Lifestyle Management: Standards of Medical Care in Diabetes-2019

Coffee intake, plasma caffeine levels, and diabetic microvascular complications: A Mendelian randomization study

BACKGROUND AND AIM

Diabetic microvascular complications pose significant health challenges for individuals. The influence of modifiable lifestyle factors, such as coffee intake, on these complications has not been conclusively determined, highlighting the need for a causality assessment.

METHODS AND RESULTS

Utilizing Mendelian randomization (MR), this study explored the causal links between coffee intake, plasma caffeine levels, and diabetic microvascular complications using data from FinnGen. Single nucleotide polymorphisms associated with coffee intake and plasma caffeine levels were identified through genome-wide association study meta-analyses. The univariable MR analysis indicated a slightly increased risk for diabetic retinopathy (OR 1.006; 95 % CI: 1.002-1.010; P = 0.003) and a suggestively elevated risk for nephropathy (OR 1.011; 95 % CI: 1.001-1.022; P = 0.036) associated with genetically predicted higher coffee intake, while no significant effect on neuropathy was observed. Multivariable MR analysis, adjusted for smoking, revealed a significant protective effect of coffee intake on diabetic retinopathy (OR 0.895; 95 % CI: 0.856-0.936; P = 9.468 × 10-7) and a suggestive reduction in risk for diabetic nephropathy (OR 0.828; 95 % CI: 0.712-0.963; P = 0.014). Higher plasma caffeine levels were also suggestively protective against these complications.

CONCLUSIONS

Our findings suggest that genetically predicted higher coffee intake and plasma caffeine levels are protective for diabetic retinopathy and nephropathy. Further research is necessary to substantiate these findings and to investigate their potential impact on diabetes management strategies.

Validity and reliability of the Turkish version of the type 1 diabetes distress scale

AIMS

This study aimed to examine the psychometric properties of the Turkish version of the Type 1 Diabetes Distress Scale METHODS: This methodological, descriptive, and correlational study was conducted with 292 individuals diagnosed with Type 1 diabetes. Data were collected between January 2024 and August 2024 using the "Information Form for Individuals with Diabetes," the "Type 1 Diabetes Distress Scale," and the "Patient Health Questionnaire." The linguistic validity and content validity of the scale were evaluated, with content validity assessed using the Davis technique. The psychometric properties of the scale were analyzed through exploratory and confirmatory factor analyses, internal consistency reliability, test-retest reliability, and parallel-form reliability.

RESULTS

The Turkish version of the Type 1 Diabetes Distress Scale consists of 21 items and two subdimensions (Factor 1: Concerns About Diabetes Management; Factor 2: Social Diabetes Perception and Pressure). The two-factor structure explained 66 % of the total variance. The overall Cronbach's alpha coefficient for the scale was 0.96. Test-retest reliability analysis revealed a high, positive, and statistically significant correlation (r = 0.995, p < 0.05).

CONCLUSIONS

The questionnaire was demonstrated to be a valid and reliable instrument for evaluating diabetes distress in patients with type 1 diabetes.

Umbrella Review of Systematic Reviews and Meta-Analyses on Consumption of Different Food Groups and Risk of Type 2 Diabetes Mellitus and Metabolic Syndrome

Type 2 diabetes is a major contributor to the burden of chronic diseases globally. Most cases of type 2 diabetes are preventable through healthy lifestyle modifications in diet and physical activity. This systematic umbrella review presents a comprehensive overview of the evidence about the associations between risk of type 2 diabetes and metabolic syndrome with 13 food groups, including refined and whole grains, fruits, vegetables, nuts, legumes, fish and fish products, eggs, dairy/milk, sugar-sweetened beverages, processed meat, and unprocessed red and white meat. We present these relationships in per-serving and with high-versus-low comparisons. After doing a systematic search in MEDLINE, Embase, Web of Science, and Epistemonikos (registered with PROSPERO: CRD42024547606), we screened 5074 references published until May 15, 2024, and included 67 articles. This included 46 meta-analyses on risk of type 2 diabetes with half a million participants, 17 meta-analyses on risk of metabolic syndrome, and 4 meta-analyses on risk of diabetes-related mortality. Based on quality assessments using AMSTAR-2, 25 of the 67 studies were classified as high-quality studies, 8 as moderate, 12 as low, and 22 as critically low quality. Our results showed that a high intake of whole grains was associated with a lower risk of type 2 diabetes (metaevidence: moderate) and metabolic syndrome (metaevidence: low), with a similar tendency also for a high intake of fruits and vegetables (metaevidence: moderate). In contrast, the high intakes of processed meat (metaevidence: high), red meat (metaevidence: moderate), and sugar-sweetened beverages (metaevidence: moderate) were associated with a higher risk of type 2 diabetes. For the other food groups, the associations were generally neutral and not statistically significant. The heterogeneity was high for most food groups except fruits, indicating potential differences within each of the food groups in association with type 2 diabetes.

Influencing factors of oral frailty in elderly patients with type 2 diabetes in China: a cross-sectional study based on the integral model of frailty

OBJECTIVES

This study aimed to investigate the current status and influencing factors of oral frailty in elderly patients with type 2 diabetes mellitus to inform the development of oral management programs in this population.

METHODS

A total of 431 elderly patients with type 2 diabetes mellitus who visited two tertiary public hospitals in Nanchong City from March 2024 to October 2024 were enrolled in this study. The General Information Questionnaire, Oral Frailty Index-8 (OFI-8), Oral Health Assessment Tool (OHAT), Eating Assessment Questionnaire Tool-10 (EAT-10), Perceived Social Support Scale (PSSS), Geriatric Depression Scale (GDS-5), and Geriatric Self Efficacy Scale for Oral Health Scale (GSEOH) were used to investigate and assess the factors related to oral frailty.

RESULTS

The prevalence of oral frailty in elderly patients with type 2 diabetes was 32.95% (142/431). Multivariate logistic regression analysis revealed that advanced age(OR = 1.098, 95% CI: 1.054 ~ 1.146), glycated hemoglobin (HbA1c) ≥ 7%(OR = 3.745, 95% CI: 1.203-12.647), dysphagia(OR = 8.401, 95% CI: 2.276-43.846), and poor oral health status (OR = 2.213, 95% CI: 1.134-4.394) were risk factors of oral frailty, and the number of remaining teeth ≥ 20(OR = 0.105, 95% CI: 0.046-0.217) and high oral health-related self-efficacy(OR = 0.934, 95% CI: 0.898-0.970) were protective factors against oral frailty (P < 0.05).

CONCLUSIONS

The Integral Model of Frailty provides a new theoretical framework for the study of oral frailty. The main OF infuencing factors in the elderly patients with type 2 diabetes mellitus are age, HbA1c, dysphagia, poor oral health status, the number of remaining teeth, and oral health-related self-efficacy. Healthcare professionals should develop and implement targeted oral health management strategies for this population to improve oral health outcomes.

Revisiting traditional Chinese exercise in prediabetes: effects on glycaemic and lipid metabolism - a systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Most existing studies have primarily focused on the effects of Traditional Chinese Exercises (TCEs) on glycemic control in individuals with prediabetes, while specific recommendations for managing dyslipidemia in this population remain insufficient. Moreover, there is a lack of systematic research and conclusive evidence regarding the optimal exercise dose required to achieve metabolic improvements in individuals with prediabetes. Therefore, this meta-analysis aims to comprehensively evaluate the efficacy of TCEs in improving glycemic and lipid profiles in individuals with prediabetes and to explore the potential impact of exercise dose on these metabolic parameters.

METHODS

A comprehensive search of six databases (PubMed, Web of Science, Cochrane Library, Embase, CNKI, and WanFang Data) followed PRISMA guidelines to identify randomized controlled trials (RCTs) on TCEs (e.g., "Tai Chi," "Yijinjing," "Baduanjin") and prediabetes (e.g., "impaired glucose tolerance," "impaired glucose regulation") published up to November 10, 2024. Three reviewers independently screened studies, extracted data, and assessed bias risk. Meta-analysis and subgroup/meta-regression analyses were conducted using Stata 17 software. The review protocol is registered in PROSPERO (CRD42024615150).

RESULTS

A total of 15 studies involving 1,839 participants were included. The meta-analysis revealed that TCEs significantly improved HbA1c (MD = -0.28%; 95% CI: -0.38% to -0.18%; P = 0.001), FBG (MD = -0.44 mmol/L; 95% CI: -0.53 to -0.34 mmol/L; P < 0.001), 2hPG (MD = -1.16 mmol/L; 95% CI: -1.48 to -0.85 mmol/L; P < 0.001), TC (MD = -0.31 mmol/L; 95% CI: -0.50 to -0.11 mmol/L; P = 0.002), TG (MD = -0.28 mmol/L; 95% CI: -0.50 to -0.06 mmol/L; P = 0.012), and HDL (MD = -0.28 mmol/L; 95% CI: -0.50 to -0.06 mmol/L; P = 0.012) compared to control groups.

CONCLUSIONS

TCEs significantly improve prediabetics' blood glucose and lipid levels. The recommended exercise regimen is 30-50 min per session, 2-3 times per week, for at least three months.

Glycemic Variability and Its Association with Traditional Glycemic Control Biomarkers in Patients with Type 1 Diabetes: A Cross-Sectional, Multicenter Study

Background/Objectives: Glycemic variability (GV) is a novel concept in the assessment of the quality of glycemic control in patients with diabetes, with its importance emphasized in patients with type 1 diabetes. Its adoption in clinical practice emerged with the increased availability of continuous glycemic monitoring systems. The aim of this study is to evaluate the GV in patients with type 1 diabetes mellitus (T1DM) and to assess its associations with other parameters used to evaluate the glycemic control. Methods: GV indexes and classical glycemic control markers were analyzed for 147 adult patients with T1DM in a multicentric cross-sectional study. Results: Stable glycemia was associated with a higher time in range (TIR) (78% vs. 63%; p < 0.001) and a lower HbA1c (6.8% vs. 7.1%; p = 0.006). The coefficient of variation (CV) was reversely correlated with TIR (Spearman's r = -0.513; p < 0.001) and positively correlated with hemoglobin A1c (HbA1c) (Spearman's r = 0.349; p < 0.001), while TIR was reversely correlated with HbA1c (Spearman's r = -0.637; p < 0.001). The composite GV and metabolic outcome was achieved by 28.6% of the patients. Conclusions: Stable glycemia was associated with a lower HbA1c, average and SD of blood glucose, and a higher TIR. A TIR higher than 70% was associated with a lower HbA1c, and SD and average blood glucose. Only 28.6% of the patients with T1DM achieved the composite GV and metabolic outcome, despite 53.7% of them achieving the HbA1c target, emphasizing thus the role of GV in the assessment of the glycemic control.

Design of the Continuous Glucose Monitoring (CGM) Study in the Dietary Approaches to Stop Hypertension for Diabetes Trial (DASH4D-CGM)

BACKGROUND

The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for adults with diabetes. However, the effects of the DASH diet on glucose control and variability have not been thoroughly investigated.

STUDY AIM

To study the effects of a modified DASH diet on glycemic control and glucose variability assessed by continuous glucose monitoring (CGM) in individuals with hypertension and type 2 diabetes.

METHODS

We conducted an ancillary study to add CGM to the Dietary Approaches to Stop Hypertension for Diabetes (DASH4D) Trial. The DASH4D Trial was designed to determine the effects, alone and combined, of a modified DASH diet (vs a diet typical of what Americans with diabetes eat) and lower (vs higher) sodium intake on systolic blood pressure among people with type 2 diabetes and elevated blood pressure. Participants were fed each of the 4 study diets for 5 weeks in a random order. We invited all participants enrolling in the DASH4D Trial to wear a masked CGM sensor for up to 14 days during screening and during each of the four 5-week feeding periods. The DASH4D-CGM Study primarily aimed to evaluate the effects of the modified DASH diet (vs comparison diet) on glycemic control (mean glucose and time-in-range) and glucose variability (coefficient of variation).

CONCLUSION

Combining CGM technology and a controlled feeding design, the DASH4D-CGM Study will generate robust data on the effects of diet on glycemic control and variability. These findings will inform dietary recommendations for adults with type 2 diabetes.

Risk factors for diabetes in recently arrived migrants in Scania, Sweden compared to the general population

Introduction

The prevalence of type 2 diabetes has increased worldwide, where the highest prevalence has been found in the Eastern Mediterranean region. Effective measures must be taken to prevent or delay the occurrence of type 2 diabetes and its complications. The present study aimed to investigate the correlation between factors linked to risk for diabetes, individually and cumulatively, and established diabetes in recently arrived migrants from Iraq and Syria in Scania and compare it to the rest of the population.

Method

A cross-sectional survey was used to compare data between a sample of recently arrived migrants and a sample from the rest of the population in Scania, Sweden.

Results

The prevalence of self-reported diabetes was significantly higher among recently arrived migrants (6.9%) compared to the rest of the population (4.9%). High blood-pressure, unhealthy weight, physical inactivity, and older age increased the risk for self-reported diabetes solely but also cumulatively.

Conclusion

It is important to identify individuals with a high risk of diabetes and put preventive efforts into combating risk factors for diabetes. Targeting specific risk factors significantly reduces the risk of developing this disease.

Role of workplace culture in successful lifestyle medicine implementation: a qualitative case series among health systems in the USA

OBJECTIVE

This study investigated how workplace culture may affect the development of lifestyle medicine (LM) programming in health systems to inform the successful growth of LM programs. No study has examined how the impact of workplace culture (shared knowledge, values and behaviours within an organisation) affects practitioners' abilities to engage in LM.

DESIGN

A cross-sectional, multiple case study investigation of the implementation of LM in five health systems was conducted by administering semi-structured in-depth interviews (n=45) from May 2022 to January 2023. Following the transcription of interviews verbatim, narrative reports depicting each health system's experience with LM were drafted and collectively reviewed by the research team who discussed emerging themes.

SETTING

Five health systems across the USA that have implemented LM were selected based on diversity in size, location, payer model, and patient population.

PARTICIPANTS

Administrative leaders, physicians and other personnel involved in the LM programming from selected health systems were invited to participate.

RESULTS

The implementation of LM is facilitated when practices such as forming social groups, visually advertising LM and offering plant-based cafeteria items are present to support core values, such as trust, gratitude, collaboration and optimism.

CONCLUSIONS

LM implementation can be supported by health system clinicians and administrators striving to make their workplaces more supportive and synergetic so that they can take advantage of all available resources. Future research should further explore this relationship between cultural factors and resource availability.

Impact of community public health care on treatment effect, health cognition, and self-management in patients with type 2 diabetes

BACKGROUND

At present, China has become the country with the largest number of individuals with diabetes mellitus (DM) in the world, with a total of approximately 140 million patients, the majority of whom have type 2 DM (T2DM). Based on conventional nursing methods, community home care has important clinical significance in controlling blood sugar and disease progression.

AIM

To explore the impact of community public health nursing on treatment effect, health cognition, and self-management in patients with T2DM.

METHODS

One hundred patients with T2DM were selected as the research subjects. The patients were divided into either a conventional nursing group or community nursing (CN) group using the random number table method. The conventional nursing group (50 cases) received routine care, while the CN group (50 cases) received community public health care in addition to routine care as that for the conventional nursing group. The rate of excellent and good blood glucose control, fasting blood glucose before and after care, 2-h postprandial blood glucose, health cognition, and self-management ability, and patient satisfaction were compared between the two groups.

RESULTS

The CN group had a higher rate of excellent blood sugar control than the conventional nursing group (88% vs 70%, P < 0.05). Before care, there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients (P > 0.05). After nursing, fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups, and both blood glucose levels in the CN group were lower than those of the conventional nursing group (P < 0.05). Compared with the scores before care, the cognitive level score for diabetes and self-management ability score improved after care in both groups. The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group (P < 0.05). The overall satisfaction of the CN group was better than that of the conventional nursing group (98% vs 86%, P < 0.05).

CONCLUSION

Community public health care based on conventional care of T2DM can achieve better blood sugar control, and improve patients' health cognitive level and self-management ability.

Nurse-Led Mobile Phone Intervention to Promote Self-Management in Type 2 Diabetes in Ghana: A Randomized Controlled Trial

PURPOSE

The purpose of the study was to test the effectiveness of a nurse-led mobile phone intervention (NMPI) on glycemic variability and self-management among people living with type 2 diabetes (T2DM) in Ghana.

METHODS

In this randomized controlled trial, the intervention group received a 3-month NMPI program plus standard care, and the control group received standard care alone in a tertiary health care setting. Ninety-eight participants (baseline A1C > 7%) were randomized 1:1 to either NMPI or standard care group. The primary study outcomes were changes in A1C testing and self-management assessed using the Summary of Diabetes Self-Care Activities tool at baseline and end of the study.

RESULTS

The intervention group had statistically significant improvement in their mean A1C level from baseline to the end of the study. In comparison, the control group also had improvement in their mean A1C level but was not statistically significant. Consistently, the intervention participants had better statistically significant improvements in self-management behaviors than the control group. There was a medium, negative correlation between A1C changes and overall self-care changes for the intervention group, whereas that of the control group was smaller.

CONCLUSIONS

Study findings have shown that a tailored NMPI program in addition to standard care could improve glycemic variability and self-management among people living with poorly managed T2DM in Ghana better than standard care alone.

Physical activity guidelines for adults with type 2 Diabetes: Systematic review

AIMS

The aim of this study was to systematically review recommendations on physical activity for adults with type 2 diabetes (T2D).

METHODS

Online databases were searched for clinical practice guidelines (CPGs), statements, and recommendations. Two authors screened the guidelines based on eligibility criteria. FITT (Frequency, Intensity, Time, Type) for physical activity and disease-specific precautions were extracted independently. The methodological quality of CPGs was assessed using the AGREE II instrument. Recommendations were categorized according to FITT, with disease-specific adaptations also recorded.

RESULTS

Fifteen guidelines were included. Nine underwent AGREE II evaluation, with three rated high quality and the rest moderate to low. The predominant recommendation was to engage in at least 150 min of moderate aerobic exercise per week. Adaptations for T2D focused on glucose levels, diet, foot care, weather conditions, sedentary behaviour, neuropathy, and retinopathy.

CONCLUSION

While guidelines consistently recommended aerobic exercise, there was limited emphasis on strength and flexibility exercises. Significant limitations in methodological and reporting quality were noted, especially in stakeholder involvement and applicability. Future guidelines should use a standardized FITT framework and adhere to standard development methods to enhance usability for healthcare professionals and patients.

Long-Term Effects of Transtheoretical Model-Based Lifestyle Intervention on Self-efficacy and Self-management in Patients with Type 2 Diabetes - Randomised Controlled Trial

BACKGROUND

Self-efficacy and self-management are fundamental factors for successful treatment of type 2 diabetes, but long-term studies are rare. The aim of the present study is to investigate whether the effects achieved in the context of a lifestyle intervention based on the transtheoretical model can be maintained by the patients in the long term.

METHOD

A two-arm randomised controlled trial examined whether long-term effects of self-efficacy, self-management, and HbA1c can be achieved by a lifestyle intervention of 12 months and persisted beyond the intervention. During the intervention, the intervention group (n = 86, mean age 59.7 years) was supported by a telephone coach and telemedical devices, while the control group (n = 65, mean age 58.8 years) received regular care. In the year after intervention, both groups received standard care.

RESULTS

The intervention group achieved significantly better self-management after 12 and 24 months (12M, 1.11 (0.81; 1.41) p < .000; 24M, 0.52 (0.19; 0.85) p = .002) as well as self-efficacy (12M, 1.18 (0.83; 1.52) p < .000; 24M, 0.76 (0.39; 1.13) p < .000) and HbA1c than the control group.

CONCLUSION

TTM-based lifestyle interventions show a long-term effect beyond the duration of the intervention in most areas, and behavioural changes can be sustained by patients.

Fat-Free Mass: Friend or Foe to Metabolic Health?

BACKGROUND

Fat mass (FM) and fat-free mass (FFM) are body composition estimates commonly reported in research studies and clinical settings. Recently, fat-free mass indexed to height (fat-free mass index; FFMI) has been shown to be positively associated with impaired insulin sensitivity or insulin resistance. Consequently, hypertrophic resistance training which can increase FFM was also questioned. This paper sets out to evaluate these propositions.

METHODS

In this narrative review, we discuss possible reasons that link FFMI to adverse metabolic health outcomes including the limitations of the body composition model that utilizes FFM. The safety of resistance training is also briefly discussed.

RESULTS

Approximately 50% of FFM is comprised of skeletal muscle (SM), with the other 50% being viscera, skin, and bone; FFM and SM cannot be conflated. FFM and fat mass (FM) can both rise with increasing body weight and adiposity, indicating a positive correlation between the two compartments. Risk assessment models not adequately adjusting for this correlation may cause erroneous conclusions, however which way FM and FFM are indexed. Adipose tissue accumulation with weight gain, measured by dual-energy X-ray absorptiometry or bioelectrical impedance, can inflate FFM estimates owing to increased connective tissue. Increased adiposity can also result in fat deposition within skeletal muscle disrupting metabolic health. Importantly, non-skeletal muscle components of the FFM, i.e., the liver and pancreas, both critical in metabolic health, can also be negatively affected by the same lifestyle factors that impact SM. The most frequently used body composition techniques used to estimate FM and FFM cannot detect muscle, liver or pancreas fat infiltration. Prospective evidence demonstrates that resistance training is a safe and effective exercise modality across all ages, especially in older adults experiencing age- or disease-related declines in muscle health.

CONCLUSIONS

The association between FFM and insulin resistance is largely an artefact driven by inadequate assessment of skeletal muscle. If FM and FFM are used, at the minimum, they need to be evaluated in context with one another. Body composition methods, such as magnetic resonance imaging, which measures skeletal muscle rather than fat-free mass, and adipose tissue as well as muscle ectopic fat, are preferred methods. Resistance training is important in achieving and maintaining good health across the lifespan. While strength and power are critical components of resistance training, the reduction of skeletal mass through ageing or disease may require hypertrophic training to mitigate and slow down the progression of this often-inevitable process.

Dietary patterns related to triglyceride glucose index and risk of type 2 diabetes: a large-scale cohort study

Background

Triglyceride glucose (TyG) index has been proposed as a credible and simple surrogate indicator for insulin resistance. The primary aim of this study was to novelly examine the associations between dietary patterns reflecting variations in circulating TyG index and the risk of type 2 diabetes mellitus (T2DM).

Methods

This study included 120,988 participants from the UK Biobank, all of whom completed multiple 24-h dietary assessments. Dietary pattern scores were derived using reduced-rank regression (RRR) and Least Absolute Shrinkage and Selection Operator (LASSO) regression, based on the TyG index and approximately 80 food groups. The associations between the TyG index, related dietary pattern scores, and T2DM risk were evaluated using Cox regression models.

Results

During a median follow-up period of 11.2 years, 3,585 participants developed T2DM. A higher TyG index was significantly associated with an increased risk of T2DM. The two dietary patterns derived from RRR and LASSO showed a strong correlation (ρ = 0.88, p < 0.001) and shared similar characteristics at higher scores, including greater intakes of margarine, meat, fruit juice, and potatoes, alongside lower intakes of green vegetables, oily fish, yogurt, nuts and seeds, and dried fruits. Corresponding blood profiles, including elevated levels of C-reactive protein and HbA1c, along with reduced levels of HDL-C and docosahexaenoic acid, substantiated the dietary pattern assessments. The adjusted hazard ratios (HRs) for T2DM risk were 1.52 (95% CI: 1.33-1.73, p trend <0.001) and 1.48 (95% CI: 1.30-1.69, p trend <0.001) for dietary patterns derived using RRR and LASSO, respectively, comparing the highest to the lowest quintiles.

Conclusion

The findings suggest that a higher TyG index and specific dietary patterns, characterized by higher intakes of margarine, meat, fruit juice, and potatoes, and lower intakes of green vegetables, oily fish, yogurt, nuts and seeds, and dried fruits, are associated with an increased risk of developing T2DM. These results underscore the potential of dietary modifications targeting these patterns to mitigate T2DM risk.

The effect of an app-based dietary education on dietary intake and cardiometabolic risk markers in people with type 2 diabetes: results from a randomized controlled trial

BACKGROUND

mHealth, i.e. mobile-health, strategies may be used as a complement to regular care to support healthy dietary habits in primary care patients. We evaluated the effect of a 12-week smartphone-based dietary education on overall diet quality (primary outcome), and dietary intake and cardiometabolic risk markers (secondary outcomes) in people with type 2 diabetes.

METHODS

In this two-armed randomized clinical trial, people with type 2 diabetes were recruited within a primary care setting and randomized 1:1 to a smartphone-delivered dietary education for 12 weeks or a control group receiving regular care only. Dietary intake and cardiometabolic risk markers were measured at baseline and after 3 months. Diet was assessed using a 4-day dietary record and a food frequency questionnaire (FFQ). Overall diet quality was estimated with a Nordic Nutrition Recommendation (NNR) score and specific dietary intake was estimated for 13 food groups/nutrients. We used linear regression models to examine differences in change from baseline to the 3-month follow-up between the intervention and control group, adjusted for baseline values of each outcome variable.

RESULTS

The study included 129 participants (67 in the intervention group and 62 controls), of whom 61% were men. At baseline, mean age was 63.0 years and mean body mass index was 29.8 kg/m2. When analyzing dietary record data, we found no effect of the intervention on diet quality or intake, however, the control group had increased their score by 1.6 points (95%CI: -2.9, -0.26) compared to the intervention group. In the analyses of FFQ data, the intervention group had lowered their daily intake in grams of saturated (β = -4.1, 95%CI: -7.9, -0.2) and unsaturated (mono- and polyunsaturated) (β = -6.9, 95%CI: -13.5, -0.4) fat more than the control group. The intervention group also presented lower serum triglycerides levels than the controls (β = -0.33, 95%CI: -0.60, -0.05). No statistical differences were found in any other dietary variables or cardiometabolic risk markers.

CONCLUSION

While we found no effect on overall diet quality, our findings suggest that a smartphone-based dietary education might impact dietary fat intake and corresponding cardiometabolic risk markers in people with type 2 diabetes. Our results should be considered hypothesis-generating and need to be confirmed in future studies.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov ( NCT03784612 ). Registered 24 December 2018.

Associations of healthy lifestyle and family income to poverty ratio with all-cause mortality among people with prediabetes and diabetes: a prospective cohort study

BACKGROUND

Family income to poverty ratio (PIR) may have independent effects on diet and lifestyle factors and the development of prediabetes and diabetes, as well as on mortality. It is unclear how the protective effect of a healthy lifestyle against death differs between individuals with different glucose metabolic profiles and whether PIR mediates this effect. This study aimed to explore whether healthy lifestyle and family PIR reduced the risk of all-cause mortality in participants with different metabolic status and the mediating role of PIR.

SUBJECTS AND METHODS

In total, 21,411 participants from the 2001-2018 National Health and Nutrition Examination Survey (NHANES) and follow-up until 2019 were included. The weighted healthy lifestyle score was constructed based on smoking, alcohol consumption, physical activity, diet (HEI-2015), and body mass index. Generalized linear regression models were used to analyze the association between healthy lifestyle, PIR, and all-cause mortality. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals, Kaplan-Meier survival curve was used to analyze the all-cause mortality associated with PIR and lifestyle. Furthermore, the mediation proportion of PIR in all-cause mortality attributed to healthy lifestyle was analyzed among participants with normal glucose regulation, prediabetes, or diabetes after multivariable adjustment.

RESULTS

There were significant differences in healthy lifestyle and PIR among people with normal glucose regulation, prediabetes and diabetes. During a mean follow-up of 92 months, participants with prediabetes or diabetes were also likely to have a higher mortality rate, respectively 583 (8.3%) and 263 (12.7%). More than 2 healthy lifestyles were associated with 42% (HR, 0.58; 95% CI, 0.35-0.95) to 76% (HR, 0.24; 95% CI, 0.12-0.44) reduced risk of all-cause mortality among participants with prediabetes, but among those with diabetes, who had ≥ 4 healthy lifestyles were associated with 72% reduced risk of all-cause mortality (HR, 0.28; 95% CI, 0.09-0.90). The middle and high PIR were associated with at least a 37% (HR, 0.63; 95% CI, 0.47-0.83) to 65% (HR, 0.35; 95% CI, 0.18-0.68) lower risk of all-cause mortality in participants with prediabetes and diabetes. Furthermore, PIR mediated 5.81-14.93% and 7.72-10.10% of the association between healthy lifestyle and all-cause mortality among normal glucose regulation and prediabetic participants, respectively. However, the mediating effect of PIR was not significant among diabetic participants.

CONCLUSIONS

Our findings highlight the importance of promoting adherence to a healthy lifestyle and improving PIR in prediabetic patients to reduce the risk of all-cause mortality, and the protective effect is more significant with more healthy lifestyles and higher PIR. This study can help clinicians and health systems develop more targeted treatments for people with different metabolic levels.

Changes in fatty acid intake and subsequent risk of all-cause and cause-specific mortality in males and females: a prospective cohort study

BACKGROUND

The associations between changes in fatty acid intake over time and subsequent mortality are unclear.

OBJECTIVES

The objective of this study was to prospectively examine associations between changes in fatty acid intake (as percentage of total energy) and mortality.

METHODS

Among 65,179 adults from the Nurses' Health Study and Health Professionals Follow-up Study, free from cardiovascular disease, cancer, and diabetes at baseline in 1994, we documented 20,571 deaths through 2020 (1,334,603 person-years). Diets were assessed every 4 years using validated questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality risk were estimated from Cox proportional hazards models.

RESULTS

A 5% energy increment in total fat intake was associated with 5% lower all-cause mortality (HR: 0.95; 95% CI: 0.93, 0.96; isocaloric comparison was total carbohydrate). The HRs of all-cause mortality (95% CI) were 0.83 (0.78, 0.89) and 0.91 (0.87, 0.94) for a 5% increment in energy intake from polyunsaturated fatty acid (PUFA) and monounsaturated fatty acid (MUFA), respectively, and was 1.10 (1.04, 1.17) for a 1% increase in energy intake from trans fatty acid (TFA; all Ptrend ≤ 0.001). Changes in saturated fatty acid (SFA) were not associated with all-cause mortality. Increases in intakes of linoleic acid, marine n-3 PUFA, and MUFA from plant sources were each significantly associated with lower all-cause mortality. In substitution analyses, replacing 5% energy from SFA with PUFA was associated with 19% lower all-cause mortality (HR: 0.81; 95% CI: 0.75, 0.87), whereas replacing 0.3% of energy from SFA with marine n-3 PUFA was associated with 11% lower all-cause mortality (HR: 0.89; 95% CI: 0.84, 0.93). Isocaloric substitution of SFA by PUFA, particularly marine n-3 PUFA, was associated with lower mortality due to cardiovascular, neurodegenerative, and respiratory diseases.

CONCLUSIONS

These findings support replacing SFA with unsaturated fatty acids (especially from plant sources) and eliminating dietary TFA to reduce premature death.

Patterns of glycaemic control and associated factors among adult patients with diabetes attending medical referral clinics in two public hospitals in North-West Ethiopia: a cross-sectional study

Background

Poor glycaemic control is the most challenging issue in diabetes care globally. The glycated haemoglobin (HbA1c) value is the most standard monitoring parameter for appropriate glycaemic control status.

Objective

To assess the patterns of glycaemic control and associated factors among patients with diabetes attending medical referral clinics in North-West Ethiopia.

Design

An institution-based cross-sectional study.

Setting

This study was conducted in two public hospitals (Felege-Hiwot Comprehensive Specialized Hospital and Tibebe Ghion Specialized Hospital), Amhara National Regional State, North-West Ethiopia.

Participants

A total of 355 adult patients with diabetes were included in the study using a systematic sampling technique. Patients were recruited from both hospitals proportionally between July and September 2021.

Outcome measures

Glycaemic control was assessed using HbA1c levels. Data were collected using a checklist and structured questionnaire and analysed using a binary logistic regression model.

Results

The overall prevalence of poor glycaemic control was 66.2% (95% CI 61.1% to 71%). Age 31-45 years (AOR=0.30, 95% CI 0.12 to 0.75), 46-60 years (AOR=0.12, 95% CI 0.04 to 0.33) and >60 years (AOR=0.09, 95% CI 0.02 to 0.31), lower educational status (AOR=3.48, 95% CI 1.01 to 12.01), type 2 diabetes (AOR=3.36, 95% CI 1.56 to 7.27), poor adherence to antidiabetic drugs (AOR=4.18, 95% CI 1.70 to 10.30), physical inactivity (AOR=4.30, 95% CI 2.11 to 8.76), longer duration of diabetes mellitus (AOR=2.06, 95% CI 1.13 to 3.75) and high body mass index (AOR=3.83, 95% CI 1.31 to 11.19) were associated with poor glycaemic control.

Conclusion

The prevalence of poor glycaemic control was high. Age, lower educational status, type 2 diabetes, physical inactivity, high body mass index, longer duration of diabetes and poor adherence to antidiabetic drugs were associated with uncontrolled glycaemia.

Exploring Type 2 Diabetes Self-Management Practices Among African Americans in Rural Counties: A Qualitative Study

PURPOSE

The purpose of the study was to understand diabetes self-management practices among African American individuals living with type 2 diabetes (T2D) in rural communities.

METHODS

This qualitative descriptive study, undergirded by the theory of integration, purposively sampled African Americans (N = 34) diagnosed with T2D living in rural communities. Thematic analysis employed both a priori and inductive coding to identify salient themes.

RESULTS

Participants' mean age was 65.9 (SD 12.3) years, with an average T2D diagnosis duration of 14 (SE 11.2) years. Two major themes emerged: deciphering the cues and body sensing, which the participants used to monitor their glucose level using a personalized feedback loop. Those with longer diabetes duration demonstrated an ability to recognize hypoglycemic or hyperglycemic symptoms (deciphering the cues), informing their decision-making and self-management strategies (body sensing).

CONCLUSIONS

The decision-making involved in glycemic level management emerges as a complex developmental process influenced by disease trajectory and cultural and environmental factors. These findings may inform a conceptual framework to guide future inquiries and provide insights for primary care clinicians and diabetes care and education specialists to better understand the complexities of T2D management among African American individuals in rural settings.

The association between oral frailty and HbA1c among older adults with T2DM: the chain mediating effect of nutritional status and physical frailty

OBJECTIVES

The present study aimed to explore the association between oral frailty and glycated hemoglobin (HbA1c), and the chain mediating role of nutritional status and physical frailty among older adults with type 2 diabetes mellitus (T2DM).

METHODS

Patients with T2DM aged > 60 years were recruited from the endocrinology department of a national metabolic center from October 2023 to March 2024. Oral frailty, nutritional status, and physical frailty were assessed with Oral Frailty Index-8 (OFI-8), the Nutrition Risk Screening 2002 (NRS2002), Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (FRAIL), respectively. Their HbA1c were collected at the same time. In order to reveal the interaction and influence between multiple variables, chain mediation analyses were conducted using the "Process" macro in SPSS 26.0 to estimate the direct and indirect effects of oral frailty on nutritional status, physical frailty and HbA1c.

RESULTS

A total of 292 participants (50.7% male) were enrolled in this study at a median age of 70.0 (65.2, 76.0) years and a T2DM disease duration of (16.5 ± 9.4) years. After adjustment for age, oral frailty of older people with T2DM significantly positively predicted their HbA1c (β = 0.198, P < 0.001). In addition, oral frailty affect HbA1c through two indirect pathways, including an independent mediating effect of physical frailty (effect = 0.046) and a chain-mediating effect of nutritional status and physical frailty (effect = 0.004).

CONCLUSIONS

Our findings suggest that less oral frailty of older adults with T2DM could optimize their nutritional status and physical frailty and, thus, their HbA1c. Consequently, improving oral health is expected to be a promising intervention target for reaching optimal glycaemic control in older adults with T2DM.

Effects of healthy low-carbohydrate diet and time-restricted eating on weight and gut microbiome in adults with overweight or obesity: Feeding RCT

The effect of a healthy low-carbohydrate diet (HLCD) and time-restricted eating (TRE), alone or in combination, on body weight and gut microbiome beyond caloric restriction remains unclear. In this 12-week two-by-two factorial randomized trial with a 28-week follow-up among 96 participants with overweight or obesity, isocaloric-restricted feeding yields significant weight loss, ranging from 2.57 to 4.11 kg across different groups. Beyond caloric restriction, HLCD and TRE lead to additional reduction in body mass index. HLCD results in additional fat mass loss while TRE yields more lean mass loss. Additionally, HLCD leads to decreased fecal branched-chain amino acids, and TRE tends to yield an increased abundance of probiotic species involved in synthesizing short-chain fatty acids. Moreover, the effect of HLCD on reducing fat mass is sustained during the post-intervention follow-up. Overall, HLCD and TRE are effective in weight management and yield profound gut microbiome and metabolome alteration beyond caloric restriction. This study was registered at ChiCTR.org.cn (ChiCTR2200056363).

Online Lifestyle Medicine Continuing Medical Education (CME) Course Completion Predicts Increases in Clinician Knowledge, Confidence, and Practice of Lifestyle Medicine

Introduction: Despite growing evidence linking lifestyle changes to disease reversal, lifestyle medicine (LM) is not widely practiced. Lack of clinician training and knowledge is cited as a barrier to LM adoption. This study measures changes in LM knowledge, attitudes, confidence, and practice behaviors following completion of a 5.5-h, asynchronous, online continuing medical education (CME) course. Methods: Participants completed a pre- and post-course survey. A repeated-measures linear model tested changes in knowledge, confidence, interest, experience, and practice of LM, after adjusting for age, gender, race, ethnicity, clinical degree/licensure, and presence of a health system value-based care model. Results: Surveys from n = 2954 course participants were analyzed. Overall, statistically significant improvements were observed in self-reported knowledge (+.47 of points) and confidence (+.53 of points) of LM. Participants across the sample reported greater frequency (+.08 of 5 points) and reach (+.10 of 5 points) of LM with their patients (p<.0001 for both). Discussion: This study demonstrated that a brief, scalable, online CME course can improve LM knowledge, confidence, attitudes, and practice. Future research should examine long-term practice changes as well as differences in outcomes across types of healthcare professionals.

Addressing diabetes by elevating access to nutrition (ADELANTE) - A multi-level approach for improving household food insecurity and glycemic control among Latinos with diabetes: A randomized controlled trial

BACKGROUND

Latinx adults are disproportionately impacted by the interrelated challenges of food insecurity and nutrition sensitive chronic diseases. Food and nutrition insecurity can exacerbate the development and progression of chronic diseases, such as diabetes. Sustainable, effective interventions aimed at improving food insecurity and diabetes management for Latinx populations are needed.

METHODS

This hybrid type 1 trial evaluates the effectiveness of a multi-level intervention that includes a medically supportive food and behavioral lifestyle program on the primary outcome of Hemoglobin A1c (HbA1c) at 6 months. Latinx adults (n = 355) with type 2 diabetes (HbA1c of 6.0-12.0 %), overweight/obesity (BMI > 25 kg/m2), and self-reported risk of food insecurity will be randomized 1:1 to intervention (12 weekly deliveries of vegetables, fruits, and whole-grain foods + culturally-modified behavioral lifestyle program) versus control (food deliveries after a 6-month delay). Outcome asessments will occur at 0, 6 and 12 months, and include HbA1c, dietary intake, psychosocial health outcomes, and diabetes-related stressors. In addition, food insecurity and the impact of the intervention on up to two household members will be measured. Qualitative interviews with patients, healthcare providers, and community partners will be conducted in accordance with Reach, Effectivenes, Adoption, Implementation, and Maintenence (RE-AIM) framework to identify barriers and best practices for future dissemination.

CONCLUSIONS

The ADELANTE trial will provide novel insight to the effectiveness of a multi-level intervention on diabetes-related outcomes in Latinx adults. The mixed-method approach will also identity the reach of this 'Food is Medicine' intervention on additional household members to inform diabetes prevention efforts.

CLINICAL TRIAL REGISTRATION

NCT05228860.

Efficacy of a High-Protein Diet to Lower Glycemic Levels in Type 2 Diabetes Mellitus: A Systematic Review

Diabetes is a metabolic disease with a high worldwide prevalence and an important factor in mortality and disability in the population. Complications can be reduced or prevented with lifestyle changes in physical activity, dietary habits, and smoking cessation. High-protein diets (HPDs, >30% or >1.0 g/Kg/day) decrease hyperglycemia in part due to their content of branched-chain amino acids (BCAAs), mainly leucine. Leucine (and other BCAAs) improve glucose metabolism by directly signaling in the medio-basal hypothalamus (MBH), increasing liver insulin sensitivity. To determine the effectiveness of an HPD to lower hyperglycemia, we analyzed the results of published clinical studies focusing on the levels of fasting plasma glucose and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM). We carried out a systematic search for clinical studies using HPDs. We searched five databases (Scopus, Web of Science, PubMed, Epistemonikos, and Cochrane), collecting 179 articles and finally selecting 8 articles to analyze their results. In conclusion, HPDs are an effective alternative to reduce hyperglycemia in patients with T2DM, especially so-called Paleolithic diets, due to their higher-quality protein from animal and vegetal sources and their exclusion of grains, dairy products, salt, refined fats, and added sugars.

A multicomponent smoking cessation program for adults with Type 2 Diabetes Mellitus (DiMe-SALUD2 project): A study protocol of a randomized controlled trial

Background

Tobacco use represents a significant public health burden, being especially harmful for smokers with Type 2 Diabetes Mellitus (T2DM). Effective smoking cessation interventions are required for this vulnerable population. The goal is to describe a study protocol of a randomized controlled trial (RCT) aimed at analyzing the effectiveness and efficiency of a multicomponent smoking cessation intervention for T2DM smokers, including a training protocol on healthy lifestyle habits and self-management of T2DM (DiMe-SALUD2 project).

Methods

This RCT will assign participants to: (1) Control Group (n = 30), including a brief psychoeducation advice about smoking cessation; (2) Cognitive-behavioral treatment (CBT) for smoking cessation (n = 30), based on a multicomponent program implemented in group-based sessions over an eight-week period; and (3) CBT plus DiMeSALUD2 protocol (n = 30), which will develop an additional psychoeducational protocol specifically designed to improve healthy lifestyle habits. Participants will be assessed at baseline, post-treatment and several follow-ups (1-, 6- and 12-months). Primary outcomes will include smoking abstinence (24-h point prevalence abstinence at post-treatment and 7-day point prevalence at follow-ups) and smoking continuous abstinence. Secondary outcomes will include treatment retention, changes in smoking patterns and nicotine dependence, as well as the impact on T2DM clinical variables, mental health, and quality of life.

Discussion

The DiMeSALUD2 program could assist T2DM smokers in quitting tobacco use and improving their overall quality of life. This project will help incorporating improvements in routine clinical practice with T2DM patients, offering a smoking cessation program adapted to their specific needs.

Trial registration

ClinicalTrials.gov. Identifier: NCT05885659. Date of registration: June 2nd, 2023.

A nutrition-focused review of the interventions in US-living Latino communities with type II diabetes

Type 2 diabetes (T2D) is a chronic, debilitating disease that disproportionally affects the Hispanic/Latino community residing in the United States. Optimal nutrition therapy is fundamental to the proper management of T2D and must be culturally adapted to facilitate permanent behavior change in this population. This review selected and assessed the nutrition components of interventions aimed to improve T2D outcomes in US-based Latinos/Hispanics, published from 2002 to 2023. An overview of the participant characteristics, nutrition intervention, and dietary assessment and outcomes is included. Nutrition interventions in this community benefit from the inclusion of bicultural registered dietitian nutritionist (RDNs) to assure the counseling team promotes culturally tailored nutrition recommendations based on current dietary guidelines. Nutrition assessment and outcomes should be captured with the use of validated dietary assessment tools and dietary quality indices appropriate to their target population. Standardizing these practices will facilitate intervention comparability and replicability and ultimately better target the needs of this community.

Association between low-carbohydrate-diet score, glycemia and cardiovascular risk factors in adults with type 1 diabetes

BACKGROUND AND AIMS

Low-carbohydrate-diets (LCDs) are gaining popularity in individuals with type 1 diabetes (T1D). However, the impact of such diets on glycemia and cardiovascular risk factors is debated. This study aims to evaluate associations between low-carbohydrate intakes using LCD score with glycemia and cardiovascular risk factors (lipid profile) in adults with T1D or LADA in Québec, Canada.

METHODS AND RESULTS

This is a cross-sectional study using data collected in the BETTER registry (02/2019 and 04/2021) including self-reported 24-h dietary recalls to calculate LCD scores, waist circumference, level-2 and level-3 hypoglycemic episodes and measured biochemical data (HbA1c, LDL-cholesterol and non-HDL-cholesterol). Participants were divided into quartiles (Q) based on LCD scores. Two hundred eighty-five adults (aged 48.2 ± 15.0 years; T1D duration 25.9 ± 16.2 years) were included. Categorical variables underwent Chi-squared/Fisher's Exact tests, while continuous variables underwent ANOVA tests. Mean carbohydrate intake ranged from 31.2 ± 6.9% (Q1) to 56.5 ± 6.8% (Q4) of total daily energy. Compared to Q4, more people in Q1 reported HbA1c ≤ 7% [≤53.0 mmol/mol] (Q1: 53.4% vs. Q4: 29.4%; P = 0.011). The same results were found in the models adjusted for age, sex and T1D duration. A greater proportion of participants in Q1 never experienced level-3 hypoglycemia compared to Q3 (Q1: 60.0% vs. Q3: 31.0%; P = 0.004). There were no differences across quartiles for frequency of level-2 hypoglycemia events and lipid profile (LDL-cholesterol and non-HDL-cholesterol).

CONCLUSIONS

Low-carbohydrate intakes are associated with higher probabilities of reaching HbA1c target and of never having experienced level-3 hypoglycemia. No associations with level-2 hypoglycemia frequency, nor cardiovascular risk factors were observed.

The Portfolio Diet and HbA1c in Adults Living with Type 2 Diabetes Mellitus: A Patient-Level Pooled Analysis of Two Randomized Dietary Trials

(1) Background: The Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is also rich in low glycemic index (GI) foods. While strong evidence supports clinically meaningful reductions in cholesterol, evidence on the relationship between the Portfolio Diet and diabetes management is lacking. (2) Objective: To evaluate the relationship between the Portfolio Diet and glycated hemoglobin (HbA1c) as a determinant of glycemic control among adults living with type 2 diabetes mellitus (T2DM). (3) Methods: Patient-level data was pooled from two randomized dietary trials of low glycemic index interventions compared to high cereal fibre control diets in adults living with T2DM where HbA1c was collected (clinicaltrials.gov identifiers: NCT00438698, NCT00438698). Dietary exposure was assessed using weighed 7-day diet records. Adherence to the Portfolio Diet and its pillars (nuts and seeds, plant protein, viscous fibre, plant sterols, monounsaturated fatty acid [MUFA] oils) was determined using the validated clinical Portfolio Diet Score (c-PDS). Multiple linear regression was used to assess the association between change in the c-PDS and change in HbA1c over 6-months with covariate adjustments. (4) Results: A total of 267 participants, predominantly White (67%) and male (63%), were included, with a mean ± standard error age of 62 ± 0.5 years, baseline BMI of 30.2 ± 0.3 kg/m2, HbA1c of 7.08 ± 0.03%, and a c-PDS of 4.1 ± 0.3 points out of 25. Change in the c-PDS was significantly associated with a change in HbA1c (β: -0.04% per point, 95% CI: -0.07, -0.02, p = 0.001). A 7.5-point (30%) increase in the c-PDS was associated with a 0.3% reduction in HbA1c. Of the individual pillars, a 1-point change in nut and seeds intake (β: -0.07%, 95% CI: -0.12, -0.02, p = 0.009) or in plant protein intake (β: -0.11%, 95% CI: -0.18, -0.03, p = 0.009) was associated with a change in HbA1c. Further analysis of plant protein intake revealed that an increase in dietary pulse intake, a particularly low-GI food, was significantly associated with a reduction in HbA1c (β: -0.24% per 1-cup points cooked pulses (226 g) or 2 c-PDS points, 95% CI: -0.45, -0.03, p = 0.028). (5) Conclusions: Among adults living with T2DM, the Portfolio Diet was associated with lower HbA1c over a 6-month period, predominantly driven by two pillars: nuts and seeds and plant protein, particularly dietary pulses. These data have implications for including the Portfolio Diet in dietary recommendations for glycemic control in T2DM. A trial demonstrating the direct causal effect of the Portfolio Diet in a diverse group is warranted.

Metabolic Changes Following Smoking Cessation in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Smoking cessation is crucial for reducing complications of type 2 diabetes mellitus (T2DM), but associated weight gain can worsen glycemic control, discouraging quitting attempts. Varenicline, a partial agonist of α4β2 nicotinic receptors, aids smoking cessation. This study examines the effects of varenicline on body weight and metabolic parameters in patients with T2DM and prediabetes.

METHODS

Fifty-three patients were enrolled, of which 32 successfully quit smoking after a three-month course of varenicline and were examined after an additional month with no medication. Measurements taken at baseline, 2.5 months, and 4 months included body weight, blood pressure, resting metabolic rate (RMR), glycated hemoglobin (HbA1c), fasting glucose, blood lipids, C-reactive protein (CRP), appetite-related hormones, and physical activity.

RESULTS

Post-treatment, there were no significant changes in body weight, blood pressure, RMR, or glycemic control. Total (CHOL) and low-density lipoprotein (LDL-C) cholesterol decreased significantly at 4 months of the study (from 168 to 156 mg/dL, p = 0.013, and from 96 to 83 mg/dL, p = 0.013, respectively). Leptin levels increased (from 11 to 13.8 ng/dL, p = 0.004), as did glucagon-like peptide-1 (GLP-1) levels (from 39.6 to 45.8 pM, p = 0.016) at 4 months of follow-up. The percentage of participants who reported moderate-intensity activity increased from 28% to 56%, while those reporting high-intensity activity increased from 19% to 22%, respectively (p = 0.039).

CONCLUSIONS

Our study showed that smoking cessation with varenicline in smokers with T2DM and prediabetes led to significant improvements in lipid profile, significant increase in plasma leptin and GLP-1 levels, and increased physical activity, without significant weight gain. Thus, smoking cessation without weight gain or deteriorated glycemic control is feasible for these smokers, with added benefits to lipid profiles, GLP-1 regulation, and physical activity.

Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program

BACKGROUND

The rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors.

METHODS

Conducted from April to November 2020 in Huai'an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables.

RESULTS

Higher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels.

CONCLUSIONS

This study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.

Diabetes and Heart Failure: A Literature Review, Reflection and Outlook

Heart failure (HF) is a complex clinical syndrome caused by structural or functional dysfunction of the ventricular filling or blood supply. Diabetes mellitus (DM) is an independent predictor of mortality for HF. The increase in prevalence, co-morbidity and hospitalization rates of both DM and HF has further fueled the possibility of overlapping disease pathology between the two. For decades, antidiabetic drugs that are known to definitively increase the risk of HF are the thiazolidinediones (TZDs) and saxagliptin in the dipeptidyl peptidase-4 (DPP-4) inhibitor, and insulin, which causes sodium and water retention, and whether metformin is effective or safe for HF is not clear. Notably, sodium-glucose transporter 2 (SGLT2) inhibitors and partial glucagon-like peptide-1 receptor agonists (GLP-1 RA) all achieved positive results for HF endpoints, with SGLT2 inhibitors in particular significantly reducing the composite endpoint of cardiovascular mortality and hospitalization for heart failure (HHF). Further understanding of the mutual pathophysiological mechanisms between HF and DM may facilitate the detection of novel therapeutic targets to improve the clinical outcome. This review focuses on the association between HF and DM, emphasizing the efficacy and safety of antidiabetic drugs and HF treatment. In addition, recent therapeutic advances in HF and the important mechanisms by which SGLT2 inhibitors/mineralocorticoid receptor antagonist (MRA)/vericiguat contribute to the benefits of HF are summarized.

Prediction of personalised postprandial glycaemic response in type 1 diabetes mellitus

Objectives

Patients with type 1 diabetes (T1D) face unique challenges in glycaemic control due to the complexity and uniqueness of the dietary structure in China, especially in terms of postprandial glycaemic response (PPGR). This study aimed to establish a personalized model for predicting PPGR in patients with T1D.

Materials and methods

Data provided by the First People's Hospital of Yunnan Province, 13 patients with T1D, were recruited and provided with an intervention for at least two weeks. All patients were asked to wear a continuous glucose monitoring (CGM) device under free-living conditions during the study period. To tackle the challenge of incomplete data from wearable devices for CGM measurements, the GAIN method was used in this paper to achieve a more rational interpolation process. In this study, patients' PPGRs were calculated, and a LightGBM prediction model was constructed based on a Bayesian hyperparameter optimisation algorithm and a random search algorithm, which integrated glucose measurement, insulin dose, dietary nutrient content, blood measurement and anthropometry as inputs.

Results

The experimental outcomes revealed that the PPGR prediction model presented in this paper demonstrated superior accuracy (R=0.63) compared to both the carbohydrate content only model (R=0.14) and the baseline model emulating the standard of care for insulin administration (R=0.43). In addition, the interpretation of the model using the SHAP method showed that blood glucose levels at meals and blood glucose trends 30 minutes before meals were the most important features of the model.

Conclusion

The proposed model offers a heightened precision in predicting PPGR in patients with T1D, so it can better guide the diet plan and insulin intake dose of patients with T1D.

Sex- and age-specific associations of serum essential elements with diabetes among the Chinese adults: a community-based cross-sectional study

BACKGROUND

Although several studies have found the relationship between essential elements and diabetes, the studies about the association of essential elements with diabetes diagnosed according to an oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) in a sex- and age-specific manner were limited. To investigate the linear and nonlinear relationship of five essential elements including iron (Fe), copper (Cu), Zinc (Zn), magnesium (Mg), and calcium (Ca) with diabetes, fasting plasma glucose (FPG), 2-h postprandial plasma glucose (PPG), and HbA1c and to evaluate the sex- and age-specific heterogeneities in these relationships.

METHODS

A total of 8392 community-dwelling adults were recruited to complete a questionnaire and undergo checkups of anthropometric parameters and serum levels of five metals (Fe, Cu, Zn, Mg, and Ca). The multivariable logistic and linear regression, the restricted cubic spline (RCS) analysis, and subgroup analysis were applied to find the associations between the essential elements and the prevalence of diabetes as well as FPG, PPG, and HbA1c.

RESULTS

In the multivariable logistic regression and multivariable linear regression, serum Cu was positively associated with FPG, PPG, and HbA1c while serum Mg was significantly inversely correlated with FPG, PPG, HbA1c, and diabetes (all P < 0.001). In the RCS analysis, the non-linear relationship of Cu and diabetes (P < 0.001) was found. In the subgroup analysis, stronger positive associations of Cu with diabetes (P for interaction = 0.027) and PPG (P for interaction = 0.002) were found in younger women.

CONCLUSIONS

These findings may lead to more appropriate approaches to essential elements supplementation in people with diabetes of different ages and sexes. However, more prospective cohort and experimental studies are needed to probe the possible mechanism of sex- and age-specific associations between serum essential elements and diabetes.

Genetic analysis: Therapeutic drug monitoring of metformin and glimepiride on diabetic patients' plasma including genetic polymorphism

Diabetes is a widespread disease that needs to be controlled. Therapeutic monitoring of drugs is very helpful in maintaining desirable doses. To study a correlation between the blood level of metformin (to a lesser extent, glimepiride) and genotyping (mainly the SULT1A1 genotype). Determine drug levels using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) tool. A validated LC-MS/MS method was developed to determine metformin and glimepiride levels in human plasma. DNA extraction was performed using Jena Bioscience's Blood DNA preparation, in which a column kit was used to extract DNA for genetic polymorphism. The investigation was carried out using both medications in type 2 diabetes patients alongside the genetic polymorphism. One hundred and six patients were assessed. The prevalence of homozygosity for SULT1A1 and wild-type CYP2D6 * 4 were 72.6% and 73.6%, respectively. After adjustment for daily intake of metformin, three patients out of five with the highest levels of metformin had no homozygosity (SULT1A1 genotype). Statistically, variables that demonstrated an insignificant correlation with the level of metformin were body mass index (rs (87) = 0.32, P = 0.011) and age (rs (87) =0.26, P = 0.017). The homozygous (SULT1A1 genotype) correlation was moderate (rs (87) =0.21, P = 0.052). According to the findings, patients with the wt/wt CYP2D6 genotype had considerably greater levels of endoxifen than those with the v/v CYP2D6 genotype. The study's results reported a probable correlation between the blood level of metformin (to a lesser extent, glimepiride) and genotyping (mainly the SULT1A1 genotype). Genotype-guided drug therapy may provide a novel contribution to maximize drug efficacy and/or minimize toxicity.

Effect of structured diet with exercise education on anthropometry and lifestyle modification in patients with type 2 diabetes: A 12-month randomized clinical trial

AIMS

Lifestyle modification involving active engagement of specialised dietitian with diet and exercise education, can be effective as first-line treatment for diabetes.

METHODS

192 patients were enrolled with diabetes in a randomised controlled trial and followed up for one year. Ninety-four patients in the intervention group participated in a comprehensive structured diet and exercise education conducted by a specialised dietitian at ambulatory centre in the United Arab Emirates.

RESULTS

The mean difference in the change in body mass index between study groups at study exit and baseline was statistically significant (BMI difference = -1.86, 95 % CI -2.68 - -1.04, P < 0.01). The intervention group reported significant decrease in total carbohydrate and daily energy intake compared to baseline (173.7 g vs 221.1 g and 1828.5 kcal vs 2177.9 kcal, respectively). Moreover, the mean metabolic equivalents (METs) in the intervention group increased significantly at study exit from baseline compared to control group METs, with mean difference between all between-group differences after baseline of 0.63 (95 % 0.29 - 0.97, P < 0.01).

CONCLUSIONS

Structured diet and exercise counselling by specialised dietitian in ambulatory settings significantly reduced carbohydrate and daily energy intake, with improved anthropometric measurements and physical activity.

Knowledge-Infused LLM-Powered Conversational Health Agent: A Case Study for Diabetes Patients

Effective diabetes management is crucial for maintaining health in diabetic patients. Large Language Models (LLMs) have opened new avenues for diabetes management, facilitating their efficacy. However, current LLM-based approaches are limited by their dependence on general sources and lack of integration with domain-specific knowledge, leading to inaccurate responses. In this paper, we propose a knowledge-infused LLM-powered conversational health agent (CHA) for diabetic patients. We customize and leverage the open-source openCHA framework, enhancing our CHA with external knowledge and analytical capabilities. This integration involves two key components: 1) incorporating the American Diabetes Association dietary guidelines and the Nutritionix information and 2) deploying analytical tools that enable nutritional intake calculation and comparison with the guidelines. We compare the proposed CHA with GPT4. Our evaluation includes 100 diabetes-related questions on daily meal choices and assessing the potential risks associated with the suggested diet. Our findings show that the proposed agent demonstrates superior performance in generating responses to manage essential nutrients.

Cardiovascular health metrics defined by Life's Essential 8 scores and subsequent macrovascular and microvascular complications in individuals with type 2 diabetes: A prospective cohort study

AIM

To investigate the association between cardiovascular health metrics defined by Life's Essential 8 (LE8) scores and vascular complications among individuals with type 2 diabetes (T2D).

MATERIALS AND METHODS

This prospective study included 11 033 participants with T2D, all devoid of macrovascular diseases (including cardiovascular and peripheral artery disease) and microvascular complications (e.g. diabetic retinopathy, neuropathy and nephropathy) at baseline from the UK Biobank. The LE8 score comprised eight metrics: smoking, body mass index, physical activity, non-high-density lipoprotein cholesterol, blood pressure, glycated haemoglobin, diet and sleep duration. Cox proportional hazards models were established to assess the associations of LE8 scores with incident macrovascular and microvascular complications.

RESULTS

During a median follow-up of 12.1 years, we identified 1975 cases of incident macrovascular diseases and 1797 cases of incident microvascular complications. After adjusting for potential confounders, each 10-point increase in the LE8 score was associated with an 18% lower risk of macrovascular diseases and a 15% lower risk of microvascular complications. Comparing individuals in the highest and lowest quartiles of LE8 scores revealed hazard ratios of 0.55 (95% confidence interval 0.47-0.62) for incident macrovascular diseases, and 0.61 (95% confidence interval 0.53-0.70) for incident microvascular complications. This association remained robust across a series of sensitivity analyses and nearly all subgroups.

CONCLUSION

Higher LE8 scores were associated with a lower risk of incident macrovascular and microvascular complications among individuals with T2D. These findings underscore the significance of adopting fundamental strategies to maintain optimal cardiovascular health and curtail the risk of developing diabetic vascular complications.

Combined associations of visceral adipose tissue and adherence to a Mediterranean lifestyle with T2D and diabetic microvascular complications among individuals with prediabetes

BACKGROUND

It's unclear if excess visceral adipose tissue (VAT) mass in individuals with prediabetes can be countered by adherence to a Mediterranean lifestyle (MEDLIFE). We aimed to examine VAT mass, MEDLIFE adherence, and their impact on type 2 diabetes (T2D) and diabetic microvascular complications (DMC) in individuals with prediabetes.

METHODS

11,267 individuals with prediabetes from the UK Biobank cohort were included. VAT mass was predicted using a non-linear model, and adherence to the MEDLIFE was evaluated using the 25-item MEDLIFE index, encompassing categories such as "Mediterranean food consumption," "Mediterranean dietary habits," and "Physical activity, rest, social habits, and conviviality." Both VAT and MEDLIFE were categorized into quartiles, resulting in 16 combinations. Incident cases of T2D and related DMC were identified through clinical records. Cox proportional-hazards regression models were employed to examine associations, adjusting for potential confounding factors.

RESULTS

Over a median follow-up of 13.77 years, we observed 1408 incident cases of T2D and 714 cases of any DMC. High adherence to the MEDLIFE, compared to the lowest quartile, reduced a 16% risk of incident T2D (HR: 0.84, 95% CI: 0.71-0.98) and 31% for incident DMC (0.69, 0.56-0.86). Conversely, compared to the lowest quartile of VAT, the highest quartile increased the risk of T2D (5.95, 4.72-7.49) and incident any DMC (1.79, 1.36-2.35). We observed an inverse dose-response relationship between MEDLIFE and T2D/DMC, and a dose-response relationship between VAT and all outcomes (P for trend < 0.05). Restricted cubic spline analysis confirmed a nearly linear dose-response pattern across all associations. Compared to individuals with the lowest MEDLIFE quartile and highest VAT quartile, those with the lowest T2D risk had the lowest VAT and highest MEDLIFE (0.12, 0.08-0.19). High MEDLIFE was linked to reduced T2D risk across all VAT categories, except in those with the highest VAT quartile. Similar trends were seen for DMC.

CONCLUSION

High adherence to MEDLIFE reduced T2D and MDC risk in individuals with prediabetes, while high VAT mass increases it, but MEDLIFE adherence may offset VAT's risk partly. The Mediterranean lifestyle's adaptability to diverse populations suggests promise for preventing T2D.

Associations of a proinflammatory diet, habitual salt intake, and the onset of type 2 diabetes: A prospective cohort study from the UK Biobank

AIM

To explore the relationship between proinflammatory diet, habitual salt intake and the onset of type 2 diabetes.

METHODS

This prospective study was conducted among 171 094 UK Biobank participants who completed at least one 24-h dietary questionnaire and were free of diabetes at baseline. Participants were followed up until 1 March 2023 for type 2 diabetes incidence, with diagnosis information obtained from linked medical records. An Energy-adjusted Diet Inflammatory Index (E-DII) was calculated based on 28 food parameters. Habitual salt intake was determined through the self-reported frequency of adding salt to foods. The associations between E-DII, habitual salt intake and type 2 diabetes incidence were tested by the Cox proportional hazard regression model.

RESULTS

Over a median follow-up period of 13.5 years, 6216 cases of type 2 diabetes were documented. Compared with participants with a low E-DII (indicative of an anti-inflammatory diet), participants with a high E-DII (indicative of a proinflammatory diet) had an 18% heightened risk of developing type 2 diabetes. The association between E-DII and type 2 diabetes tends to be linear after adjustment for major confounders. Participants with a proinflammatory diet and always adding salt to foods had the highest risk of type 2 diabetes incidence (hazard ratio 1.60, 95% confidence interval 1.32-1.94).

CONCLUSIONS

Our findings indicate that a proinflammatory diet and higher habitual salt intake were associated with an increased risk of type 2 diabetes. These results support the public health promotion of an anti-inflammatory diet and reducing salt intake to prevent the onset of type 2 diabetes.

Long-term effects of a telemedically-assisted lifestyle intervention on glycemic control in patients with type 2 diabetes - A two-armed randomised controlled trial in Germany

Purpose

Diabetes is considered one of the fastest growing diseases worldwide. Especially in the treatment of type 2 diabetes, lifestyle interventions have proven to be effective. However, long-term studies in real-world contexts are rare, which is why further research is needed. The aim of the present study is to investigate whether effects achieved in the context of a long-term lifestyle intervention can be sustained by patients in the long term.

Methods

In a two-arm randomized trial we compared diabetes care as usual to a lifestyle intervention combining telemedically support and individual needs-based telephone coaching. The study included 151 patients with type 2 diabetes randomized to either the intervention or control group. Intervention Group (IG; N = 86, 80.2% male, mean age: 59.7) received telemedical devices and telephone coaching over a period of 12 months, Control Group (CG; N = 65, 83.1% male, mean age: 58,8) received care as usual. The primary outcome was chance in HbA1c. A follow-up survey was conducted after 24 months.

Results

The intervention group showed significantly better HbA1c- values compared to the control group at both 12 and 24 months (12 M: - 0.52 (-0.73; - 0.32), p < .000; 24 M: - 0.38 (-0.61; - 0.15), p = .001). The strongest change was seen in the first three months, with the best value obtained at 6 months and stable thereafter.

Conclusion

Combined telephone coaching with telemedicine support could lead to better long-term glycemic control in people with type 2 diabetes. In the future, more long-term studies should be conducted in real-world settings and lifestyle interventions should be offered more widely.

Impact of various dietary lipids on amelioration of biomarkers linked to metabolic syndrome in both healthy and diabetic Wistar rats

BACKGROUND

The present study was designed to investigate the influence of different dietary lipids (sheep's fat, olive oil, coconut oil, and corn oil) on specific biomarkers associated with metabolic syndrome in both healthy and diabetic rats.

METHODS

The study designed for 45 days, utilized a male diabetic wistar rat (body weight, 180-220 g) model induced by streptozotocin (45 mg/kg bw). The rats were divided into two sections: five non-diabetic and five diabetic groups, each containing six rats. The first group in each section serving as the control, received a standard diet. Both non-diabetic or diabetic groups, were provided with a standard diet enriched with 15% sheep fat, 15% coconut oil, 15% olive oil, and 15% corn oil, respectively for a duration of 45 days.

RESULTS

Post-supplementation, both healthy and diabetic control rats exhibited a higher food intake compared to rats supplemented with lipid diet; notably food intake was higher in diabetic control than healthy control. However, rats fed with coconut oil, olive oil and sheep fat showed weight gain at the end of the experiment, in both healthy and diabetic groups. Coconut oil supplementation significantly (p ≤ 0.05) increased HDL-C and total cholesterol level in diabetic groups compared to healthy group, it was confirmed by an increased PPAR-α and ABCA-1 protein level. Olive oil significantly decreased triglyceride, total cholesterol, and LDL-C levels in diabetic rats when compared to sheep fat or coconut oil. Corn oil significantly decreased fasting glucose, total cholesterol and LDL-C levels compared to all other groups. Corn and olive oil supplemented normal groups, found with significant increase in hepatic glucose-lipid oxidative metabolism associated protein, like FGF-21, MSH, ABCA-1, PPAR-γ and decreased lipogenesis proteins like, SREBP and PPAR-α levels. In contrast, sheep grease and coconut oil increased SREBP and PPAR-α expression in both normal and diabetic groups. Most notably, normal and diabetic groups pretreated with sheep grease resulted in increased inflammatory (MCP-1, IL-1β, TLR-4, TNF-α), and oxidative stress markers (LPO, GSH, GPx, SOD and CAT) linked with metabolic complications.

CONCLUSION

The combination or alternative use of olive oil and corn oil in daily diet may play a significant role in preventing proinflammatory condition associated with insulin resistance and cardiovascular diseases.

Effects of Dietary Carbohydrate Concentration and Glycemic Index on Blood Glucose Variability and Free Fatty Acids in Individuals with Type 1 Diabetes

Monitoring glycemic control status is the cornerstone of diabetes management. This study aimed to reveal whether moderate-carbohydrate (CHO) diets increase the risk of free fatty acid (FFA) levels, and it presents the short-term effects of four different diet models on blood sugar, glycemic variability (GV), and FFA levels. This crossover study included 17 patients with type 1 diabetes mellitus to identify the effects of four diets with different CHO contents and glycemic index (GI) on GV and plasma FFA levels. Diet 1 (D1) contained 40% CHO with a low GI, diet 2 (D2) contained 40% CHO with a high GI, diet 3 (D3) contained 60% CHO with a low GI, and diet 4 (D4) contained 60% CHO with a high GI. Interventions were performed with sensor monitoring in four-day periods and completed in four weeks. No statistical difference was observed among the groups in terms of blood glucose area under the curve (p = 0.78), mean blood glucose levels (p = 0.28), GV (p = 0.59), and time in range (p = 0.567). FFA and total triglyceride levels were higher in the D1 group (p < 0.014 and p = 0.002, respectively). Different diets may increase the risk of cardiovascular diseases by affecting GI, FFA, and blood glucose levels.

Understanding suboptimal insulin use in type 1 and 2 diabetes: a cross-sectional survey of healthcare providers who treat people with diabetes

BACKGROUND

The purpose of this study was to understand the healthcare provider (HCP) perspective on the extent of suboptimal insulin dosing in people with diabetes (PwD), as well as specific challenges and solutions to insulin management.

METHODS

An online survey of general practitioners and specialists (N = 640) who treat PwD in Germany, Spain, the United Kingdom, and the United States was conducted. Responses regarding HCP background and their patients, HCP perceptions of suboptimal insulin use, and challenges associated with optimal insulin use were collected. Categorical summary statistics were presented.

RESULTS

Overall, for type 1 diabetes (T1D) and type 2 diabetes (T2D), most physicians indicated < 30% of PwD missed or skipped a bolus insulin dose in the last 30 days (T1D: 83.0%; T2D: 74.1%). The top 3 reasons (other than skipping a meal) HCPs believed caused the PwD to miss or skip insulin doses included they "forgot," (bolus: 75.0%; basal: 67.5%) "were too busy/distracted," (bolus: 58.8%; basal: 48.3%), and "were out of their normal routine" (bolus: 57.8%; basal: 48.6%). HCPs reported similar reasons that they believed caused PwD to mistime insulin doses. Digital technology and improved HCP-PwD communication were potential solutions identified by HCPs to optimize insulin dosing in PwD.

CONCLUSIONS

Other studies have shown that PwD frequently experience suboptimal insulin dosing. Conversely, results from this study showed that HCPs believe suboptimal insulin dosing among PwD is limited in frequency. While no direct comparisons were made in this study, this apparent discrepancy could lead to difficulties in HCPs giving PwD the best advice on optimal insulin management. Approaches such as improving the objectivity of dose measurements for both PwD and HCPs may improve associated communications and help reduce suboptimal insulin dosing, thus enhancing treatment outcomes.

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross-Sectional Survey

Background

Diabetes distress (DD) is a negative emotion related to diabetes management and a predictor of depression; it affects diabetic retinopathy (DR) patients' quality of life and disease outcomes. The prevalence of DD was higher in patients undergoing surgery for DR. However, few studies have been conducted on DD in DR surgery patients. The present study aims to investigate the status of DD in DR surgery patients and identify factors associated with DD.

Methods

Using a convenience sampling method, 210 DR surgery patients who were admitted to 2 tertiary-level hospitals in Wenzhou City (Zhejiang Province) and Zhengzhou City (Henan Province) from February to June 2023 were selected as research subjects. A questionnaire collecting demographic and disease-related information, the Diabetes Distress Scale, the Summary of Diabetes Self-Management Activities, the Family Care Index Scale, and the Social Support Rating Scale were used to collect data. Statistical analyses included descriptive statistics, t tests, ANOVAs, Pearson's correlation analyses and stepwise multiple linear regression. This study is reported according to the STROBE guidelines.

Results

In total, 156 out of 210 (74.29%) DR surgery patients experienced DD, with an average score of 2.13±0.63. The results of the stepwise multiple regression analysis showed that residential location, employment status, self-management level, family support, and social support were significantly associated with DD. These variables accounted for 30.6% of the total variation in DD.

Conclusions

DR surgery patients exhibit moderate levels of distress. Health care professionals should pay attention to DD in DR surgery patients and develop targeted interventions to improve the self-management ability of these patients, increase their family support and social support to reduce their DD levels.

The therapeutic effect of mesenchymal stem cells in diabetic kidney disease

Abstract

Diabetes mellitus (DM) often causes chronic kidney damage despite best medical practices. Diabetic kidney disease (DKD) arises from a complex interaction of factors within the kidney and the whole body. Targeting specific disease-causing agents using drugs has not been effective in treating DKD. However, stem cell therapies offer a promising alternative by addressing multiple disease pathways and promoting kidney regeneration. Mesenchymal stem cells (MSCs) offer great promise due to their superior accessibility ratio from adult tissues and remarkable modes of action, such as the production of paracrine anti-inflammatory and cytoprotective substances. This review critically evaluates the development of MSC treatment for DKD as it moves closer to clinical application. Results from animal models suggest that systemic MSC infusion may positively impact DKD progression. However, few registered and completed clinical trials exist, and whether the treatments are effective in humans is still being determined. Significant knowledge gaps and research opportunities exist, including establishing the ideal source, dose, and timing of MSC delivery, better understanding of in vivo mechanisms, and developing quantitative indicators to obtain a more significant therapeutic response. This paper reviews recent literature on using MSCs in preclinical and clinical trials in DKD. Potent biomarkers related to DKD are also highlighted, which may help better understand MSCs’ action in this disease progression.

Key messages

Inflammation in diabetes complications: molecular mechanisms and therapeutic interventions

At present, diabetes mellitus (DM) has been one of the most endangering healthy diseases. Current therapies contain controlling high blood sugar, reducing risk factors like obesity, hypertension, and so on; however, DM patients inevitably and eventually progress into different types of diabetes complications, resulting in poor quality of life. Unfortunately, the clear etiology and pathogenesis of diabetes complications have not been elucidated owing to intricate whole-body systems. The immune system was responsible to regulate homeostasis by triggering or resolving inflammatory response, indicating it may be necessary to diabetes complications. In fact, previous studies have been shown inflammation plays multifunctional roles in the pathogenesis of diabetes complications and is attracting attention to be the meaningful therapeutic strategy. To this end, this review systematically concluded the current studies over the relationships of susceptible diabetes complications (e.g., diabetic cardiomyopathy, diabetic retinopathy, diabetic peripheral neuropathy, and diabetic nephropathy) and inflammation, ranging from immune cell response, cytokines interaction to pathomechanism of organ injury. Besides, we also summarized various therapeutic strategies to improve diabetes complications by target inflammation from special remedies to conventional lifestyle changes. This review will offer a panoramic insight into the mechanisms of diabetes complications from an inflammatory perspective and also discuss contemporary clinical interventions.

The therapeutic effect of mesenchymal stem cells in diabetic kidney disease

Diabetes mellitus (DM) often causes chronic kidney damage despite best medical practices. Diabetic kidney disease (DKD) arises from a complex interaction of factors within the kidney and the whole body. Targeting specific disease-causing agents using drugs has not been effective in treating DKD. However, stem cell therapies offer a promising alternative by addressing multiple disease pathways and promoting kidney regeneration. Mesenchymal stem cells (MSCs) offer great promise due to their superior accessibility ratio from adult tissues and remarkable modes of action, such as the production of paracrine anti-inflammatory and cytoprotective substances. This review critically evaluates the development of MSC treatment for DKD as it moves closer to clinical application. Results from animal models suggest that systemic MSC infusion may positively impact DKD progression. However, few registered and completed clinical trials exist, and whether the treatments are effective in humans is still being determined. Significant knowledge gaps and research opportunities exist, including establishing the ideal source, dose, and timing of MSC delivery, better understanding of in vivo mechanisms, and developing quantitative indicators to obtain a more significant therapeutic response. This paper reviews recent literature on using MSCs in preclinical and clinical trials in DKD. Potent biomarkers related to DKD are also highlighted, which may help better understand MSCs' action in this disease progression. KEY MESSAGES: Mesenchymal stem cells have anti-inflammatory and paracrine effects in diabetic kidney disease. Mesenchymal stem cells alleviate in animal models having diabetic kidney disease. Mesenchymal stem cells possess promise for the treatment of diabetic kidney disease.

Effectiveness of a Smartphone App to Promote Physical Activity Among Persons With Type 2 Diabetes: Randomized Controlled Trial

BACKGROUND

Physical activity is well known to have beneficial effects on glycemic control and to reduce risk factors for cardiovascular disease in persons with type 2 diabetes. Yet, successful implementation of lifestyle interventions targeting physical activity in primary care has shown to be difficult. Smartphone apps may provide useful tools to support physical activity. The DiaCert app was specifically designed for integration into primary care and is an automated mobile health (mHealth) solution promoting daily walking.

OBJECTIVE

This study aimed to investigate the effect of a 3-month-long intervention promoting physical activity through the use of the DiaCert app among persons with type 2 diabetes in Sweden. Our primary objective was to assess the effect on moderate to vigorous physical activity (MVPA) at 3 months of follow-up. Our secondary objective was to assess the effect on MVPA at 6 months of follow-up and on BMI, waist circumference, hemoglobin A1c, blood lipids, and blood pressure at 3 and 6 months of follow-up.

METHODS

We recruited men and women with type 2 diabetes from 5 primary health care centers and 1 specialized center. Participants were randomized 1:1 to the intervention or control group. The intervention group was administered standard care and access to the DiaCert app at baseline and 3 months onward. The control group received standard care only. Outcomes of objectively measured physical activity using accelerometers, BMI, waist circumference, biomarkers, and blood pressure were assessed at baseline and follow-ups. Linear mixed models were used to assess differences in outcomes between the groups.

RESULTS

A total of 181 study participants, 65.7% (119/181) men and 34.3% (62/181) women, were recruited into the study and randomized to the intervention (n=93) or control group (n=88). The participants' mean age and BMI were 60.0 (SD 11.4) years and 30.4 (SD 5.3) kg/m2, respectively. We found no significant effect of the intervention (group by time interaction) on MVPA at either the 3-month (β=1.51, 95% CI -5.53 to 8.55) or the 6-month (β=-3.53, 95% CI -10.97 to 3.92) follow-up. We found no effect on any of the secondary outcomes at follow-ups, except for a significant effect on BMI at 6 months (β=0.52, 95% CI 0.20 to 0.84). However, mean BMI did not differ between the groups at the 6-month follow-up.

CONCLUSIONS

We found no evidence that persons with type 2 diabetes being randomized to use an app promoting daily walking increased their levels of MVPA at 3 or 6 months' follow-up compared with controls receiving standard care. The effect of the app on BMI was unclear, and we found nothing to support an effect on secondary outcomes. Further research is needed to determine what type of mHealth intervention could be effective to increase physical activity among persons with type 2 diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03053336; https://clinicaltrials.gov/study/NCT03053336.

Dietary composition and time in range in population with type 2 diabetes mellitus-exploring the association using continuous glucose monitoring device

AIM

To understand the association between macronutrient composition of a diet with Time in Range (TIR), Time above Range (TAR) and Time below Range (TBR) derived using a Continuous Glucose Monitoring (CGM) device for 14 days.

METHODOLOGY

An exploratory analysis on the baseline data of 50 Type 2 Diabetes Mellitus participants with age 25-55 years, HbA1c upto 8% and on Metformin only) enrolled for an interventional clinical trial was performed.

RESULTS

Participants consuming adequate carbohydrates (CHO) of 55 to 60% of total calories had better Average Blood Glucose of 142.0 ± 24.0 mg/dL with a significance of p = 0.03 and Glucose Management Indicator (GMI) of 6.6 ± 0.7% significant at p = 0.01, than those with high CHO intake >60% of the total calories, with Average Blood Glucose - 155.0 ± 13.4 mg/dL and GMI - 7.06 ± 0.4%. Similarly, TIR - 68.2 ± 5.1% and TAR - 23.0 ± 10.8% was significantly better (p = 0.00) among those consuming adequate protein (12-15%) as compared to low protein (≤ 10%) with TIR- 61.0 ± 5.1% & TAR- 32.9 ± 10.3%. A correlation (r = -0.482 & p = 0.00) and simple linear regression analysis (R² = 0.33, F = 7.72, p = 0.000) revealed that when CHO intake increases the TIR decreases whereas TAR increases (r = 0.380 & p = 0.006). We did not find any significant relation between fat intake and TIR, TAR or TBR.

CONCLUSION

Our results suggest that lowering CHO, while increasing protein in the diet may help improve TIR. Further in-depth studies are needed to confirm these findings.