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Wheatley-Guy CM, Shea MG, Parks JK, Scales R, Goodman BP, Butterfield RJ, Johnson BD. Semi-supervised exercise training program more effective for individuals with postural orthostatic tachycardia syndrome in randomized controlled trial. Clin Auton Res 2023; 33:659-672. [PMID: 37598401 PMCID: PMC10751269 DOI: 10.1007/s10286-023-00970-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE Exercise like any medication requires the correct dose; to be effective the appropriate frequency, duration, and intensity are necessary. This study aimed to assess if a semi-supervised exercise training (ET) program would be more effective at improving aerobic fitness (VO2PEAK), exercise tolerance, and symptoms in individuals with postural orthostatic tachycardia syndrome (POTS) compared to the standard of care (SOC). METHODS Subjects were randomized to either the ET or SOC groups (n 26 vs. 23; age 33 ± 11 vs. 37 ± 10 years; VO2PEAK 66 ± 15 vs. 62 ± 15% predicted, ET vs. SOC respectively, p > 0.05). Composite Autonomic Symptom Score (COMPASS 31), 10 min stand test, and cardiopulmonary exercise test were performed at baseline and following 12 weeks. The ET group received an exercise consultation and eight semi-supervised in-person or virtual exercise sessions. RESULTS The ET group demonstrated a greater improvement in VO2PEAK, higher or longer tolerance for baseline peak workload, and more often had a delayed symptom onset with exercise than the SOC group (ΔVO2PEAK 3.4 vs. - 0.2 mL/min/kg, p < 0.0001, ΔWorkload 19 ± 17 vs. 0 ± 10 W; Workload time 63 ± 29 vs. 22 ± 30 s; onset-delay 80% vs. 30%, p < 0.05). Individuals in the ET group reported a significant improvement in orthostatic intolerance domain score (p = 0.02), but there was not a significant difference in the improvement in total COMPASS score (- 11.38 vs. - 6.49, p = 0.09). CONCLUSION Exercise training was more effective with greater improvements in aerobic fitness, orthostatic symptoms, and exercise tolerance for individuals with POTS when intensity and progression were personalized and delivered with minimal supervision compared to the SOC.
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Affiliation(s)
- Courtney M Wheatley-Guy
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Meredith G Shea
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jordan K Parks
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Robert Scales
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | | | | | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
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Wilson HK, Castillo-Hernandez IM, Evans EM, Williams ER, Berg AC. Diet Quality Outcomes of a Cooperative Extension Diabetes Prevention Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:734-742. [PMID: 37480887 DOI: 10.1016/j.jneb.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE The effectiveness of the National Diabetes Prevention Program (DPP) in improving diet quality (DQ) in community settings is largely unknown. This study aimed to evaluate the DQ changes of Extension DPP participants. METHODS A single-group, repeated-measures design was used to evaluate an Extension-implemented DPP using the PreventT2 curriculum. Participants were overweight adults with or at high risk for prediabetes (n = 88). Weight and DQ (Healthy Eating Index-2015, Dietary Screener Questionnaire) were evaluated using mixed-effects regression. RESULTS There was no change in the Healthy Eating Index-2015 total score. Predicted fiber, fruit, and vegetable intake increased (P < 0.05) but remained below recommendations. CONCLUSIONS AND IMPLICATIONS Clinically meaningful DQ changes of Extension DPP participants were limited. The effect of the DPP on DQ in Extension and other implementation settings should be evaluated through randomized controlled trials. Diabetes Prevention Program curriculum revisions that include more specific dietary goals and educational tools may promote greater DQ changes in DPP participants.
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Affiliation(s)
- Hannah K Wilson
- Department of Nutrition, Dietetics and Exercise Science, Concordia College, Moorhead, MN.
| | | | - Ellen M Evans
- Department of Kinesiology, Indiana University Bloomington, Bloomington, IN
| | - Ewan R Williams
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | - Alison C Berg
- Department of Nutritional Sciences, University of Georgia, Athens, GA
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Wang L, Liu X, Yang W, Lai J, Yu X, Liu J, Gao X, Ming J, Ma K, Xu J, Tian Z, He Q, Ji Q. Comparison of Blood Glucose Variability Between Exenatide and Biphasic Insulin Aspart 30 in Chinese Participants with Type 2 Diabetes Inadequately Controlled with Metformin Monotherapy: A Multicenter, Open-Label, Randomized Trial. Diabetes Ther 2020; 11:2313-2328. [PMID: 32856226 PMCID: PMC7509011 DOI: 10.1007/s13300-020-00904-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION To compare blood glucose variability (GV) in Chinese participants with type 2 diabetes mellitus (T2DM) whose blood glucose levels are inadequately controlled with metformin monotherapy after twice-daily exenatide or biphasic insulin aspart 30 (BIAsp30). METHODS In this 16-week multicenter, randomized clinical trial, 104 participants were randomized 1:1 to receive exenatide (exenatide group) or BIAsp30 (BIAsp30 group) twice daily. All participants continued metformin treatment. The primary outcome was the change in GV as measured by a continuous glucose monitoring system (CGMS) from baseline to 16 weeks. RESULTS At 16 weeks, both the Exenatide and BIAsp30 groups effectively decreased mean glucose (MG), but neither group changed the mean amplitude of glycemic excursion (MAGE), largest amplitude of glycemic excursion (LAGE), mean of daily difference (MODD), or standard deviation of blood glucose (SDBG). The decrease in 2-h post-breakfast glucose excursions was greater in the Exenatide group compared to the BIAsp30 group, with a least square (LS) mean difference [95% CI] of (1.58 [0.53, 2.63]). Exenatide also significantly reduced 2-h post-lunch glucose excursion compared to BIAsp30 (LS mean difference [95% CI], 1.19 [0.18, 2.20]). The Exenatide group had significantly reduced body weight and body mass index (BMI), while the BIAsp30 group had increased weight and had no change in BMI. Both treatments were well tolerated with no serious hypoglycemic events and with fewer identified hypoglycemic events in the Exenatide group than in the BIAsp30 group (5.77% vs. 17.31%, P < 0.01). CONCLUSION Although there was no difference in change of GV between Exenatide and BIAsp30, exenatide provided more improvement in postprandial glucose excursion and weight control, without increasing the risk of hypoglycemia in Chinese patients with T2DM whose blood glucose was inadequately controlled with metformin. These findings may provide new options for patients who choose further hypoglycemic treatment, especially in patients with obesity who have large postprandial plasma glucose excursions. TRIAL REGISTRATION ClinicalTrials.gov indentifier: NCT02449603.
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Affiliation(s)
- Li Wang
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiangyang Liu
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wenjuan Yang
- Department of Endocrinology, Shaanxi Aerospace Hospital, Xi'an, Shaanxi, China
| | - Jingbo Lai
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xinwen Yu
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianrong Liu
- Department of Endocrinology, Xi'an Chang an Hospital, Xi'an, Shaanxi, China
| | - Xiling Gao
- Department of Endocrinology, Yan'an People's Hospital, Yan'an, Shaanxi, China
| | - Jie Ming
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kaiyan Ma
- Department of Endocrinology, Shangluo Central Hospital, Shangluo, Shaanxi, China
| | - Jing Xu
- Department of Endocrinology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhufang Tian
- Department of Endocrinology, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Qingzhen He
- Department of Endocrinology, Xi'an Gaoxin Hospital, Xi'an, Shaanxi, China
| | - Qiuhe Ji
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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Yee JK, Lucas-Wright A, Liu PY, Chung B, Bross R, Malkhassian S, Norris KC, Wang C, Jones L. Initiating Dialogue in Community-Partnered Participatory Research to Address Obesity in South Los Angeles. J Health Care Poor Underserved 2018; 29:601-614. [PMID: 29805126 DOI: 10.1353/hpu.2018.0044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In South Los Angeles, a community-engaged research project on obesity was initiated between a translational research institute seeking to build community-based or partnered participatory research (CBPR/CPPR) capacity, and a community partner with extensive experience. This manuscript describes the partnership-building process and discusses results from a bi-directional knowledge transfer event.
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Mudaliar U, Zabetian A, Goodman M, Echouffo-Tcheugui JB, Albright AL, Gregg EW, Ali MK. Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Meta-analysis. PLoS Med 2016; 13:e1002095. [PMID: 27459705 PMCID: PMC4961455 DOI: 10.1371/journal.pmed.1002095] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/17/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States. METHODS AND FINDINGS In this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs (focused on modest [5%-7%] weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake) in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], systolic or diastolic blood pressure [SBP/DBP], total [TC] or HDL-cholesterol). We searched the MEDLINE, EMBASE, Cochrane Library, and Clinicaltrials.gov databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics (duration, number of core and maintenance sessions), and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals (CI). To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants (prediabetes or other), and intervention delivery personnel (lay or professional). Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index (BMI) of 34.8 kg/m2, and 25.2% were male. On average, study follow-up was 9.3 mo (median 12.0) with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance (either email or in person). Mean absolute changes observed were: weight -3.77 kg (95% CI: -4.55; -2.99), HbA1c -0.21% (-0.29; -0.13), FBG -2.40 mg/dL (-3.59; -1.21), SBP -4.29 mmHg (-5.73, -2.84), DBP -2.56 mmHg (-3.40, 1.71), HDL +0.85 mg/dL (-0.10, 1.60), and TC -5.34 mg/dL (-9.72, -0.97). Programs with a maintenance component achieved greater reductions in weight (additional -1.66kg) and FBG (additional -3.14 mg/dl). Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs. CONCLUSIONS DPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective.
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Affiliation(s)
- Uma Mudaliar
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Azadeh Zabetian
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann L. Albright
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward W. Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mohammed K. Ali
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Marrero DG, Palmer KNB, Phillips EO, Miller-Kovach K, Foster GD, Saha CK. Comparison of Commercial and Self-Initiated Weight Loss Programs in People With Prediabetes: A Randomized Control Trial. Am J Public Health 2016; 106:949-56. [PMID: 26890171 DOI: 10.2105/ajph.2015.303035] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine if a widely available weight-management program (Weight Watchers) could achieve sufficient weight loss in persons with prediabetes compared with a Diabetes Prevention Program-based individual counseling program supported by National Diabetes Education Program materials. METHODS We conducted an individual, randomized intervention trial in Indianapolis, Indiana, in 2013 to 2014, in 225 persons with prediabetes. We compared the Weight Watchers weight-management program (n = 112) with Your Game Plan to Prevent Type 2 Diabetes, a program developed by the National Diabetes Education Program. Outcomes were weight and metabolic markers measured at baseline, 6 months, and 12 months. RESULTS Intervention participants lost significantly more weight than controls at 6 months (5.5% vs 0.8%) and 12 months (5.5% vs 0.2%; both P < .001). The intervention group also had significantly greater improvements in hemoglobin A1c and high-density lipoprotein cholesterol level than did controls. CONCLUSIONS A large weight-management program is effective for achieving lifestyle changes associated with diabetes prevention. Such programs could significantly increase the availability of diabetes prevention programs worldwide making an immediate and significant public health impact.
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Affiliation(s)
- David G Marrero
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Kelly N B Palmer
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Erin O Phillips
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Karen Miller-Kovach
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Gary D Foster
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Chandan K Saha
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
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Neamah HH, Sebert Kuhlmann AK, Tabak RG. Effectiveness of Program Modification Strategies of the Diabetes Prevention Program: A Systematic Review. DIABETES EDUCATOR 2016; 42:153-65. [PMID: 26879459 DOI: 10.1177/0145721716630386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study is to review the effectiveness of commonly used program modifications classified under cultural adaptation and program translational strategies for the Diabetes Prevention Program (DPP) in terms of risk reduction for type 2 diabetes. METHODS Authors extracted data about weight, body mass index (BMI), and 5 areas of program modification strategies from 28 interventions and analyzed them in SPSS software. Bivariate analyses examined the odds of achieving a significant reduction in outcomes by each modification of the DPP and by presence of a maintenance component, as well as the mean reduction of weight and BMI by more versus fewer modifications and by the presence of a maintenance component. RESULTS There were no statistically significant differences in achieving a significant reduction in weight or BMI by any type of modification or by the presence of a maintenance component. Programs with fewer modifications reported significantly greater reduction in mean weight at 12 months postintervention and the furthest time point extracted. Programs with a maintenance component achieved significantly greater reduction in mean weight measured at the furthest time point extracted. CONCLUSIONS The DPP appears to be programmatically robust to a variety of cultural adaptation and translational strategies. Potentially cost-saving modifications do not seem to reduce effectiveness, which should encourage implementation on a broader scale. Program planners should, however, make efforts to include maintenance components because they appear to significantly reduce risk for acquiring type 2 diabetes.
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Affiliation(s)
- Hind H Neamah
- Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Neamah, Dr Sebert Kuhlmann)
| | - Anne K Sebert Kuhlmann
- Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Neamah, Dr Sebert Kuhlmann),Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA (Dr Sebert Kuhlmann)
| | - Rachel G Tabak
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Tabak)
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A review of diabetes prevention program translations: use of cultural adaptation and implementation research. Transl Behav Med 2015; 5:401-14. [PMID: 26622913 DOI: 10.1007/s13142-015-0341-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Diabetes Prevention Program (DPP) has been shown to prevent type 2 diabetes through lifestyle modification. The purpose of this study was to describe the literature on DPP translation, synthesizing studies using cultural adaptation and implementation research. A systematic search was conducted. Original studies evaluating DPP implementation and/or cultural adaptation were included. Data about cultural adaptation, implementation outcomes, and translation strategies was abstracted. A total of 44 were included, of which 15 reported cultural adaptations and 38 explored implementation. Many studies shortened the program length and reported a group format. The most commonly reported cultural adaptation (13 of 15) was with content. At the individual level, the most frequently assessed implementation outcome (n = 30) was adoption. Feasibility was most common (n = 32) at the organization level. The DPP is being tested in a variety of settings and populations, using numerous translational strategies and cultural adaptations. Implementation research that identifies, evaluates, and reports efforts to translate the DPP into practice is crucial.
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Haw JS, Tantry S, Vellanki P, Pasquel FJ. National Strategies to Decrease the Burden of Diabetes and Its Complications. Curr Diab Rep 2015; 15:65. [PMID: 26255260 DOI: 10.1007/s11892-015-0637-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Comparative results from national strategies for diabetes care and prevention are needed to understand the impact and barriers encountered during the implementation process. Long-term outcomes are limited, but results on intermediate outcomes and processes of diabetes care measures are available from translational research studies. In this narrative review, we highlight programs with nationwide reach, targeting various ethnic, racial, and socioeconomic populations with diabetes. We describe the implementation strategies, the impact on clinical outcomes, specific barriers, and cost-effectiveness results of national efforts aimed at improving diabetes care and prevention in the USA.
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Affiliation(s)
- J Sonya Haw
- Division of Endocrinology, Emory University School of Medicine, 49 Jesse Hill Dr SE, FOB Rm 439, Atlanta, GA, 30303, USA,
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Effects of weight regain following intentional weight loss on glucoregulatory function in overweight and obese adults with pre-diabetes. Obes Res Clin Pract 2014; 9:266-73. [PMID: 25293586 DOI: 10.1016/j.orcp.2014.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the extent to which initial, intentional weight loss-associated improvements in glucose tolerance and insulin action are diminished with weight regain. METHODS 138 overweight and obese (BMI: 32.4±3.9kg/m(2)), adults (59.0±9.7 years), with pre-diabetes were followed through a 6-month weight loss intervention and subsequent 18-month weight maintenance period, or usual care control condition. Longitudinal change in weight (baseline, 6, 24 months) was used to classify individuals into weight pattern categories (Loser/Maintainer (LM), n= 50; Loser/Regainer (LR), n=51; and Weight Stable (WS), n=37). Fasting plasma glucose (FPG), insulin, and insulin resistance (HOMA-IR) were measured at baseline, 6, 12, 18 and 24 months and model adjusted changes, by weight pattern category, were assessed. RESULTS LMs and LRs lost 8.3±4.7kg (8.7±4.5%) and 9.6±4.7kg (10.2±4.7%) during the first 6 months, respectively. LM continued to lose 1.1±3.4kg over the next 18 months (9.9±6.5% reduction from baseline; p<0.05), while LRs regained 6.5±3.7kg (3.3±5.3% reduction from baseline; p<0.05). Weight change was directly associated with change in all DM risk factors (all p<0.01). Notably, despite an absolute reduction in body weight (from baseline to 24 months) achieved in the LR group, 24-month changes in FPG, insulin, and HOMA-IR did not differ between WS and LR groups. Conversely, LM saw sustained improvements in all measured DM risk factors. CONCLUSIONS Significant weight loss followed by weight loss maintenance is associated with sustained improvements in FPG, insulin, and HOMA-IR; conversely, even partial weight regain is associated with regression of initial improvements in these risk factors towards baseline values.
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Almeida FA, Pardo KA, Seidel RW, Davy BM, You W, Wall SS, Smith E, Greenawald MH, Estabrooks PA. Design and methods of "diaBEAT-it!": a hybrid preference/randomized control trial design using the RE-AIM framework. Contemp Clin Trials 2014; 38:383-96. [PMID: 24956325 DOI: 10.1016/j.cct.2014.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diabetes prevention is a public health priority that is dependent upon the reach, effectiveness, and cost of intervention strategies. However, understanding each of these outcomes within the context of randomized controlled trials is problematic. PURPOSE To describe the methods and design of a hybrid preference/randomized control trial using the RE-AIM framework. METHODS The trial, which was developed using the RE-AIM framework, will contrast the effects of 3 interventions: (1) a standard care, small group, diabetes prevention education class (SG), (2) the small group intervention plus 12 months of interactive voice response telephone follow-up (SG-IVR), and (3) a DVD version of the small group intervention with the same IVR follow-up (DVD-IVR). Each intervention includes personal action planning with a focus on key elements of the lifestyle intervention from the Diabetes Prevention Program (DPP). Adult patients at risk for diabetes will be randomly assigned to either choice or RCT. Those assigned to choice (n=240) will have the opportunity to choose between SG-IVR and DVD-IVR. Those assigned to RCT group (n=360) will be randomly assigned to SG, SG-IVR, or DVD-IRV. Assessment of primary (weight loss, reach, & cost) and secondary (physical activity, & dietary intake) outcomes will occur at baseline, 6, 12, and 18 months. CONCLUSION This will be the first diabetes prevention trial that will allow the research team to determine the relationships between reach, effectiveness, and cost of different interventions.
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Affiliation(s)
- Fabio A Almeida
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Kimberlee A Pardo
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Richard W Seidel
- Department of Psychiatry, Carilion Clinic, Roanoke, VA 24014, United States.
| | - Brenda M Davy
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Wen You
- Department of Agriculture and Applied Economics, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Sarah S Wall
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Erin Smith
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24013, United States.
| | - Paul A Estabrooks
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States; Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24013, United States.
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Stein JH, Asthana A, Smith SS, Piper ME, Loh WY, Fiore MC, Baker TB. Smoking cessation and the risk of diabetes mellitus and impaired fasting glucose: three-year outcomes after a quit attempt. PLoS One 2014; 9:e98278. [PMID: 24893290 PMCID: PMC4043674 DOI: 10.1371/journal.pone.0098278] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/30/2014] [Indexed: 12/24/2022] Open
Abstract
Weight gain after smoking cessation may increase diabetes mellitus and impaired fasting glucose (IFG) risk. This study evaluated associations between smoking cessation and continued smoking with incident diabetes and IFG three years after a quit attempt. The 1504 smokers (58% female) were mean (standard deviation) 44.7 (11.1) years old and smoked 21.4 (8.9) cigarettes/day. Of 914 participants with year 3 data, the 238 abstainers had greater weight gain, increase in waist circumference, and increase in fasting glucose levels than the 676 continuing smokers (p≤0.008). In univariate analyses, Year 3 abstinence was associated with incident diabetes (OR = 2.60, 95% CI 1.44–4.67, p = .002; 4.3% absolute excess) and IFG (OR = 2.43, 95% CI 1.74–3.41, p<0.0001; 15.6% absolute excess). In multivariate analyses, incident diabetes was associated independently with older age (p = 0.0002), higher baseline body weight (p = 0.021), weight gain (p = 0.023), baseline smoking rate (p = 0.008), baseline IFG (p<0.0001), and baseline hemoglobin A1C (all p<0.0001). Smoking more at baseline predicted incident diabetes among eventual abstainers (p<0.0001); weighing more at baseline predicted incident diabetes among continuing smokers (p = 0.0004). Quitting smoking is associated with increased diabetes and IFG risk. Independent risk factors include older age, baseline body weight, baseline glycemic status, and heavier pre-quit smoking. These findings may help target smokers for interventions to prevent dysglycemia. Trial Registration Clinicaltrials.gov NCT00332644
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Affiliation(s)
- James H. Stein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
- * E-mail:
| | - Asha Asthana
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Stevens S. Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Megan E. Piper
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Wei-Yin Loh
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Michael C. Fiore
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Timothy B. Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
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W Seidel R, Pardo KA, A Estabrooks P, WenYou EY, Wall SS, M Davy B, A Almeida F. Beginning a patient-centered approach in the design of a diabetes prevention program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2003-13. [PMID: 24534767 PMCID: PMC3945581 DOI: 10.3390/ijerph110202003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The purpose of this study was to identify patient preferences for different components of a local diabetes prevention program that would improve reach. A secondary purpose was to determine if patient characteristics were related to program preferences. METHODS Participants were identified through electronic medical records from two family medicine clinics in Virginia. Participants completed a mailed survey addressing demographics, economic status, risk factors for diabetes, and preferences regarding diabetes prevention interventions-delivery mode, program length, and duration. RESULTS Twenty-nine percent of eligible participants responded (n = 142); 83% of participants were at risk for diabetes and 82% had a household income <$20,000. When presented with the choice between a class-based vs. a technology-based program, 83% preferred a technology-based program. Whites were less likely to choose the technology-based program, with no significant differences based on age, education, income, or gender. CONCLUSIONS Contrary to beliefs that lower income individuals may not use technology-based interventions, lower socioeconomic patients indicated a preference for a technology- and telephone-supported diabetes prevention program over in-person class approaches. Findings provide formative data to support the design of a patient-centered, technology-enhanced diabetes prevention program in a real-world setting, thereby increasing potential participation and reach.
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Affiliation(s)
- Richard W Seidel
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, 2017 South Jefferson Street, Roanoke, VA 24014, USA.
| | - Kimberlee A Pardo
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Paul A Estabrooks
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Emptyyn Y WenYou
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Sarah S Wall
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Brenda M Davy
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Fabio A Almeida
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
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Venditti EM, Wylie-Rosett J, Delahanty LM, Mele L, Hoskin MA, Edelstein SL. Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence. Int J Behav Nutr Phys Act 2014; 11:16. [PMID: 24521153 PMCID: PMC4015875 DOI: 10.1186/1479-5868-11-16] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts. Methods Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 ± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic characteristics. Results Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time management (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having any type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were significantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness and access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle coaches used problem-solving with most participants (≥75% short-term; > 90% long term) and regularly reviewed self-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (≤10%) but increased over 3.2 years. Conclusion Behavioral problem solving approaches have short and long term dissemination potential for many kinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the consistent use of these approaches appears warranted.
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Affiliation(s)
- Elizabeth M Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Limberg JK, Johansson RE, McBride PE, Schrage WG. Increased leg blood flow and improved femoral artery shear patterns in metabolic syndrome after a diet and exercise programme. Clin Physiol Funct Imaging 2013; 34:282-9. [PMID: 24237709 DOI: 10.1111/cpf.12095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/01/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Altered vascular shear profiles may contribute to the development of atherosclerosis. Physical activity promotes anti-atherogenic shear patterns, resulting in reduced cardiovascular disease risk. Adults with metabolic syndrome (MetSyn) are at increased risk of developing atherosclerosis and cardiovascular disease. Thus, we hypothesized that conduit artery antegrade shear rate (ASR) would increase and retrograde shear rate (RSR) and oscillatory shear indices (OSI) would decrease in MetSyn patients (n = 16, 51 ± 2 years) after participation in a diet and exercise programme (DEP). METHODS Blood flow (Doppler ultrasound, brachial and femoral arteries) was measured, and shear rates were calculated in MetSyn patients before and after 12 weeks of DEP participation. In addition, plasma samples were collected to measure atherogenic markers. RESULTS Diet and exercise programme participation increased resting leg blood flow and femoral artery ASR (P ≤ 0·05), and tended to decrease OSI (P = 0·09); RSR did not change (P>0·05). No changes in resting arm blood flow or ASR were observed (P>0·05), and both RSR and OSI increased after participation (P≤0·05). DEP participation reduced plasma vascular cell adhesion molecule(VCAM)-1 (P = 0·03), with a trend for reduced intercellular cell adhesion molecule(ICAM)-1 (P = 0·09) (i.e. atherogenic markers). CONCLUSION Modest changes in diet and physical activity result in limb-specific improvements in vascular shear profiles and reduced systemic markers of atherosclerotic risk in MetSyn patients. These data provide novel physiologic insight into adaptations that may limit the progression of atherosclerosis in patients with MetSyn.
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Affiliation(s)
- Jacqueline K Limberg
- Department of Kinesiology, School of Education, University of Wisconsin - Madison, Madison, WI, USA
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Venditti EM, Kramer MK. Diabetes Prevention Program community outreach: perspectives on lifestyle training and translation. Am J Prev Med 2013; 44:S339-45. [PMID: 23498296 PMCID: PMC3609413 DOI: 10.1016/j.amepre.2012.12.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 10/19/2012] [Accepted: 12/11/2012] [Indexed: 12/31/2022]
Abstract
The gap between what is known from clinical efficacy research and the systematic community translation of diabetes prevention programs is narrowing. During the past 5 years, numerous randomized and nonrandomized dissemination studies have evaluated the modified delivery of structured Diabetes Prevention Program (DPP) interventions in diverse real-world settings. Programs of sufficient dose and duration, implemented with fidelity, have reported weight losses in the range of 4%-7% with associated improvements in cardiometabolic risk factors at 6 and 12 months from baseline. The current article describes some of the experiences and perspectives of a team of University of Pittsburgh researchers as they have engaged in these efforts.
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Affiliation(s)
- Elizabeth M Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Earnest CP, Artero EG, Sui X, Lee DC, Church TS, Blair SN. Maximal estimated cardiorespiratory fitness, cardiometabolic risk factors, and metabolic syndrome in the aerobics center longitudinal study. Mayo Clin Proc 2013; 88:259-70. [PMID: 23391253 PMCID: PMC3622904 DOI: 10.1016/j.mayocp.2012.11.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/06/2012] [Accepted: 11/08/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the relationship between estimated maximal cardiorespiratory fitness (CRF) and metabolic syndrome (MetSyn). PATIENTS AND METHODS We performed a cross-sectional analysis of 38,659 Aerobics Center Longitudinal Study participants seen between January 1, 1979, and December 31, 2006, to examine CRF levels defined as low (lower 20%), moderate (middle 40%), and high (upper 40%) of age- and sex-specific distributions vs National Cholesterol Education Program-derived MetSyn expressed as a summed z-score continuous variable. We used a general linear model for continuous variables, the χ(2) test for distribution of categorical variables, and multiple linear regression for single and cumulative MetSyn scores adjusted for body mass index, smoking status, alcohol intake, and family history of cardiovascular disease. RESULTS We observed significant inverse trends for MetSyn vs CRF in both sexes (P for trend <.001). The CRF associations vs individual components were as follows: waist circumference-men: β=-.14, r(2)=0.78; women: β=-.04, r(2)=0.71; triglycerides-men: β=-.29, r(2)=0.18; women: β=-.17, r(2)=0.18; high-density lipoprotein cholesterol-men: β=.25, r(2)=0.17; women: β=.08, r(2)=0.19; fasting glucose-men: β=-.09, r(2)=0.09; women: β=.09, r(2)=0.01; systolic blood pressure-men: β=-.09, r(2)=0.09; women: β=-.01, r(2)=0.21; and diastolic blood pressure-men: β=-.07, r(2)=0.12; women: β=-.05, r(2)=0.14. All associations except for systolic blood pressure (both sexes) and glucose (women) are significant (P<.001). CONCLUSION Cardiorespiratory fitness demonstrated a strong inverse relationship with MetSyn in both sexes, with the strongest single associative component being waist circumference.
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Affiliation(s)
- Conrad P Earnest
- Department for Health Sport, Health, and Exercise Science, University of Bath, Bath, United Kingdom.
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Yank V, Stafford RS, Rosas LG, Ma J. Baseline reach and adoption characteristics in a randomized controlled trial of two weight loss interventions translated into primary care: a structured report of real-world applicability. Contemp Clin Trials 2012; 34:126-35. [PMID: 23124047 DOI: 10.1016/j.cct.2012.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although the Diabetes Prevention Program (DPP) lifestyle intervention reduced type 2 diabetes incidence by 58% among high-risk adults at academic centers, it requires translation into typical primary care settings. Using baseline data from the Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE) randomized controlled trial, we evaluated the potential of its two DPP-based interventions to reach their target populations and be adopted into routine use. METHODS Overweight/obese adults with increased cardiometabolic risk enrolled from one primary care clinic. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model, we assessed reach with data on patient identification, participation, and representativeness, and adoption with data on intervention feasibility and potential for organizational diffusion. RESULTS The target population was identified by searching electronic health records. Contact was attempted for 2391 patients who completed initial screening by phone (56% uptake) or online (44%). Most (88%) of those screened ineligible were not within the target population; 12% were excluded because of research requirements. Conservatively estimated participation rate was 44%. Participants (n=241) included 54% men and had a mean (SD) age of 52.9 years (10.6) and body mass index of 32 kg/m(2) (5.4). Regarding adoption, all clinic physicians agreed to participate. The feasibility of intervention implementation and dissemination was enhanced by leveraging existing intervention, training, and primary care resources. CONCLUSIONS E-LITE's lifestyle interventions had fair-to-good potential for primary care reach and adoption. Our trial evidence and structured reporting may inform real-world implementation of translational trials by health networks, physicians, and payers.
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Affiliation(s)
- Veronica Yank
- Division of General Medical Disciplines, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Road, Mail Code 5411, Stanford, CA 94305-5411, USA.
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Kanaya AM, Santoyo-Olsson J, Gregorich S, Grossman M, Moore T, Stewart AL. The Live Well, Be Well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults. Am J Public Health 2012; 102:1551-8. [PMID: 22698027 DOI: 10.2105/ajph.2011.300456] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated a community-based, translational lifestyle program to reduce diabetes risk in lower-socioeconomic status (SES) and ethnic minority adults. METHODS Through an academic-public health department partnership, community-dwelling adults at risk for diabetes were randomly assigned to individualized lifestyle counseling delivered primarily via telephone by health department counselors or a wait-list control group. Primary outcomes (6 and 12 months) were fasting glucose level, triglycerides, high- and low-density lipoprotein cholesterol, weight, waist circumference, and systolic blood pressure. Secondary outcomes included diet, physical activity, and health-related quality of life. RESULTS Of the 230 participants, study retention was 92%. The 6-month group differences for weight and triglycerides were significant. The intervention group lost 2 pounds more than did the control group (P=.03) and had decreased triglyceride levels (difference in change, 23 mg/dL; P=.02). At 6 months, the intervention group consumed 7.7 fewer grams per day of fat (P=.05) and more fruits and vegetables (P=.02) than did control participants. CONCLUSIONS Despite challenges designing effective translational interventions for lower-SES and minority communities, this program modestly improved some diabetes risk factors. Thus, individualized, telephone-based models may be a promising alternative to group-based interventions.
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Affiliation(s)
- Alka M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA 94115, USA.
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Abstract
Several efficacy trials and subsequent dissemination studies indicate that behavioral lifestyle interventions for diabetes risk reduction require, at a minimum, provision of 4 to 6 months of frequent intervention contact to induce clinically meaningful weight losses of at least 5% of initial body weight. Weekly contact during the first several months of intervention, followed by less frequent but regular therapeutic contact for a longer time period, appears necessary for participants to adopt and enact behavioral self-regulatory skills such as the self-monitoring of diet, weight, and physical activity and the problem solving of common physical, social, and cognitive barriers that impede sustained weight loss. In-person contact is associated with the largest effect sizes but may not be a necessary component for clinically meaningful weight loss. Regardless of intervention mode, setting, or provider, the interactive process of feedback and social support is crucial for skill development and sustained weight loss.
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Affiliation(s)
- Elizabeth M Venditti
- Diabetes Prevention Program Outcomes Study, Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Colberg SR. Physical activity: the forgotten tool for type 2 diabetes management. Front Endocrinol (Lausanne) 2012; 3:70. [PMID: 22649427 PMCID: PMC3355983 DOI: 10.3389/fendo.2012.00070] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/02/2012] [Indexed: 11/13/2022] Open
Abstract
Individuals who are currently sedentary, unfit, or overweight can benefit metabolically from simply taking breaks from sitting. Since avoidance of sedentary behavior appears to have a large impact on glycemic management, all individuals with type 2 diabetes should be encouraged to minimally engage in greater daily movement to better manage their diabetes and body weight. In addition, engaging in physical activity of any intensity (including low-intensity ones) likely positively impacts insulin action and blood glucose control acutely. Moreover, as long as total caloric expenditure during exercise is matched (i.e., total exercise dose), daily exercise may be done every other day instead with the same glycemic results, although at least 150 min of weekly physical activity is recommended. Both aerobic and resistance training are important for individuals with diabetes, and ideally a program that combines the two types of training should be undertaken to achieve maximal glycemic and other benefits. Once individuals have successfully implemented more daily movement into their lifestyle, they will be more likely to participate in structured forms of physical activity to gain additional benefits. All clinicians working with individuals with either type 2 diabetes or prediabetes should consider incorporating these suggestions into care plans to improve their patients' glycemic management.
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Affiliation(s)
- Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA.
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West DS, Bursac Z, Cornell CE, Felix HC, Fausett JK, Krukowski RA, Lensing S, Love SJ, Prewitt TE, Beck C. Lay health educators translate a weight-loss intervention in senior centers: a randomized controlled trial. Am J Prev Med 2011; 41:385-91. [PMID: 21961465 PMCID: PMC6737925 DOI: 10.1016/j.amepre.2011.06.041] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 04/19/2011] [Accepted: 06/09/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Older adults have high obesity rates and respond well to evidence-based weight-loss programs, such as the Diabetes Prevention Program (DPP) Lifestyle intervention. The goal of this study was to determine whether a translation of the DPP Lifestyle program delivered by lay health educators and conducted in senior centers is effective in promoting weight loss among older adults. DESIGN An RCT with older adults nested within senior centers. Senior centers identified lay health educators to receive training and deliver the intervention program at the senior center. Senior centers were randomized to DPP Lifestyle program or an attention control intervention (cognitive training). SETTING/PARTICIPANTS Senior centers (N=15) located throughout Arkansas. Participants (N=228) were obese (BMI=34.5±4.9) older (aged 71.2±6.6 years) adults able to engage in moderate exercise. Follow-up data were collected at 4 months on 93% of the original cohort between February 2009 and July 2010. INTERVENTIONS A 12-session translation of the Diabetes Prevention Program Lifestyle behavioral weight-control program delivered in group sessions by trained lay health educators. MAIN OUTCOME MEASURES Body weight was assessed by digital scale. Percentage weight loss from baseline and proportion achieving ≥5% and ≥7% weight loss were examined. Analyses were completed in March 2011. RESULTS Participants attending senior centers randomized to Lifestyle lost a significantly greater percentage of baseline weight (3.8%, 95% CI=2.9%, 4.6%) than those in the control senior centers (0.2%, 95% CI= -0.6%, -0.9%) after adjusting for baseline BMI and gender (p<0.001). Among participants attending senior centers offering the Lifestyle program, 38% lost ≥5% of baseline weight compared with 5% in the control arm (p<0.001). Similarly, significantly more participants (24%) in Lifestyle senior centers lost ≥7% than did control participants (3%, p=0.001). CONCLUSIONS A behavioral lifestyle weight-loss intervention delivered by a lay health educator offers a promising vehicle for translation of evidence-based obesity treatment programs in underserved areas. TRIAL REGISTRATION This study is registered at Clinicaltrials.govNCT01377506.
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Affiliation(s)
- Delia Smith West
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA.
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Whittemore R. A systematic review of the translational research on the Diabetes Prevention Program. Transl Behav Med 2011; 1:480-91. [PMID: 24073067 PMCID: PMC3717627 DOI: 10.1007/s13142-011-0062-y] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
International clinical trials have demonstrated compelling evidence on the prevention or delay of type 2 diabetes (T2D) by lifestyle change programs. Numerous studies have translated the Diabetes Prevention Program (DPP) protocol to "real-world" settings. The purpose of this paper is to review the translational research of the DPP protocol in adults at-risk for T2D. This study is a systematic review based on the guidelines from the Cochrane Handbook for Systematic Reviews. There were 16 studies that translated the DPP protocol in four distinct settings: (a) hospital outpatient, (b) primary care, (c) community, and (d) work and church. Settings varied considerably in terms of reach, efficacy, adoption, implementation, and maintenance. There were strengths and limitations to each setting. Better understanding of program adaptation and mediators and moderators to program efficacy are indicated. Future research also needs to continue to explore mechanisms to improve access and long-term outcomes.
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Affiliation(s)
- Robin Whittemore
- Yale School of Nursing, 100 Church Street South, New Haven, CT 06536 USA
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Katula JA, Vitolins MZ, Rosenberger EL, Blackwell CS, Morgan TM, Lawlor MS, Goff DC. One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) Project. Diabetes Care 2011; 34:1451-7. [PMID: 21593290 PMCID: PMC3120203 DOI: 10.2337/dc10-2115] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although the Diabetes Prevention Program (DPP) and the Finnish Diabetes Prevention Study (FDPS) demonstrated that weight loss from lifestyle change reduces type 2 diabetes incidence in patients with prediabetes, the translation into community settings has been difficult. The objective of this study is to report the first-year results of a community-based translation of the DPP lifestyle weight loss (LWL) intervention on fasting glucose, insulin resistance, and adiposity. RESEARCH DESIGN AND METHODS We randomly assigned 301 overweight and obese volunteers (BMI 25-40 kg/m(2)) with fasting blood glucose values between 95 and 125 mg/dL to a group-based translation of the DPP LWL intervention administered through a diabetes education program (DEP) and delivered by community health workers (CHWs) or to an enhanced usual-care condition. CHWs were volunteers with well-controlled type 2 diabetes. A total of 42.5% of participants were male, mean age was 57.9 years, 26% were of a race/ethnicity other than white, and 80% reported having an education beyond high school. The primary outcome is mean fasting glucose over 12 months of follow-up, adjusting for baseline glucose. RESULTS Compared with usual-care participants, LWL intervention participants experienced significantly greater decreases in blood glucose (-4.3 vs. -0.4 mg/dL; P<0.001), insulin (-6.5 vs. -2.7 μU/mL; P<0.001), homeostasis model assessment of insulin resistance (-1.9 vs. -0.8; P<0.001), weight (-7.1 vs. -1.4 kg; P<0.001), BMI (-2.1 vs. -0.3 kg/m2; P<0.001), and waist circumference (-5.9 vs. -0.8 cm; P<0.001). CONCLUSIONS This translation of the DPP intervention conducted in community settings, administered through a DEP, and delivered by CHWs holds great promise for the prevention of diabetes by significantly decreasing glucose, insulin, and adiposity.
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Affiliation(s)
- Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA.
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Blackwell CS, Foster KA, Isom S, Katula JA, Vitolins MZ, Rosenberger EL, Goff DC. Healthy Living Partnerships to Prevent Diabetes: recruitment and baseline characteristics. Contemp Clin Trials 2010; 32:40-9. [PMID: 20974289 DOI: 10.1016/j.cct.2010.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/08/2010] [Accepted: 10/15/2010] [Indexed: 11/15/2022]
Abstract
Healthy Living Partnerships to Prevent Diabetes (HELP PD) is a randomized controlled trial designed to translate the Diabetes Prevention Program (DPP) lifestyle intervention into a community setting using community health workers engaged through an existing Diabetes Care Center (DCC). Overweight and obese (BMI 25-40 kg/m²) individuals with pre-diabetes (fasting blood glucose 95-125 mg/dl) with no medical contraindications to participate in a lifestyle intervention were recruited for participation in this study. Standard recruitment strategies were employed, including mass mailing, direct provider referral, and community events. Participant recruitment and randomization for this trial began in 2007 and was concluded in 2009. 1818 screenings were conducted; of these, 326 (17.9%) qualified and 301 (16.6%) participants were randomized over a 21 month period. 23.8% of potential participants were excluded during the initial telephone screening, primarily for BMI and recent history of CVD. The majority of participants (220, 73.1%) reported mass mailing as their primary source of information about the study. Mass mailing was more effective with participants who identified themselves as white when compared to African-Americans. The cost of recruitment per randomized participant was $816, which includes direct costs and staff effort. 41% of the randomized participants were male and approximately 27% reported a race or ethnicity other than white. In comparison to the DPP study cohort, the HELP PD population is older, more educated and predominately white. These differences, reflecting in part the community in which HELP PD was conducted, may have implications for retention and adherence in the lifestyle intervention group.
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Affiliation(s)
- Caroline S Blackwell
- Wake Forest University School of Medicine, Division of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Brown BD, Harris KJ, Harris JL, Parker M, Ricci C, Noonan C. Translating the diabetes prevention program for Northern Plains Indian youth through community-based participatory research methods. DIABETES EDUCATOR 2010; 36:924-35. [PMID: 20944056 DOI: 10.1177/0145721710382582] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to use a community-based participatory research (CBPR) approach to translate the original Diabetes Prevention Program (DPP) to be age and culturally specific for American Indian (AI) youth. METHODS Tribally enrolled members on 2 Montana Indian reservations conducted focus groups and interviews to discuss community members' perspectives of factors that encouraged or were barriers to healthy diet and exercise behaviors in AI youth. In total, 31 community members, aged 10 to 68 years old, participated in 4 focus groups and 14 individual interviews. Participants were self-identified as elder, cultural expert, tribal health worker, educator, parent/guardian, youth, or school food service worker. Researchers analyzed transcripts based on inductive methods of grounded theory. RESULTS Data analysis revealed translating the DPP to youth was contingent on the lessons incorporating cultural strategies for healthy behaviors in youth such as berry picking, gardening, horseback riding, and dancing; improving knowledge and access to healthy foods and physical activity for youth and their parents; having interactive, hands-on learning activities for healthy lifestyles in the DPP lessons; using a group format and tribal members to deliver the DPP lessons; and having tribal elders talk to youth about the importance of adopting healthy behaviors when they are young. CONCLUSIONS A CBPR approach engaged community members to identify strategies inherent in their culture, tradition, and environment that could effectively translate the DPP to Montana Indian youth living in rural reservation communities.
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Affiliation(s)
- Blakely D Brown
- The Department of Health and Human Performance (Dr Brown, Ms Ricci)
| | - Kari Jo Harris
- School of Public Health and Community Health Sciences (Dr K. J. Harris)
| | - Jeri Lyn Harris
- University of Montana, Missoula; Crow Tribal Health Diabetes Program, Crow Agency, Montana (Ms J. L. Harris)
| | - Martin Parker
- Rocky Boy Tribal Health, Box Elder, Montana (Mr Parker)
| | - Christiana Ricci
- The Department of Health and Human Performance (Dr Brown, Ms Ricci)
| | - Curtis Noonan
- Center for Environmental Health Sciences (Dr Noonan)
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Parikh P, Simon EP, Fei K, Looker H, Goytia C, Horowitz CR. Results of a pilot diabetes prevention intervention in East Harlem, New York City: Project HEED. Am J Public Health 2010; 100 Suppl 1:S232-9. [PMID: 20147680 DOI: 10.2105/ajph.2009.170910] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Our community-academic partnership employed community-based participatory research to develop and pilot a simple, peer-led intervention to promote weight loss, which can prevent diabetes and eliminate racial/ethnic disparities in incident diabetes among overweight adults with prediabetes. METHODS We recruited overweight adults at community sites, performed oral glucose tolerance testing to identify persons with blood glucose levels in the prediabetes range, and randomized eligible people to a peer-led lifestyle intervention group or delayed intervention in 1 year. Outcomes, including weight, blood pressure, and health behaviors, were measured at baseline and 3, 6, and 12 months. RESULTS More than half of those tested (56%, or 99 of 178) had prediabetes and enrolled in the study. Participants were predominantly Spanish-speaking, low-income, undereducated women. The intervention group lost significantly more weight than the control group and maintained weight loss at 12 months (7.2 versus 2.4 pounds; P < .01). One fourth (24 of 99) of participants progressed to diabetes. CONCLUSIONS In underserved minority communities, prediabetes prevalence may be higher than previously reported. Low-cost, community-based interventions can succeed in encouraging weight loss to prevent diabetes.
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Affiliation(s)
- Punam Parikh
- Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY 10029, USA
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Dunn AL. The Effectiveness of Lifestyle Physical Activity Interventions to Reduce Cardiovascular Disease. Am J Lifestyle Med 2009; 3:11S-18S. [PMID: 20161356 PMCID: PMC2777660 DOI: 10.1177/1559827609336067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lifestyle interventions have evolved from proof of concept pilot studies to efficacy and effectiveness studies and have now moved toward translation and dissemination studies because of their demonstrated ability to improve cardiovascular diseases (CVD) outcomes including blood pressure. When combined with diet, they also have demonstrated the ability to normalize blood glucose and help to regulate weight. This review highlights the converging lines of evidence that led to lifestyle physical activity interventions beginning with early epidemiology studies and provides evidence for the efficacy and effectiveness of lifestyle interventions. However, if lifestyle interventions are to play a role in preventing CVD and improving CVD outcomes, their use must be more widespread. This will require translational and dissemination research in order to understand how to move into real world settings. Successful examples of translational studies will be highlighted and issues related to theoretical and practical issues as well as capacity building will be discussed. Building bridges between research and practice must be done if lifestyle interventions are to deliver on their public health promise.
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Affiliation(s)
- Andrea L Dunn
- Klein Buendel, Inc., 1667 Cole Blvd, Suite 225, Golden, Colorado 80401 , 3030-56504342
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Delahanty LM, Nathan DM. Implications of the diabetes prevention program and Look AHEAD clinical trials for lifestyle interventions. ACTA ACUST UNITED AC 2008; 108:S66-72. [PMID: 18358260 DOI: 10.1016/j.jada.2008.01.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 10/19/2007] [Indexed: 12/31/2022]
Abstract
The Diabetes Prevention Program (DPP) and Look AHEAD (Action for Health in Diabetes) trials are long-term randomized clinical trials that have the potential to direct diabetes care and medical nutrition therapy for obesity, prediabetes, and type 2 diabetes both now and in the future. This article summarizes and compares the important evidence-based results of these diabetes and obesity clinical trials and reviews the similarities and differences in lifestyle interventions that were designed for these trials. Although there were many similarities in the features of the DPP and Look AHEAD interventions, the Look AHEAD lifestyle intervention was more ambitious in several ways: higher individual weight-loss goals, lower calorie and fat-gram targets based on initial body weight, more intensive intervention frequency, combining closed group and individual session format, and use of more structured nutrition intervention strategies from the outset, including meal replacements, structured menus, and combined fat and calorie counting. Evidence, knowledge, and insights gained from working on these clinical trials will be very important in determining the strategies, methods, and approaches needed to make sure that the results of these trials will be fully applied in real-world practice settings for obesity, prediabetes, and type 2 diabetes.
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Affiliation(s)
- Linda M Delahanty
- MGH Diabetes Center, Massachusetts General Hospital, Boston, MA 02114, USA
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