Obesity and type 2 diabetes mellitus

Sacred Sharing Circles: Urban Indigenous Experience with Bariatric Surgery in Manitoba

INTRODUCTION

Obesity and type 2 diabetes (T2DM) are growing global health concerns. A disproportionate number of Indigenous Peoples live with obesity and its complications. Bariatric surgery offers superior weight loss and comorbidity resolution when compared to medical management. There is a paucity of literature regarding the experiences of Indigenous Peoples undergoing bariatric surgery. The aim of this study was to employ two-eyed seeing and a decolonizing approach to explore the experiences of urban Indigenous bariatric surgery patients.

METHODS

An Indigenous Advisory Committee guided the conception and design of the study. Four urban Indigenous bariatric surgery patients with T2DM participated in two sequential sharing circles and individual interviews facilitated by an Elder. Audio transcripts were analyzed for emerging themes using inductive thematic analysis.

RESULTS

Themes generated from shared participant experiences and knowledge included the following: (1) Experiencing hardship or challenges; (2) Reflecting on the importance of supports; (3) Understanding relationships with food; and (4) Healing and recovery. Overall, the participants described a generally positive experience with the bariatric pathway. Participants also described varied connectedness to their Indigenous identity but uniformly expressed interest in more culturally diverse supports such as sharing circles, access to an elder, and Indigenous peer mentorship.

CONCLUSIONS

Indigenous Peoples have strong motivators for pursuing bariatric surgery and desire access to culturally relevant supports. Suggestions for program improvement included offering sharing circles, providing access to an elder, and Indigenous peer mentorship. This study is the first to qualitatively explore the bariatric surgery experiences of Indigenous Peoples in Canada.

Experiences and Outcomes of Indigenous Patients Undergoing Bariatric Surgery: a Mixed-Method Scoping Review

Obesity and type 2 diabetes (T2D) are growing global health concerns. Evidence suggests that Indigenous peoples are at higher lifetime risk of obesity and its associated conditions. Obesity increases the risk of T2D, cardiovascular disease, and all-cause mortality. Bariatric surgery is the most sustained and effective intervention for treating obesity-associated medical problems. This review aims to explore the experiences and outcomes of Indigenous peoples undergoing bariatric surgery in Canada, the USA, Australia, and New Zealand (CANZUS). Analysis of quantitative data revealed that Indigenous patients had fewer bariatric procedures, poorer clinic attendance, similar weight loss outcomes and slightly higher post-operative complication rates. Qualitative data analysis revealed that Indigenous patients living with obesity have a desire to improve their health and quality of life.

Relationship Between Cardiometabolic Index and Insulin Resistance in Patients with Type 2 Diabetes

Purpose

Cardiometabolic index (CMI) has been suggested as innovative measures for assessing the cardiometabolic status. However, there is a lack of relevant studies on exploring the relationship between CMI and insulin resistance (IR). Consequently, this study aims to examine the relationship between CMI and IR in subjects with type 2 diabetes mellitus (T2DM).

Patients and Methods

A cross-sectional study was performed on 2493 patients with T2DM (including 1505 males and 988 females). IR was measured through the homeostatic model assessment of insulin resistance (HOMA-IR), which was defined as HOMI-IR≥2.69. The relationship between CMI and IR was evaluated with Spearman's correlation, ROC analysis, multiple logistic regression, generalized smooth curve fitting and subgroup analysis.

Results

CMI was correlated with HOMA-IR in patients with T2DM (Spearman correlation coefficient = 0.391 in females and 0.346 in males, P<0.001). Through the multiple logistic regression analysis, CMI was significantly correlated with IR (OR=1.30, 95% CI=1.15-1.47 in males and OR=1.62, 95% CI=1.32-1.99 in females). In addition, a non-linear correlation between CMI and IR risk was identified. The AUC of CMI (AUC = 0.702 for males and 0.733 for females, all p < 0.01) was the largest compared with traditional indexes of adiposity and blood lipids. According to the subgroup analysis, the two had a more significantly positive correlation in females, the elderly and subjects with HbA1c < 7%.

Conclusion

In patients with T2DM, elevated CMI is significantly correlated with IR, as a useful index of IR.

The nonlinear correlation between the cardiometabolic index and the risk of diabetes: A retrospective Japanese cohort study

BACKGROUND

The cardiometabolic index (CMI) has been proposed as a novel indicator of cardiometabolic status. However, evidence on the relationship between CMI and diabetes mellitus (DM) risk was limited. Our study aimed to explore the relationship between CMI and DM risk among a large cohort of Japanese adults.

METHODS

This retrospective cohort study recruited 15453 Japanese adults without diabetes at baseline who underwent physical examinations at the Murakami Memorial Hospital between 2004 and 2015. Cox proportional-hazards regression was applied to evaluate the independent relationship between CMI and diabetes. Our study performed a generalized smooth curve fitting (penalized spline technique) and an additive model (GAM) to determine the non-linear relationship between CMI and DM risk. In addition, a set of sensitivity analyses and subgroup analyses were employed to evaluate the relationship between CMI and incident DM.

RESULTS

After adjusting for confounding covariates, CMI was positively related to the DM risk in Japanese adults (HR: 1.65, 95%CI: 1.43-1.90, P<0.0001). A series of sensitivity analyses were also employed in this study to guarantee the reliability of the findings. In addition, our study discovered a non-linear association between CMI and diabetes risk. CMI's inflection point was 1.01. A strong positive association between CMI and diabetes incidence was also discovered to the left of the inflection point (HR: 2.96, 95%CI: 1.96-4.46, P<<0.0001). However, their association was not significant when CMI was higher than 1.01 (HR: 1.27, 95%CI: 0.98-1.64, P=0.0702). Interaction analysis showed that gender, BMI, habit of exercise, and smoking status interacted with CMI.

CONCLUSION

Increased CMI level at baseline is associated with incident DM. The association between CMI and incident DM is also non-linear. A high CMI level is associated with an increased risk for DM when CMI is below 1.01.

The multifaceted role of cytochrome P450-Derived arachidonic acid metabolites in diabetes and diabetic cardiomyopathy

Understanding lipid metabolism is a critical key to understanding the pathogenesis of Diabetes Mellitus (DM). It is known that 60-90% of DM patients are obese or used to be obese. The incidence of obesity is rising owing to the modern sedentary lifestyle that leads to insulin resistance and increased levels of free fatty acids, predisposing tissues to utilize more lipids with less glucose uptake. However, the exact mechanism is not yet fully elucidated. Diabetic cardiomyopathy seems to be associated with these alterations in lipid metabolism. Arachidonic acid (AA) is an important fatty acid that is metabolized to several bioactive compounds by cyclooxygenases, lipoxygenases, and the more recently discovered, cytochrome P450 (P450) enzymes. P450 metabolizes AA to either epoxy-AA (EETs) or hydroxy-AA (HETEs). Studies showed that EETs could have cardioprotective effects and beneficial effects in reversing abnormalities in glucose and insulin homeostasis. Conversely, HETEs, most importantly 12-HETE and 20-HETE, were found to interfere with normal glucose and insulin homeostasis and thus, might be involved in diabetic cardiomyopathy. In this review, we highlight the role of P450-derived AA metabolites in the context of DM and diabetic cardiomyopathy and their potential use as a target for developing new treatments for DM and diabetic cardiomyopathy.

Impact of neighbourhood walkability on the onset of multimorbidity: a cohort study

Multimorbidity has become highly prevalent around the globe and been associated with adverse health outcomes and cost of care. The built environment has become an important dimension in response to obesity and associated chronic diseases by addressing population sedentariness and low physical activity.

OBJECTIVE

The aim of the following study was to examine whether there was an increased risk for multimorbidity for those living in less walkable neighbourhoods. It was hypothesised that participants residing in less walkable neighbourhoods would have a higher risk for multimorbidity.

SETTING

City of Toronto and 14 neighbouring regions/municipalities within Ontario, Canada.

PARTICIPANTS

Study participants who had completed the Canadian Community Health Survey between the year 2000 and 2012, between 20 and 64 and 65 and 95 years of age, residing within a neighbourhood captured in the Walkability Index, and who were not multimorbid at the time of interview, were selected.

INTERVENTION

The Walkability Index was the key exposure in the study, which is divided into quintiles (1-least, 5-most walkable neighbourhoods). Participants were retrospectively allocated to one of five quintiles based on their area of residency (at the time of interview) and followed for a maximum of 16 years.

PRIMARY OUTCOME MEASURE

Becoming multimorbid with two chronic conditions.

SECONDARY OUTCOME MEASURE

Becoming multimorbid with three chronic conditions.

RESULTS

Risk for multimorbidity (two chronic conditions) was highest in least compared with most walkable neighbourhoods with an HR of 1.14 (95% CI: 1.02 to 1.28, p=0.0230). While results showed an overall gradient response between decreased walkability and increased risk for multimorbidity, they were not statistically significant across all quintiles or in the older-adult cohort (65-95 years of age).

CONCLUSION

Study results seem to suggest that low neighbourhood walkability may be a risk factor for multimorbidity over time. More studies are needed to examine whether neighbourhood walkability is a potential solution for multimorbidity prevention at the population level.

Prevalent, uncontrolled, and undiagnosed diabetes mellitus among urban adults in Dire Dawa, Eastern Ethiopia: A population-based cross-sectional study

OBJECTIVE

Globally, 8.8% of adults were estimated to have diabetes mellitus, with the low-and middle-income countries sharing the largest burden. However, the research evidence for targeted interventions is lacking in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of diabetes mellitus, disaggregated by the epidemiology of diabetes mellitus morbidity and associated factors among adults in Dire Dawa town, Eastern Ethiopia.

METHODS

Data from a total of 872 randomly sampled adults aged 25-64 years were obtained for analysis using the World Health Organization STEPwise approach to non-communicable disease risk factors surveillance instruments. We estimated the prevalence of diabetes mellitus disaggregated by the previous diabetes mellitus diagnosis status and by the current blood sugar level control status. The bivariable and multivariable binary logistic regression model was used to identify correlates of diabetes mellitus, along with STATA version 14.2 for data management and analysis. All statistical tests were declared significant at p-value < 0.05.

RESULTS

14.9% (95% confidence interval: 12.1, 17.4) of adults aged 25-64 years had diabetes mellitus in the study sample with 58.5% (95% confidence interval: 49.7, 66.7) on diabetes mellitus medication. Among adults currently taking diabetes mellitus medications, 30.3% (95% confidence interval: 19.8, 45.6) had uncontrolled diabetes mellitus. The magnitude of previously undiagnosed diabetes mellitus was 6.2% (95% confidence interval: 4.8, 8.0) in the study sample and 41.5% (95% confidence interval: 33.3, 50.3) among the diabetics. The odds of diabetes mellitus were higher among adults over the age of 55 years (adjusted odds ratio = 2.1, 95% confidence interval: 1.2, 3.6), currently married adults (adjusted odds ratio = 2.3, 95% confidence interval: 1.2, 4.4), and overweight adults (adjusted odds ratio = 1.6, 95% confidence interval: 1.1, 2.1). Adults with primary education (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) and no formal education (adjusted odds ratio = 0.5, 95% confidence interval: 0.2, 0.9) had lower odds of diabetes mellitus.

CONCLUSION

The prevalence of diabetes mellitus among adults was high in Dire Dawa, with a third of the diabetics having poor control of their blood sugar levels and, nearly four in ten were previously undiagnosed. Adults who were overweight, currently married, and those over 55 years need to be targeted for regular diabetes health checkups and community-based screening. Also, a mechanism should be instituted to track a patient's adherence to medications and promote diabetes self-care management.

Decolonising qualitative research to explore the experiences of Manitoba's urban Indigenous population living with type 2 diabetes mellitus, obesity and bariatric surgery

INTRODUCTION

Obesity and type 2 diabetes mellitus (T2DM) are growing global health concerns associated with significant morbidity, mortality and healthcare expenditures. Due to histories of colonisation and contemporary marginalisation, Canada's Indigenous populations are disproportionately burdened by obesity, T2DM and many other chronic illnesses. Culturally appropriate research on experiences and outcomes of Indigenous patients undergoing bariatric surgery in Canada is scarce. This qualitative study protocol will use a decolonising approach guided by an Indigenous Elder to explore the perspectives and experiences of urban Indigenous Manitobans with respect to T2DM, obesity and bariatric surgery. This knowledge will guide the development and implementation of culturally sensitive bariatric care.

METHODS AND ANALYSIS

Sequential sharing circles (SSCs) and semistructured conversational interviews that have been purposefully designed to be culturally relevant with the guidance of an Indigenous Elder and advisory group (IAG) will be carried out in Winnipeg, Manitoba, Canada. Indigenous adults who are obese (body mass index >35 kg/m²), have T2DM and live in an urban centre will be recruited. Three groups will be investigated: (1) those who have had bariatric surgery; (2) those on the wait list for bariatric surgery and (3) those not associated with a bariatric surgery programme. Each group of 10-12 participants will be guided through a semistructured script led by an Indigenous Elder. Elder-facilitated conversational interviews will also be completed following the SSCs. All content will be audio recorded and transcribed. Thematic analysis will be used to identify emerging patterns using a constructive grounded theory approach.

ETHICS AND DISSEMINATION

This study has received ethical approval from the University of Manitoba Health Research Ethics Board. Findings will inform the development and implementation of culturally sensitive programmes at Manitoba's Centre for Metabolic and Bariatric Surgery. Results will be disseminated in peer-reviewed scientific journals, at obesity and Indigenous health conferences, and knowledge sharing ceremonies.

Psychological wellbeing and biochemical modulation in response to weight loss in obese type 2 diabetes patients

BACKGROUND

Obesity in type 2 diabetes patients is a serious health issue by itself; it is also associated with other health problems including psychiatric illnesses. The psychological effects of dieting and weight loss have been a matter of controversy in the field of obesity management.

OBJECTIVE

The aim of this study was to compare the impact of weight loss because of aerobic exercise training and dietary measures on psychological wellbeing and biochemical modulation in obese type 2 diabetes patients.

MATERIAL AND METHODS

One hundred obese type 2 diabetes patients of both sexes participated in this study, and were included into two equal groups. The first group (A) received aerobic exercise training, three sessions per week for three months combined with dietary measures. The second group (B) received no training intervention for three months.

RESULTS

There was a significant decrease in body mass index (BMI), leptin, total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), triglycerides(TG), homeostasis model assessment-insulin resistance- index (HOMA-IR) , beck depression inventory (BDI ) & profile of mood states(POMS) and increase in high density lipoprotein cholesterol (HDL-c) & Rosenberg self-esteem scale (RSES) of group (A) after treatments, but the changes of group (B) were not significant. Moreover, there were significant differences between mean levels of the investigated parameters of group (B) and group (A) at the end of the study.

CONCLUSION

Physical training and dietary measures can be used as methods of choice for psychological wellbeing and biochemical modulation in obese type 2 diabetes patients.

Variations over four decades in body mass index trajectories prior to diagnosis of diabetes mellitus: The Manitoba Follow-up Study, 1948-2007

OBJECTIVE

The aim of the study was to explore the variations in body mass index (BMI) trajectories during the 20 years before diagnosis of type 2 diabetes mellitus (T2DM) over four decades between 1968 and 2007.

METHODS

Longitudinal measurements of BMI from 437 men, all with a diagnosis of T2DM, were used in the analysis. A mixed method approach was used to fit individual patterns of BMI measurements during the 20 years before diagnosis of T2DM.

RESULTS

The mean BMI at diagnosis was 26.7 kg/m2 (95% confidence interval, 26.4-27.1). Compared with men whose condition was diagnosed between 1968 and 1977, for men with a diagnosis between 1978 and 2007 the mean BMI about 10 years before diagnosis significantly increased by 0.92 to 1.54 BMI units. Decades also varied in how long there was a persistent increase in BMI during the 20 years before diagnosis. The rate of change in mean BMI among men whose T2DM was diagnosed in the most recent two decades increased by 8.8% to 22.6% during the 10-year interval before diagnosis, but there was no significant difference among men given a diagnosis between 1978 and 1987. The quadratic trend of BMI prior to diagnosis was also significantly affected by age at diagnosis.

CONCLUSION

The BMI trajectories during the 20 years leading up to T2DM varied by decade of diagnosis. The increase in BMI persisted for much longer among relatively younger men with a diagnosis in more recent decades. Strategies to prevent T2DM, informed by the pattern of BMI trajectories, should be customized to consider a potential age-period effect.