Insulin-Associated Weight Gain in Type 2 Diabetes Is Associated With Increases in Sedentary Behavior

Brain glucose hypometabolism and hippocampal inflammation in Goto-Kakizaki rats

Brain glucose hypometabolism and neuroinflammation are early pathogenic manifestations in neurological disorders. Neuroinflammation may also disrupt leptin signaling, an adipokine that centrally regulates appetite and energy balance by acting on the hypothalamus and exerting neuroprotection in the hippocampus. The Goto-Kakizaki (GK) rat is a non-obese type 2 diabetes mellitus (T2DM) animal model used to investigate diabetes-associated molecular mechanisms without obesity jeopardizing effects. Wistar and GK rats received the maintenance adult rodent diet. Also, an additional control group of Wistar rats received a high-fat and high-sugar diet (HFHS) provided by free consumption of condensed milk. All diets and water were provided ad libitum for eight weeks. Brain glucose uptake was evaluated by 2-deoxy-2-[fluorine-18] fluoro-D-glucose under basal (saline administration) or stimulated (CL316,243, a selective β3-AR agonist) conditions. The animals were fasted for 10-12 h, anesthetized, and euthanized. The brain was quickly dissected, and the hippocampal area was sectioned and stored at -80°C in different tubes for protein and RNA analyses on the same animal. GK rats exhibited attenuated brain glucose uptake compared to Wistar animals and the HFHS group under basal conditions. Also, the hippocampus of GK rats displayed upregulated leptin receptor, IL-1β, and IL-6 gene expression and IL-1β and the subunit of the transcription factor NF-κB (p-p65) protein expression. No significant alterations were detected in the hippocampus of HFHS rats. Our data indicated that a genetic predisposition to T2DM has significant brain deteriorating features, including brain glucose hypometabolism, neuroinflammation, and leptin signaling disruption in the hippocampal area.

Assessment and Management of Obesity and Self-Maintenance (AMOS): An Evaluation of a Rural, Regional Multidisciplinary Program

Obesity is common in rural areas, and reduced specialist healthcare access impedes its management. A pilot nurse-practitioner-led Assessment and Management of Obesity and Self-Maintenance (AMOS) Clinic focused on individualised obesity care in people living with type 2 diabetes delivered in a rural setting. This study aimed to explore participant and staff experiences of the multidisciplinary obesity clinic to identify barriers and facilitators to self-care, health, and well-being. A two-stage, mixed-method design was used. Initially, three focus groups involving a sample of AMOS participants and semi-structured staff interviews helped identify key barriers/facilitators. These findings informed a survey delivered to all AMOS participants. Qualitative data were analysed using an inductive two-step thematic networks technique to identify themes. Quantitative data were summarised using descriptive statistics. A total of 54 AMOS participants and 4 staff participated in the study. Four themes were identified to describe AMOS participant experiences': 1. affordability; 2. multidisciplinary care; 3. person-centred care; and 4. motivation. Specialised, multidisciplinary and individualised obesity care available through one clinic facilitated self-care and improved health and well-being. Dedicated multidisciplinary obesity clinics are recommended in rural and remote areas.

Course of body weight before and after the initiation of insulin therapy in type 2 diabetes mellitus: Retrospective inception cohort study (ZODIAC 58)

Aims

The aim of this study was to explore the effect of insulin treatment initiation on weight by taking weight change prior to initiation into account.

Materials and methods

We performed an observational retrospective inception cohort study, concerning Dutch primary care. We identified all patients that initiated insulin treatment (n = 7967) and individually matched patients with a reference patient (n = 5213 pairs). We obtained estimated mean weight changes in the five years prior to five years post insulin therapy. We applied linear regression analysis on weight change in the first year after insulin therapy (T0 to T+1), with matched group as primary determinant adjusted for pre-insulin weight change and additional covariates.

Results

Estimated mean weight increased in the five consecutive years prior to insulin therapy (-0.23 kg in year T-5 to T-4, 0.01 kg in year T-4 to T-3, 0.07 kg in year T-3 to T-2, 0.24 kg in year T-2 to T-1, and 0.46 kg in year T-1 to T0) and continued to increase in the first year after, that is T0 to T+1, at a slightly lower rate (0.31 ± 3.9 kg). Pre-insulin weight change had the highest explained variance and was inversely and independently associated with weight change (p < .001). Starting insulin was associated with weight increase, independent of pre-insulin weight change (β-adjusted 1.228, p < .001). Stratification revealed that despite having a more or less similar baseline BMI, patients with substantial weight increase showed higher estimated mean BMI's followed by weight loss pre-insulin. In matched references, estimated mean weight changes were negative in all years concerning the study period, indicating consistent weight loss.

Conclusions

Initiation of insulin therapy was independently associated with weight increase; however, overall effect on weight was small and subject to substantial variation. Pre-insulin weight change is identified as a relatively strong inverse determinant of weight change after insulin initiation.

The impact of social distancing and self-isolation in the last corona COVID-19 outbreak on the body weight in Sulaimani governorate- Kurdistan/Iraq, a prospective case series study

BACKGROUND

Our area, corona (COVID-19) quarantine was applied from March 14 to April 23, 2020. It was in all forms, including curfew, social distancing, self-quarantine, area quarantine, self-monitoring, and isolation. Due to their concerns about their safety and families, friends, colleagues, and society, everybody was feeling upset, fearful, and anxious. Several studies have reported an association between prolonged sitting time and weight gain. As a way to relieve the tension during that period, people started stocking up on unhealthy foods like over-salted snacks and over-sweetened sugars. People stayed at home, feeling bored, anxious, and stressed and sought relief by eating. Also, there was a rise in emotional eating when the stress of isolation increased by the closure of gyms, casinos, and movie theaters. Moreover, restaurants were allowed to serve the only takeout. Besides, unemployment was skyrocketing, hospitals were overflowing (or were preparing for the possibility), many people were struggling to meet their basic needs, and no one knows when or how it would end.

OBJECTIVE

The study aimed to figure out whether social isolation during the COVID-19 quarantine is consistent and associated with emotional eating and gaining weight or not.

METHODS

A prospective cross-sectional case series study was conducted on 765 patients who have visited the bariatric clinic in Sulaimani city, Kurdistan-Iraq, from April 23 to June 23, 2020. An individual face-to-face interview was conducted with each participant to obtain signed informed consent, provide them with information about the type and the subject of the work, and ask them the study's questions. Each interview lasted between 30 and 45 min and was conducted in a closed session by two Kurdistan Board trainees.

RESULTS

No patient who was quarantined for the COVID-19 was included in the work, but all other patients were included. The selected patients were those who had undergone social distancing (n = 568, 82.48%) by the local law and did self-isolation (n = 134, 17.51%) at home for reasons like having comorbidity, being prone to contamination due to their jobs (health, police, and media workers), having some family members at home with comorbidity (n = 23, 03.00%), and having comorbidity and having undergone social distancing because of their other family members' need to do so for their physical disability (n = 25, 03.27%). Almost all patients (n = 741, 96.86%), even, those with comorbidity (n = 136, 17.78%), were emotionally stable before the outbreak. Seventy-three female patients (09.54%) and138 males (20.65%) sustain their weight during and two months after the outbreak, while the rest (n = 554, 72.41%) gained different amounts of weight.

CONCLUSION

Social distancing and self-isolation in the last COVID-19 outbreak influenced weight gain, but weight gain of less than 2 kg was observed among almost all patients who gained weight (98.05%). The patients who were gain more than 3 kg were mostly females or/and from the center of large cities.