowano w czasie hiperinsulinemii, a GDR znamiennie wzrósł (p < 0,00001) u osób obojga płci (odpowiednio: -53% do -41% i 63% do 43%; p = NS). U mężczyzn stwierdzono korzystniejszą zmianę rozkładu tkanki tłuszczowej poprzez redukcję w większym stopniu górnych niż dolnych i głębszych niż płytszych magazynów tkanki tłuszczowej (p < 0,01). Spadki masy ciała i masy tkanki tłuszczowej poprzedzały poprawę GDR, ale nie stężenia glukozy na czczo lub FFA na czczo; jednak zmniejszenie FFA podczas hiperinsulinemii znacząco wpłynęło na polepszenie GDR. Tłuszcz wątrobowy był jedyną lokalizacją narządową, której zmiana wpływała niezależnie na zmianę wskaźników metabolicznych. WNIOSKI. U chorych na cukrzycę typu 2 poddanych rocznej zmianie stylu życia stwierdzono znaczącą poprawę GDR, stężenia glukozy na czczo, FFA i dystrybucji tkanki tłuszczowej. Natomiast najważniejszymi determinantami poprawy metabolizmu były ogólne zmiany masy ciała (masy tkanki tłuszczowej) i tłuszczu wątrobowego. (Diabet. Prakt. 2011; 11, 4: 142-152)OBJECTIVE. To characterize the relationships among long-term improvements in peripheral insulin sensitivity (glucose disposal rate, GDR), fasting glucose, and free fatty acids (FFA) and concomitant changes in weight and adipose tissue mass and distribution induced by lifestyle intervention in obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS. We measured GDR, fasting glucose, and FFAs during a euglycemic clamp and adipose tissue mass and distribution, organ fat, and adipocyte size by dual-energy X-ray absorptiometry, CT scan, and adipose tissue biopsy in 26 men and 32 women in the Look-AHEAD trial before and after 1 year of diet and exercise aimed at weight loss. RESULTS. Weight and fasting glucose decreased significantly (p < 0.0001) and significantly more in men than in women (-12 vs. -8% and -16 vs. -7%, respectively; p < 0.05), while FFAs during hyperinsulinemia decreased and GDR increased significantly (p < 0.00001) and similarly in both sexes (-53 vs. -41% and 63 vs. 43%; p = NS). Men achieved a more favorable fat distribution by losing more from upper compared with lower and from deeper compared with superficial adipose tissue depots (p < 0.01). Decreases in weight and adipose tissue mass predicted improvements in GDR but not in fasting glucose or fasting FFAs; however, decreases in FFAs during hyperinsulinemia significantly determined GDR improvements. Hepatic fat was the only regional fat measure whose change contributed independently to changes in metabolic variables. CONCLUSIONS. Patients with type 2 diabetes undergoing a 1-year lifestyle intervention had significant improvements in GDR, fasting glucose, FFAs and adipose tissue distribution. However, changes in overall weight (adipose tissue mass) and hepatic fat were the most important determinants of metabolic improvements. (Diabet. Prakt. 2011; 11, 4: 142-152

Description and preliminary results from a structured specialist behavioural weight management group intervention:Specialist Lifestyle Management (SLiM) programme

Background -  Specialist Lifestyle Management (SLiM) is a structured patient education and self-management group weight management programme. Each session is run monthly over a 6-month period providing a less intensive long-term approach. The groups are patient-centred incorporating educational, motivational, behavioural and cognitive elements. The theoretical background, programme structure and preliminary results of SLiM are presented. Subjects/methods - The study was a pragmatic service evaluation of obese patients with a body mass index (BMI) ≥35 kg/m2 with comorbidity or ≥40 kg/m2 without comorbidity referred to a specialist weight management service in the West Midlands, UK. 828 patients were enrolled within SLiM over a 48-month period. Trained facilitators delivered the programme. Preliminary anonymised data were analysed using the intention-to-treat principle. The primary outcome measure was weight loss at 3 and 6 months with comparisons between completers and non-completers performed. The last observation carried forward was used for missing data. Results - Of the 828 enrolled within SLiM, 464 completed the programme (56%). The mean baseline weight was 135 kg (BMI=49.1 kg/m2) with 87.2% of patients having a BMI≥40 kg/m2 and 12.4% with BMI≥60 kg/m2. The mean weight change of all patients enrolled was −4.1 kg (95% CI −3.6 to −4.6 kg, p=0.0001) at the end of SLiM, with completers (n=464) achieving −5.5 kg (95% CI −4.2 to −6.2 kg, p=0.0001) and non-completers achieving −2.3 kg (p=0.0001). The majority (78.6%) who attended the 6-month programme achieved weight loss with 32.3% achieving a ≥5% weight loss. Conclusions - The SLiM programme is an effective group intervention for the management of severe and complex obesity

Treatment of Diabetes with Lifestyle Changes: Diet

The present chapter critically reviews scientific evidence on the impact of the diet and its components on the metabolic control, cardiovascular risk factors, and morbidity/mortality in diabetic patients. Three main topics are included in this chapter: (1) the effects of dietary treatment on body weight control in diabetic patients; (2) the optimal dietary composition in order to achieve blood glucose control and reduce other cardiovascular risk factors associated with type 2 diabetes; (3) the effects of lifestyle modifications and dietary changes on the risk to develop type 2 diabetes. The overall body of evidence seems to confirm the efficacy of current recommendations for diabetes management. However, although dietary strategies based on structured interventions are often successful, particularly in relation to body weight control, they are not easily applicable in clinical practice and, therefore, more feasible strategies should be identified. In addition, further intervention studies focused on the effects of lifestyle on hard endpoints in diabetic subjects are needed to definitively prove the role of diet in the prevention of both cardiovascular and microvascular complications in these patients over and above their impact on weight reduction