Efficacy of lifestyle interventions in patients with type 2 diabetes: A systematic review and meta-analysis

Factors Determining the Success of Therapeutic Lifestyle Interventions in Diabetes - Role of Partner and Family Support

Background and aims: Knowledge of therapeutic lifestyle interventions is one of the most important pillars of diabetes care; however, its incorporation in real-world settings is poor. This review evaluates the role of partner and family support in diabetes management. Methods: Literature searches were performed in PubMed, Medline and Embase for articles published before July 2018, using the terms “therapeutic lifestyle intervention” [MeSH Terms], OR “diet changes” [All Fields], OR “spousal participation” [All Fields], OR “lifestyle interventions” [All Fields], “lifestyle changes” [All Fields] AND “diabetes” [All Fields]. The search was not restricted to English-language literature; literature in Spanish, French and German were also evaluated. Results: A total of 66 of articles were reviewed, which included 33 original work, 21 review articles, and 12 systematic reviews and meta-analyses. Studies and meta-analyses have showed that if one partner has type-2 diabetes this increases the risk in other by 5–26%. Partner and family have similar diet, lifestyle, and micro- and macro-environments which could explain the similar increased risk of diabetes and non-communicable diseases. Studies have consistently shown that spousal and family support plays a key role in overcoming negative behaviours and optimising behaviours in diabetes control. Partner support has major role in prevention and control of diabetes distress, associated depression, and medication non-compliance which have an adverse impact in glycaemic outcomes. These data are predominantly available from observational studies. There is paucity of data from interventional trials evaluating effects of family and spousal participation on health, glycaemic control and quality of life. Conclusion: The support of family and spouse/partner is beneficial to improve adherence to the lifestyle interventions and pharmacotherapy required to achieve optimum glycaemic control and avoid associated complications.

Quantified patient preferences for lifestyle intervention programs for diabetes prevention-a protocol for a systematic review

BACKGROUND

The 20-70% participation of diabetes patients in lifestyle interventions (LSI) worldwide seems to be rather sub-optimal, in spite of all intents of such interventions to delay further progress of the disease. Positive effects through LSI are expected in particular for patients who suffer less from diabetes-related limitations or other chronic diseases. Seeing that diabetes prevalence and with it mortality are increasing, LSI have become an inherent part of diabetes treatment standards. Various qualitative studies have been carried out to identify participation barriers for LSI. However, these have not resulted in more detailed knowledge about the relative importance of factors with an inhibiting impact on participation. Since it cannot be assumed that all of the influencing factors have equivalent values, it is necessary to investigate their individual importance with regard to a positive or negative decision about participating. There are no systematic reviews on patient preferences for LSI programs in diabetes prevention. As a result, the main objectives of this systematic review are to (i) identify existing patient preference elicitation studies related to LSI for diabetic patients, (ii) summarize the methods applied and findings, and (iii) appraise the reporting and methodological quality of such studies.

METHODS

We will perform systematic literature searches to identify suitable studies from 14 electronic databases. Retrieved study records will be included based on predefined eligibility criteria as defined in this protocol. We will run abstract and full-text screenings and then extract data from all selected studies by filling in a predefined data extraction spreadsheet. We will undertake a descriptive, narrative synthesis of findings to address the study objectives, since no pooling for quantified preferences is for methodological reasons implementable. We will pay special attention to aspects of methodological quality of preference elicitation by applying established evaluation criteria of the ISPOR and some own developed criteria for different elicitation techniques. All critical stages within the screening, data extraction, and synthesis processes will be conducted by two pairs of authors. This protocol adheres to PRISMA and PRISMA-P standards.

DISCUSSION

The proposed systematic review will provide an overview of the methods used and current practice in the elicitation and quantification of patients' preferences for diabetes prevention lifestyle interventions. Furthermore, the methodological quality of the identified studies will be appraised as well.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018086988.

Effects of nutrition motivational intervention in patients affected by type 2 diabetes mellitus: a longitudinal study in Naples, South Italy

Background

Type 2 diabetes (T2D) is associated with a prion diminished quality of life, especially due to the severe complications that it implicates. Changing dietary habits is an absolute priority, as well as implementing nutritional motivational programs. The aim of this study was to verify the effectiveness of a nutritional intervention in improving the health of patients affected by T2D.

Methods

A total of 69 patients participated in a nine-months motivational program focused on the principles of the Mediterranean diet, the classes of nutrients, the distribution of the meals during the day and the dietary choices. During regular meetings, the patients were requested to fill out a questionnaire about their dietary habits and behaviours. Clinical and metabolic parameters were also analysed.

Results

At the end of the intervention the number of people who declared that they ate five meals a day (p = 0.006) and preferred to have fruit for snack (p = 0.004) increased, while there was a reduction in the use of sweeteners and an elimination of the use of fructose (p = 0.05). The total daily consumption of kilocalories (kcal) had been reduced and the percentages of carbohydrates, proteins and lipids, after the intervention, follow the guidelines. In relation to this, a significant improvement (p < 0.05) was registered in systolic and diastolic pressure, BMI and waist circumference, as well as in glycaemic values (p = 0.018).

Conclusions

A nutritional motivational intervention may be useful in improving dietary habits and health status of patients with T2D. We hope that a similar intervention will be applied in Campania and in other Italian regions.

Trial registration

Registration number is ISRCTN11067689; date of registration: 10/09/2018. Retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6101-6) contains supplementary material, which is available to authorized users.

The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2

OBJECTIVE

The purpose of this study was to evaluate the efficacy of self-management education on psychological outcomes and glycemic control in type 2 diabetes mellitus.

METHODS

Patients were randomly assigned to education group and control group. Education group received professional education and control group received routine outpatient education.

RESULTS

A total of 118 patients were randomly assigned to two groups (education group, n = 63; control group, n = 55). Compared with control group, the anxiety score (36.00 vs. 42.50, P < 0.05) and depression score (35.50 vs. 44.00, P < 0.05) significantly decreased at the sixth month in education group, respectively. Compared with control group, fasting blood glucose (6.78 mmol/L vs. 7.70 mmol/L, P < 0.00), postprandial blood glucose (7.90 mmol/L vs. 10.58 mmol/L, P < 0.00) and glycosylated haemoglobin A1_C level [6.20 (5.80, 6.60)% vs. 6.70 (6.40, 7.30)%, P < 0.01] significantly decreased after the sixth month in education group.

CONCLUSION

The psychological status and blood glucose of patients with diabetes receiving self-management education were significantly improved.

PRACTICE IMPLICATIONS

Type 2 diabetes mellitus has been usually linked to increased prevalence and risk of depression and anxiety, which can affect blood glucose levels. Through education, the mood of newly diagnosed patients with diabetes improved, resulting in better blood glucose control.

Impact of prolonged neuromuscular electrical stimulation on metabolic profile and cognition-related blood parameters in type 2 diabetes: A randomized controlled cross-over trial

AIMS

This study aimed to examine the effect of prolonged neuromuscular electrical stimulation (NMES) on the metabolic profile and cognition-related blood parameters in patients with type 2 diabetes mellitus (T2DM).

METHODS

Fourteen patients with T2DM (63.2 ± 3.0 years, 76.1 ± 3.5 kg) participated in a randomized controlled cross-over study, in which 8-week-long NMES interventions were performed on both legs. The NMES training protocol consisted of 40-min sessions, 5 days per week, for 8 weeks. The relative changes in glucose and lipid profiles, and cognition-related blood parameters were evaluated.

RESULTS

NMES training induced significant changes in the fasting glucose concentration (p < 0.05) and percent body fat (p < 0.05), although there were no significant changes in HbA1c and blood lipid levels (p ≥ 0.05). The change in plasma brain-derived neurotrophic factor (BDNF) levels was significantly higher in the NMES period than in the control period (p < 0.05).

CONCLUSIONS

This study showed that an 8-week NMES training program could induce greater changes in the blood glucose concentration, percent body fat, and plasma BDNF levels than the control intervention in patients with T2DM. NMES training might prove to be an alternative exercise method for patients who might have difficulties in performing adequate voluntary exercise.

Clinical outcomes to exercise training in type 1 diabetes: A systematic review and meta-analysis

AIMS

To establish the relationship between exercise training and clinical outcomes in people with type I diabetes.

METHODS

Studies were identified through a MEDLINE search strategy, Cochrane Controlled Trials Registry, CINAHL, SPORTDiscus and Science Citation Index. The search strategy included a mix of key concepts related to trials of exercise training in people with type 1 diabetes; glycaemic control. Searches were limited to prospective randomized or controlled trials of exercise training in humans with type 1 diabetes lasting 12  weeks or more.

RESULTS

In exercised adults there were significant improvements in body mass Mean Difference (MD): -2.20 kg, 95% Confidence Interval (CI) -3.79-0.61, p = .007; body mass index (BMI) MD: -0.39 kg/m², 95% CI -0.75-0.02, p = .04; Peak VO₂ MD: 4.08 ml/kg/min, 95% CI -2.18-5.98, p < .0001; and, low-density lipoprotein cholesterol (LDL) MD: -0.21 mmol/L, 95% CI -0.33-0.08, p = .002. In exercised children there were significant improvements in insulin dose MD: -0.23 IU/kg, 95% CI -0.37-0.09, p = .002; waist circumference MD: -5.40 cm, 95% CI -8.45 to -2.35, p = .0005; LDL MD: -0.31 mmol/L, 95% CI -0.55 to -0.06, p = .02; and, triglycerides MD: -0.21 mmol/L, 95% CI -0.42 to -0.01, p = .04. There were no significant changes in glycosylated haemoglobin (HbA1C%), fasting blood glucose, resting heart rate, resting systolic blood pressure or high density lipoproteins in either group.

CONCLUSIONS

Exercise training improves some markers of type 1 diabetes severity; particularly body mass, BMI, Peak VO₂ and LDL in adults and insulin dose, waist circumference, LDL and triglycerides in children.

Effect of telehealth interventions on major cardiovascular outcomes: a meta-analysis of randomized controlled trials

Background

Telehealth interventions (THI) were associated with lower levels of cardiovascular risk factors in adults, whereas the effect of THI on cardiovascular disease (CVD) still remains controversial. A meta-analysis was conducted to summarize the evidence from randomized controlled trials (RCT) which investigated potential impact of THI on the incidence of CVD in patients with or without prior CVD.

Methods

PubMed, EmBase, and the Cochrane Library were searched to identify RCTs to fit our analysis through December 2016. Relative risk (RR) with its 95% confidence interval (CI) was used to measure the effect of THI using a random-effect model. Sensitivity analysis, subgroup analysis, heterogeneity tests, and tests for publication bias were also conducted.

Results

Eight RCTs were included and with a total of 1635 individuals. The summarized results indicated that participants who received THI showed a significant reduction of the CVD incidence as compared with usual care (RR: 0.59; 95% CI: 0.47–0.74; P < 0.001). Furthermore, the effect of THI was greater in patients with history of CVD (RR: 0.55; 95% CI: 0.44–0.70; P < 0.001) than in patients without history of CVD (RR: 0.99; 95% CI: 0.51–1.94; P = 0.977). Sensitivity analysis suggested that the intervention effect persisted and the conclusion was not changed. Subgroup analysis indicated mean age, study quality might play an important role on the risk of CVD.

Conclusions

The findings of this study indicated THI could reduce the recurrence of CVD. Further large-scale trials are needed to verify the effect of THI on CVD in healthy individuals.

Multimedia education program and nutrition therapy improves HbA1c, weight, and lipid profile of patients with type 2 diabetes: a randomized clinical trial

PURPOSE

To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes.

RESEARCH QUESTION

What is the effect of a multimedia education program and nutritional therapy on metabolic control in type 2 diabetes?

PATIENTS AND METHODS

A randomized clinical trial was conducted in 351 patients randomly assigned to either an experimental group receiving a multimedia diabetes education program (MDE) and nutrition therapy (NT) (NT + MDE: n = 173), or to a control group who received nutrition therapy only (NT: n = 178). At baseline, 7, 14, and 21 months, the glycated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol were measured. Weight, body mass index (BMI), waist circumference (WC), fat percentage, fat and lean mass, systolic blood pressure (SBP), and diastolic (DBP) were also recorded.

RESULTS

Glycated hemoglobin decreased in both groups, although the group with NT + MDE had a greater reduction, with a difference of -0.76% (95%CI -1.33 to -0.19) at 7 months and -0.73% (95%CI -1.37 to -0.09) at 21 months. Only in the NT + MDE did the glucose decrease at 7 (-41.2 mg/dL; 95%CI -52.0 to -30.5), 14 (-27.8 mg/dL; 95%CI -32.6 to -23.1), and 21 months (-36.6 mg/dL; 95%CI -46.6 to -26.6). Triglycerides and the atherogenic index decreased in both groups at 7 and 14 months; while only in the NT + MDE group did it decrease at 21 months. (p < 0.05). Weight decreased at 21 months in the NT + MDE group (-1.23, -2.29 at -0.16; p < 0.05).

CONCLUSION

Nutrition therapy and a multimedia diabetes education program have a favorable impact on achieving metabolic control goals in type 2 diabetes.

Health education for patients with acute coronary syndrome and type 2 diabetes mellitus: an umbrella review of systematic reviews and meta-analyses

OBJECTIVES

This umbrella review aimed to identify the current evidence on health education-related interventions for patients with acute coronary syndrome (ACS) or type two diabetes mellitus (T2DM); identify the educational content, delivery methods, intensity, duration and setting required. The purpose was to provide recommendations for educational interventions for high-risk patients with both ACS and T2DM.

DESIGN

Umbrella review of systematic reviews and meta-analyses.

SETTING

Inpatient and postdischarge settings.

PARTICIPANTS

Patients with ACS and T2DM.

DATA SOURCES

CINAHL, Cochrane Library, Joanna Briggs Institute, Journals@Ovid, EMBase, Medline, PubMed and Web of Science databases from January 2000 through May 2016.

OUTCOMES MEASURES

Clinical outcomes (such as glycated haemoglobin), behavioural outcomes (such as smoking), psychosocial outcomes (such as anxiety) and medical service use.

RESULTS

Fifty-one eligible reviews (15 for ACS and 36 for T2DM) consisting of 1324 relevant studies involving 2 88 057 patients (15 papers did not provide the total sample); 30 (58.8%) reviews were rated as high quality. Nurses only and multidisciplinary teams were the most frequent professionals to provide education, and most educational interventions were delivered postdischarge. Face-to-face sessions were the most common delivery formats, and many education sessions were also delivered by telephone or via web contact. The frequency of educational sessions was weekly or monthly, and an average of 3.7 topics was covered per education session. Psychoeducational interventions were generally effective at reducing smoking and admissions for patients with ACS. Culturally appropriate health education, self-management educational interventions, group medical visits and psychoeducational interventions were generally effective for patients with T2DM.

CONCLUSIONS

Results indicate that there is a body of current evidence about the efficacy of health education, its content and delivery methods for patients with ACS or T2DM. These results provide recommendations about the content for, and approach to, health education intervention for these high-risk patients.

Associations of lifestyle factors (smoking, alcohol consumption, diet and physical activity) with type 2 diabetes among American adults from National Health and Nutrition Examination Survey (NHANES) 2005-2014

BACKGROUND

Over the long term, unhealthy lifestyles can lead to many health problems, especially type 2 diabetes (T2D). The aim of the present study was to determine associations between lifestyle factors (smoking, alcohol consumption, physical activity, and diet) and T2D in American adults (aged ≥20 years) in a nationally representative sample.

METHODS

Data for 12 987 American adults participating in the National Health and Nutrition Examination Survey 2005-2014 were evaluated. Weighted multiple logistic regression models were used to examine associations between the four lifestyle factors and T2D after adjusting for demographics and socioeconomic status (SES). Prevalence trends for T2D were examined using Cochran-Armitage tests.

RESULTS

There was a significant increasing prevalence trend for T2D among American adults. Smokers and individuals consuming >12 alcoholic drinks in the past year were less likely to report having T2D than non-smokers (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.35-0.48) and those consuming <12 alcoholic drinks (OR 0.46; 95% CI 0.39-0.55). Participants with light physical activity have a greater likelihood of having T2D than those engaging in vigorous physical activity (OR 5.72; 95% CI 4.30-7.60). Individuals consuming a poor diet were more likely to report having T2D than those eating an excellent diet (OR 1.18; 95% CI 1.02-1.41). All these relationships remained significant after adjustment for demographics and SES.

CONCLUSION

All four lifestyle factors were significantly associated with T2D among American adults. The findings of the present study provide useful information for healthcare providers that may help them promote specific lifestyle modifications.

Improving Self-Management of Type 2 Diabetes in Overweight and Inactive Patients Through an Educational and Motivational Intervention Addressing Diet and Physical Activity: A Prospective Study in Naples, South Italy

INTRODUCTION

Nutrition and physical activity are key elements in the prevention and management of type 2 diabetes. A community-based, multidisciplinary educational intervention aimed to improve quality of life and disease self-management in sedentary, overweight/obese type 2 diabetic patients was implemented in Naples, South Italy.

METHODS

The 9-month intervention included a motivational program, a nutrition program, and an exercise program. Satisfaction, worry, and embarrassment regarding their condition, together with disease-related behaviors and propensity towards physical activity, were evaluated through a validated questionnaire before and after the intervention; health status perception was evaluated through the short-form 12 questionnaire. Changes in HbA1c level and weight were also checked.

RESULTS

A significant improvement (p < 0.05) was registered in behaviors related to the management of hypoglycemic crisis and food choice; in nearly all the items related to living with the disease (p < 0.01); and in health status perception (p < 0.01). The adoption of healthy behavior was more common among women (OR 2.17, 95% CI 1.09, 3.02) and persons with higher educational levels (OR 1.26, 95% CI 0.83, 2.17; OR 1.54, 95% CI 0.56, 2.27). About 30% of participants did not modify their emotional status after the intervention. Although not significantly (p = 0.18), the trust of patients towards physical activity increased at the end of the study, together with their active lifestyle (p < 0.01) and with the decrease of perceived barriers (p < 0.01). A significant improvement was registered in glycemic control and weight status (p < 0.01).

CONCLUSIONS

The intervention was feasible and effective in addressing diet and physical activity among participants, giving consequent improvements in health status. Similar educational interventions including a training program for people with diabetes should be standardized and adopted by the Italian National Health System.

Characterization of lipid profile by nuclear magnetic resonance spectroscopy (1H NMR) of metabolically healthy obese women after weight loss with Mediterranean diet and physical exercise

Obesity is associated with an atherogenic lipid profile. No data exists on lipoprotein particle profiles in metabolically healthy obese (MHO) individuals. Our aim is to characterize lipoprotein size, particle, and subclass concentrations in MHO women after 3 months of weight loss through dietary restriction and physical exercise.A total of 115 nondiabetic women (aged 35-55 years) with a body mass index (BMI) of 30 to 40 kg/m and ≤1 of the following criteria: blood pressure ≤135/85 mm Hg, fasting plasma glucose ≤100 mg/dL, HDL-cholesterol ≤50 mg/dL, and triglycerides ≤150 mg/dL were included. After 3 months of intensive lifestyle modification (Mediterranean diet and physical exercise), they were classified according to their weight loss: <5%, ≥5% to <10%, and ≥10%. Lipoprotein size, particle, and subclass concentrations were measured using H NMR.The final sample, after dropouts, comprised 104 women (age: 44.4 ± 3.7 years, BMI: 36.3 ± 4.7 kg/m), of whom 47 (45.2%), 27 (26%), and 30 (28.8%) lost <5%, ≥5% to <10%, and ≥10% of baseline body weight, respectively. All participants experienced significant weight loss and decreases in BMI. The lipid profiles showed an increase in small, medium, and large very low density lipoprotein (VLDL) particles in all groups of study with the exception of small VLDL particles in women with ≥10% of weight loss, in which it decreased. The number of VLDL particles decreased in women who had ≥10% weight loss. On the other hand, we detected a decrease in all low density lipoprotein (cLDL) and high density lipoprotein (cHDL) concentrations.These results indicate that intensive lifestyle modification alters lipid profiles. In particular, it decreases small LDL and HDL particle numbers and does not increase medium or large HDL particles numbers.

Assessing the evidence: Exploring the effects of exercise on diabetic microcirculation

Diabetes mellitus (DM) is associated with cardiovascular complications. Impairment of glycemic control induces noxious glycations, an increase in oxydative stress and dearangement of various metabolic pathways. DM leads to dysfunction of micro- and macrovessels, connected to metabolic, endothelial and autonomic nervous system. Thus, assessing vascular reactivity might be one of the clinical tools to evaluate the impact of harmful effects of DM and potential benefit of treatment; skin and skeletal muscle microcirculation have usually been tested. Physical exercise improves vascular dysfunction through various mechanisms, and is regarded as an additional effective treatment strategy of DM as it positively impacts glycemic control, improves insulin sensitivity and glucose uptake in the target tissues, thus affecting glucose and lipid metabolism, and increases the endothelium dependent vasodilation. Yet, not all patients respond in the same way so titrating the exercise type individualy would be desirable. Resistance training has, apart from aerobic one, been shown to positively correlate to glycemic control, and improve vascular reactivity. It has been prescribed in various forms or in combination with aerobic training. This review would assess the impact of different modes of exercise, the mechanisms involved, and its potential positive and negative effects on treating patients with Type I and Type II DM, focusing on the recent literature.

Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis

BACKGROUND

Diabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed.

METHODS

Randomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911.

RESULTS

42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I ² = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60-0.90, P = 0.003; absolute risk difference: -0.8 %, 95 %CI -1.4 to -0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46-0.96, P = 0.02; I ² = 0 %) and 0.64 (95 % CI 0.47- 0.88, P = 0.005; I ² = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk was also found in those patients receiving diabetes self-management education with contact hours more than 10 h (pooled risk ratio: 0.60, 95 %CI 0.44-0.82, P = 0.001; I ² = 0 %), those receiving repeated diabetes self-management education (pooled RR: 0.71, P = 0.001; I ² = 0 %), those receiving diabetes self-management education using structured curriculum (pooled risk ratio: 0.72, P = 0.01; I ² = 0 %) and those receiving diabetes self-management education using in-person communication (pooled risk ratio: 0.75, P = 0.02; I ² = 0 %). The quality of evidence for the effect of diabetes self-management education in reducing all-cause mortality risk among type 2 diabetes patients was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation method, and the absolute risk reduction of all-cause mortality of type 2 diabetic patients by diabetes self-management education was estimated to be 4 fewer per 1000 person-years (from 1 fewer to 6 fewer).

CONCLUSIONS

The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients. Further clinical trials with longer time of follow-up are needed to validate the finding above.

The variability in beta-cell function in placebo-treated subjects with type 2 diabetes: application of the weight-HbA1c-insulin-glucose (WHIG) model

AIM

The weight-glycosylated haemoglobin (HbA1C)-insulin-glucose (WHIG) model describes the effects of changes in weight on insulin sensitivity (IS) in newly diagnosed, obese subjects receiving placebo treatment. This model was applied to a wider population of placebo-treated subjects, to investigate factors influencing the variability in IS and β-cell function.

METHODS

The WHIG model was applied to the WHIG dataset (Study 1) and two other placebo datasets (Studies 2 and 3). Studies 2 and 3 consisted of nonobese subjects and subjects with advanced type 2 diabetes mellitus (T2DM). Body weight, fasting serum insulin (FSI), fasting plasma glucose (FPG) and HbA1c were used for nonlinear mixed-effects modelling (using NONMEM v7.2 software). Sources of interstudy variability (ISV) and potential covariates (age, gender, diabetes duration, ethnicity, compliance) were investigated.

RESULTS

An ISV for baseline parameters (body weight and β-cell function) was required. The baseline β-cell function was significantly lower in subjects with advanced T2DM (median difference: Study 2: 15.6%, P < 0.001; Study 3: 22.7%, P < 0.001) than in subjects with newly diagnosed T2DM (Study 1). A reduction in the estimated insulin secretory response in subjects with advanced T2DM was observed but diabetes duration was not a significant covariate.

CONCLUSION

The WHIG model can be used to describe the changes in weight, IS and β-cell function in the diabetic population. IS remained relatively stable between subjects but a large ISV in β-cell function was observed. There was a trend towards decreasing β-cell responsiveness with diabetes duration, and further studies, incorporating subjects with a longer history of diabetes, are required.

Type 2 diabetes: cost-effectiveness of medication adherence and lifestyle interventions

INTRODUCTION

Type 2 diabetes is a major burden for the payer, however, with proper medication adherence, diet and exercise regime, complication occurrence rates, and consequently costs can be altered.

AIMS

The aim of this study was to conduct a cost-effectiveness analysis on real patient data and evaluate which medication adherence or lifestyle intervention is less cost demanding for the payer.

METHODS

Medline was searched systematically for published type 2 diabetes interventions regarding medication adherence and lifestyle in order to determine their efficacies, that were then used in the cost-effectiveness analysis. For cost-effectiveness analysis-required disease progression simulation, United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used. The intervention duration was set to 1, 2, 5, and 10 years. Complications and drug costs in euro (EUR) were based on previously published type 2 diabetes costs from the Health Care payer perspective in Slovenia.

RESULTS

Literature search proved the following interventions to be effective in type 2 diabetes patients: medication adherence, the Mediterranean diet, aerobic, resistance, and combined exercise. The long-term simulation resulted in no payer net savings. The model predicted following quality-adjusted life-years (QALY) gained and incremental costs for QALY gained (EUR/QALYg) after 10 years of intervention: high-efficacy medication adherence (0.245 QALY; 9,984 EUR/QALYg), combined exercise (0.119 QALY; 46,411 EUR/QALYg), low-efficacy medication adherence (0.075 QALY; 30,967 EUR/QALYg), aerobic exercise (0.069 QALY; 80,798 EUR/QALYg), the Mediterranean diet (0.057 QALY; 27,246 EUR/QALYg), and resistance exercise (0.050 QALY; 111,847 EUR/QALYg).

CONCLUSION

The results suggest that medication adherence intervention is, regarding cost-effectiveness, superior to diet and exercise interventions from the payer perspective. However, the latter could also be utilized by patients without additional costs, but medication adherence intervention requires trained personnel because of its complex structure. Interventions should be performed for >2 years to produce noticeable health/cost results.