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Lam A, Piya MK, Foroughi N, Mohsin M, Chimoriya R, Kormas N, Conti J, Hay P. Predictors of Mental Health Outcomes in a Multidisciplinary Weight Management Program for Class 3 Obesity. Nutrients 2024; 16:1068. [PMID: 38613100 PMCID: PMC11013199 DOI: 10.3390/nu16071068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to examine the potential predictors of improvement in mental health outcomes following participation in an intensive non-surgical outpatient weight management program (WMP) in an Australian public hospital. This was a retrospective cohort study of all adults with Class 3 obesity (BMI ≥ 40 kg/m2) who enrolled in the WMP from March 2018 to June 2021. The participants completed the Eating Disorder Examination Questionnaire Short Version (EDE-QS), Kessler-10 Psychological Distress Scale, and 36-Item Short-Form Survey (SF-36) at baseline and 12-month follow-up. A total of 115 patients completed 12 months in the WMP and were included in the study, with 76.5% being female, a mean ± SD age at baseline of 51.3 ± 13.8 years, a weight of 146 ± 26 kg, and a BMI of 51.1 ± 8.6 kg/m2. The participants lost an average of 8.6 ± 0.2 kg over 12 months, and greater weight loss at follow-up was significantly associated with improved global EDE-QS scores, psychological distress, and improved mental health quality of life. However, improvements in most mental health outcomes were not predicted by weight loss alone. Notably, a lower eating disorder risk at baseline was associated with less psychological distress at follow-up and greater weight loss at follow-up. Our results also found an association between reduced psychological distress and reduced binge eating frequency. These findings support the inclusion components of obesity interventions that target the psychological correlates of obesity to support improved outcomes in people with Class 3 obesity. Future studies should aim to identify which aspects of the WMP helped improve people's psychological outcomes.
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Affiliation(s)
- Ashley Lam
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia;
| | - Milan K. Piya
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (M.K.P.); (N.F.); (R.C.)
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia;
| | - Nasim Foroughi
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (M.K.P.); (N.F.); (R.C.)
| | - Mohammed Mohsin
- Mental Health Research and Teaching Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 1871, Australia;
- Faculty of Medicine & Health, School of Clinical Medicine, Discipline of Psychiatry, University of New South Wales, Kensington, NSW 2052, Australia
| | - Ritesh Chimoriya
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (M.K.P.); (N.F.); (R.C.)
| | - Nic Kormas
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia;
| | - Janet Conti
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia;
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (M.K.P.); (N.F.); (R.C.)
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (M.K.P.); (N.F.); (R.C.)
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia;
- Mental Health Research and Teaching Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 1871, Australia;
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Chimoriya R, Mitlehner K, Khoo CL, Osuagwu UL, Thomson R, Si L, Lean M, Simmons D, Piya MK. Translation of a Diabetes Remission Service into Australian Primary Care: Findings from the Evaluation of DiRECT-Australia. J Diabetes Res 2024; 2024:2350551. [PMID: 38361965 PMCID: PMC10869186 DOI: 10.1155/2024/2350551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/02/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
Background The Diabetes Remission Clinical Trial (DiRECT) study demonstrated that an intensive and structured weight management program in UK primary care resulted in high rates of diabetes remission in adults with recent onset type 2 diabetes mellitus (T2DM). This study was aimed at evaluating the translation of the DiRECT intervention into an Australian primary care setting. Methods All patients enrolled in the DiRECT-Australia Type 2 Diabetes Remission Service in a region of Sydney (Macarthur region, South Western Sydney, Australia) were included. Eligible participants were aged 20-70 years, noninsulin treated, with T2DM of ≤6 years' duration, and body mass index (BMI) ≥ 27 kg/m2. Total diet replacement of 825-853 kcal/day using meal replacements was implemented for 12 weeks, followed by an ongoing structured program until 52 weeks, with regular follow-up with a general practitioner, dietitian, and/or practice nurse. Results Of 39 recruited participants, 32 (82.1%) and 27 (69.2%) completed 12 weeks and 52 weeks of the structured program, respectively. Decrease in weight by -12.0 kg (95% CI: -9.6, -14.4; p < 0.001) and -9.1 kg (95% CI: -5.2, -12.9; p < 0.001) and decrease in glycated haemoglobin (HbA1c) by -1.1% (95% CI: -0.6, -1.6; p < 0.001) and -0.6% (95% CI: -0.1, -1.1; p = 0.013) were observed at 12 and 52 weeks, respectively. At the end of 12 and 52 weeks, 93.8% (30/32) and 55.6% (15/27) of those with follow-up data met the criteria for diabetes remission, respectively. Quality of life and wellbeing scores increased over the course of 12 weeks, remaining significantly higher at 52 weeks. Participants reported they would be willing to pay A$92.50 (95% CI: A$75.80, A$109.30) per fortnight for the low-calorie meal replacement shakes. Conclusions These findings support the feasibility of a structured diabetes remission service in an Australian primary care setting to achieve improvements in glycaemia, weight, and quality of life and wellbeing, and suggest a substantial willingness to pay for diet replacement products among participants.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Kimberly Mitlehner
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Chee L. Khoo
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Healthfocus Family Practice, Ingleburn, NSW, Australia
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Bathurst Rural Clinical School (BRCS), Western Sydney University, Bathurst, NSW, Australia
| | - Russell Thomson
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, Australia
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Campbelltown and Camden Hospitals, Campbelltown, NSW, Australia
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Chimoriya R, MacMillan F, Lean M, Simmons D, Piya MK. A qualitative study of the perceptions and experiences of participants and healthcare professionals in the DiRECT-Australia type 2 diabetes remission service. Diabet Med 2024:e15301. [PMID: 38311881 DOI: 10.1111/dme.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND The UK Diabetes Remission Clinical Trial (DiRECT) study was replicated in an Australian primary care setting. This qualitative study aimed to explore and understand the perceptions and experiences of both participants and healthcare professionals (HCPs) involved in the DiRECT-Australia Type 2 Diabetes Remission Service. METHODS All participants and HCPs delivering the service were invited to participate in semi-structured interviews via online videoconferencing. The interview guides explored perceptions and experiences in DiRECT-Australia, covering aspects such as barriers and facilitators to recruitment and participation, motivations and challenges across service phases, adequacy of support provided and the overall acceptability of the service. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Eight DiRECT-Australia participants and six HCPs (three general practitioners, two practice nurses and one dietitian) participated. Four overarching themes were identified: (1) Enablers and barriers to recruitment and continuous participation in DiRECT-Australia; (2) Motivators and overcoming barriers across the total diet replacement, food reintroduction and weight maintenance phases; (3) Importance of participant-HCP interactions and continuous support; (4) Acceptance and long-term need for DiRECT-Australia. Adherence to total diet replacement was less challenging than anticipated by participants. Transitioning to the food reintroduction phase was difficult but overcome through HCP support. DiRECT-Australia was well accepted by both participants and HCPs, and participants expressed willingness to continue with the service, if provided on a long-term basis. CONCLUSIONS Both participants and HCPs were highly interested in the new diabetes remission service set up in an Australian primary care setting. The acceptability of DiRECT-Australia was underscored by participants emphasising the effectiveness of the service in achieving significant weight loss and diabetes remission. There is a need for long-term and wider implementation of the service to ensure that anyone with recent onset type 2 diabetes is offered the best possible chance to achieve remission.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Freya MacMillan
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
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Termaat J, Piya MK, McBride KA. Community-based care needs for adults with class III obesity before and after tertiary weight management: An exploratory study. Obes Sci Pract 2024; 10:e732. [PMID: 38213316 PMCID: PMC10782639 DOI: 10.1002/osp4.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024] Open
Abstract
Objective Class 3 obesity (severe obesity) is defined by a body mass index ≥40 kg/m2. Tertiary weight-management programs (WMPs) are hospital-based multidisciplinary services that aim to support individuals with severe obesity. Severe shortage of WMPs has led to waitlists and pressure on clinicians to discharge patients. Community obesity management often fails to support patients in maintaining weight loss/health gains. This study aimed to explore the needs of patients for community-based obesity care. Methods A qualitative study was undertaken via a tertiary WMP in Sydney, Australia. Semi-structured interviews/focus groups explored perceptions of purposively sampled patients and their clinicians on the community-based support needs of people with severe obesity. Data were audio-recorded, transcribed verbatim, and then thematically analyzed. Results Eleven patients and seven clinicians were interviewed. Four themes were identified: the importance of accountability and motivation to maintain weight-loss/health gains; limitations within community-based obesity management for those with severe obesity; perspectives on structured community programs for patients transitioning into/out of tertiary WMPs; and impact of mental health, stigma, and social isolation on engagement with community-based services. Conclusions Community-based programs are needed to support those awaiting access to tertiary WMPs and to help maintain health gains once discharged. Such programs should address issues of social isolation and integrate with current models of tertiary metabolic and primary health care.
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Affiliation(s)
- Jillian Termaat
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Milan K. Piya
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- South Western Sydney (SWS) Metabolic Rehabilitation and Bariatric ProgramCamden and Campbelltown HospitalsCamdenNew South WalesAustralia
- Translational Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Kate A. McBride
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- Translational Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
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Chimoriya R, Ho V, Wang ZV, Chang R, Boumelhem BB, Simmons D, Kormas N, Gorrell MD, Piya MK. Application and Diagnostic Performance of Two-Dimensional Shear Wave Elastography and Liver Fibrosis Scores in Adults with Class 3 Obesity. Nutrients 2023; 16:74. [PMID: 38201904 PMCID: PMC10780854 DOI: 10.3390/nu16010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
There are no ideal non-invasive tests for assessing the severity of liver fibrosis in people with metabolic dysfunction-associated steatotic liver disease (MASLD) and class 3 obesity, where body habitus often makes imaging technically challenging. This study aimed to assess the applicability and diagnostic performance of two-dimensional shear wave elastography (2D-SWE), alongside several serum-based liver fibrosis scoring methods, in individuals with class 3 obesity. A cross-sectional study was conducted in patients aged ≥18 years and with a body mass index (BMI) ≥ 40 kg/m2 who were participants in a publicly funded multidisciplinary weight management program in South Western Sydney. The 2D-SWE was performed using the ElastQ Imaging (EQI) procedure with the Phillips EPIQ Elite series ultrasound. An EQI Median value of ≥6.43 kPa was taken as a cutoff score for significant fibrosis, and the scan was considered valid when the liver EQI IQR/Med value was <30%. The Fibrosis-4 (FIB-4) index, AST-to-platelet ratio index (APRI), NAFLD fibrosis score (NFS), and circulating fibroblast activation protein index (FAP index) were calculated from fasting blood samples. The participants (n = 116; 67.2% female) were aged 47.2 ± 12.9 years, with BMI 54.5 ± 11.0 kg/m2. EQI Median values were obtained for 97.4% (113/116) of the 2D-SWE scans, and 91.4% (106/116) of the scans were considered valid. The EQI Median values exhibited a moderately positive correlation with the FIB-4 index (r = 0.438; p < 0.001) and a weakly positive correlation with the APRI (r = 0.388; p < 0.001), NFS (r = 0.210; p = 0.036) and FAP index (r = 0.226; p = 0.020). All liver fibrosis scores were positively correlated with one another. Among those referred for a liver biopsy based on the 2D-SWE and serum scores, half (11/22) underwent liver biopsy, and their 2D-SWE scores exhibited 72.7% accuracy (sensitivity: 71.4%; specificity: 75%) in detecting significant fibrosis. Our results show that 2D-SWE is a feasible, non-invasive test to assess liver fibrosis among people with class 3 obesity. Further research is needed to assess how 2D-SWE can be used alongside existing serum-based risk scores to reliably detect significant fibrosis, which would potentially reduce the need for invasive liver biopsy.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (V.H.); (D.S.)
| | - Vincent Ho
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (V.H.); (D.S.)
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
| | - Ziqi Vincent Wang
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Z.V.W.); (B.B.B.); (M.D.G.)
| | - Ruby Chang
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
| | - Badwi B. Boumelhem
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Z.V.W.); (B.B.B.); (M.D.G.)
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (V.H.); (D.S.)
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
| | - Nic Kormas
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
| | - Mark D. Gorrell
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Z.V.W.); (B.B.B.); (M.D.G.)
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (V.H.); (D.S.)
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
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Yang Y, Conti J, McMaster CM, Piya MK, Hay P. "I Need Someone to Help Me Build Up My Strength": A Meta-Synthesis of Lived Experience Perspectives on the Role and Value of a Dietitian in Eating Disorder Treatment. Behav Sci (Basel) 2023; 13:944. [PMID: 37998690 PMCID: PMC10669240 DOI: 10.3390/bs13110944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Dietitians are included in eating disorder (ED) treatment teams for their expertise in nutrition. However, little is known about an individual's experience of dietetic intervention as part of their ED treatment and what they value as part of dietetic care. Therefore, the aim of this review was to synthesise the available qualitative literature to understand the role and value of a dietitian in ED treatment from the perspective of individuals with lived experience. Six databases and Google Scholar were searched and a thematic synthesis and meta-synthesis of fifteen studies were conducted. Four themes were constructed from the data: (1) "guidance and structure"-Provision of nutrition knowledge and skills; (2) "having all my bases covered"-Dietitians as part of a multidisciplinary team; (3) Challenges in nutritional treatment; and (4) "it was my treatment and my recovery"-Person-centred dietetic treatment. Across all identified themes was the cross-cutting theme of a shared treatment journey between the dietitian and the individual receiving treatment. These findings support dietitians having a role that is not limited only to the provision of nutrition treatment in ED care and illustrates the importance of dietitians engaging with clients by centring on the individual's needs and preferences. Further understanding helpful dietetic treatment components and identifying gaps in training is needed to develop these broader roles for dietetic care.
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Affiliation(s)
- Yive Yang
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.); (M.K.P.)
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.); (M.K.P.)
- School of Psychology, Western Sydney University, Penrith, NSW 2750, Australia
| | - Caitlin M. McMaster
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia;
- Eating Disorder and Nutrition Research Group (ENRG), Translational Health Research Institute, Faculty of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Milan K. Piya
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.); (M.K.P.)
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Liverpool, NSW 2560, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.); (M.K.P.)
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Liverpool, NSW 2560, Australia
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Law KK, Coyle DH, Neal B, Huang L, Barrett EM, Arnott C, Chow CK, Di Tanna GL, Lung T, Mozaffarian D, Berkowitz SA, Wong J, Wu T, Twigg S, Gauld A, Simmons D, Piya MK, MacMillan F, Khoo CL, Tian M, Trieu K, Wu JHY. Protocol for a randomized controlled trial of medically tailored meals compared to usual care among individuals with type 2 diabetes in Australia. Contemp Clin Trials 2023; 132:107307. [PMID: 37516164 DOI: 10.1016/j.cct.2023.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND 'Food is medicine' strategies aim to integrate food-based nutrition interventions into healthcare systems and are of growing interest to healthcare providers and policy makers. 'Medically Tailored Meals' (MTM) is one such intervention, which involves the 'prescription' by healthcare providers of subsidized, pre-prepared meals for individuals to prevent or manage chronic conditions, combined with nutrition education. OBJECTIVE This study will test the efficacy of an MTM program in Australia among participants with type 2 diabetes (T2D) and hyperglycemia, who experience difficulties accessing and eating nutritious food. METHODS This study will be a two-arm parallel trial (goal n = 212) with individuals randomized in a 1:1 ratio to a MTM intervention group or a control group (106 per arm). Over 26 weeks, the intervention group will be prescribed 20 MTM per fortnight and up to 3 sessions with an accredited dietitian. Controls will continue with their usual care. The primary outcome is glycated hemoglobin (HbA1c, %) and secondary outcomes include differences in blood pressure, blood lipids and weight, all measured at 26 weeks. Process and economic data will be analyzed to assess the feasibility, acceptability, scalability, and cost-effectiveness of the intervention. Recruitment commenced in the first quarter of 2023, with analyses and results anticipated to be available by March 2025. DISCUSSION Few randomized controlled trials have assessed the impact of MTM on clinical outcomes. This Australian-first trial will generate robust data to inform the case for sustained, large-scale implementation of MTM to improve the management of T2D among vulnerable populations. ANZCTR ACTRN12622000852752. PROTOCOL VERSION Version 1.1, July 2023.
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Affiliation(s)
- Kristy K Law
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | - Daisy H Coyle
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Liping Huang
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Eden M Barrett
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Clare Arnott
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Clara K Chow
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Thomas Lung
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
| | - Seth A Berkowitz
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jencia Wong
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, Central Clinical School, Central Sydney (Patyegarang) Precinct, University of Sydney, NSW, Australia
| | - Ted Wu
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Stephen Twigg
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, Central Clinical School, Central Sydney (Patyegarang) Precinct, University of Sydney, NSW, Australia
| | - Amanda Gauld
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
| | - Freya MacMillan
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia.; School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Chee L Khoo
- Healthfocus Family Practice, Sydney, NSW, Australia
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, Harbin Medical University, Harbin, China
| | - Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Dashputre A, Agho KE, Piya MK, Glenister K, Bourke L, Hannah S, Bhat R, Osuagwu UL, Simmons D. Prevalence and factors associated with mental health problems of psychological distress and depression among rural Victorians - analysis of cross-sectional data (Crossroads II). BMC Psychiatry 2023; 23:450. [PMID: 37340331 DOI: 10.1186/s12888-023-04931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Research suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems. METHODS The Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016-18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders. RESULTS Of the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community participation reduced the risk of mental health problems. Compared to rural towns, the regional town had higher risk of depression which was non-significant after adjusting for community participation and health conditions. CONCLUSIONS The high prevalence of psychological distress and depression in this rural population was consistent with other rural studies. Personal and lifestyle factors were more relevant to mental health problems than degree of rurality in Victoria. Targeted lifestyle interventions could assist in reducing mental illness risk and preventing further distress.
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Affiliation(s)
- Anushka Dashputre
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Macarthur Diabetes Endocrinology Metabolism Services, Camden and Campbelltown Hospitals, Campbelltown, NSW, 2560, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, VIC, Australia
| | - Lisa Bourke
- Department of Rural Health, University of Melbourne, Shepparton, VIC, Australia
| | - Stephanie Hannah
- School of Science, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Ravi Bhat
- Department of Rural Health, University of Melbourne, Shepparton, VIC, Australia
| | - Uchechukwu L Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Bathurst Rural Clinical School (BRCS), School of Medicine, Western Sydney University, Bathurst, NSW, 2795, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- Macarthur Diabetes Endocrinology Metabolism Services, Camden and Campbelltown Hospitals, Campbelltown, NSW, 2560, Australia.
- Department of Rural Health, University of Melbourne, Shepparton, VIC, Australia.
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Khoo CL, Chimoriya R, Simmons D, Piya MK. Partial meal replacement for people with type 2 diabetes: 2-year outcomes from an Australian general practice. Aust J Prim Health 2023; 29:74-80. [PMID: 36318919 DOI: 10.1071/py22180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to determine weight loss and improvement in glycaemia at 12 and 24months in patients with type 2 diabetes mellitus (T2DM), following a 3-month partial meal replacement and subsequent reduced calorie diet. METHODS This was a retrospective cohort study of patients with T2DM attending a solo general practice in Sydney, New South Wales, Australia. Participants were advised to follow a 3-month partial meal replacement plan comprising of two meal replacement shakes plus a healthy meal. Over the subsequent 21months, patients were encouraged to follow a reduced calorie diet with a particular emphasis on lowering carbohydrate intake. RESULTS Of the 153 patients with T2DM, 51 (33.3%) agreed to follow a 3-month partial meal replacement plan, which was completed by 66.7% (n =34/51). Compared to baseline, the average weight loss at 12 and 24months was 7.1±7.0kg (102.2±20.9kg vs 95.1±18.7kg, P <0.001) and 4.2±7.7kg (102.2±20.9kg vs 98.0±18.2kg, P =0.003), respectively. Haemoglobin A1c (HbA1c) was significantly reduced at 12months (6.9±1.5% vs 6.3±0.9%, P =0.003), but not at 24months. The proportion of participants that met the criteria for diabetes remission was similar at baseline (8.8%) and 12months (11.8%), but increased to 32.4% at 24months (P =0.016). CONCLUSIONS Patients with T2DM who were able to follow a partial meal replacement plan for 3months with advice from a general practitioner achieved significant weight loss over 24months. A multicentre randomised controlled trial to confirm these findings is required as this could significantly change the management of T2DM in primary care.
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Affiliation(s)
- Chee L Khoo
- Healthfocus Family Practice, Ingleburn, NSW 2565, Australia; and School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; and Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; and Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
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10
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Hannah S, Agho KE, Piya MK, Glenister K, Bourke L, Osuagwu UL, Simmons D. Trends and Factors Associated with Obesity Prevalence in Rural Australian Adults-Comparative Analysis of the Crossroads Studies in Victoria over 15 Years. Nutrients 2022; 14:4557. [PMID: 36364819 PMCID: PMC9659019 DOI: 10.3390/nu14214557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 08/14/2023] Open
Abstract
This study examined the changes in the prevalence of obesity and associated lifestyle factors using data from repeated cross-sectional, self-reported surveys (Crossroads I: 2001-2003 and Crossroads II: 2016-2018, studies) and clinic anthropometric measurements collected from regional and rural towns in the Goulburn Valley, Victoria. Given that past community studies have only focused categorically on dietary intake, or assessed caloric energy intake, we examined the difference in broad dietary practices at two different times. Clinical assessments from randomly selected household participants aged ≥18 years were analyzed. Differences in obesity prevalence were calculated for each individual variable. Logistic regression was used to determine the odds ratios (95% confidence intervals (CI)) with and without adjustment for key lifestyle factors. There were 5258 participants in Crossroads I and 2649 in Crossroads II surveys. Obesity prevalence increased from 28.2% to 30.8% over 15 years, more among those who ate fried food, but decreased significantly among rural dwellers (31.7: 27.0, 36.8% versus 25.1: 22.9, 27.5%) and those who had adequate fruit intake (28.5: 25.0, 32.3% to 23.9: 21.8, 26.2%). Obesity was associated with older age (≥35 years), use of fat-based spreads for bread (adjusted odds ratio, aOR:1.26: 1.07, 1.48) and physical inactivity. The increase in obesity prevalence especially in the rural towns, was associated with unhealthy dietary behaviour which persisted over 15 years. Understanding and addressing the upstream determinants of dietary intake and choices would assist in the development of future health promotion Programs.
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Affiliation(s)
- Stephanie Hannah
- School of Science, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Kingsley E. Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Milan K. Piya
- Macarthur Diabetes Endocrinology Metabolism Services, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, VIC 3010, Australia
| | - Lisa Bourke
- Department of Rural Health, University of Melbourne, Shepparton, VIC 3632, Australia
| | - Uchechukwu L. Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Bathurst Rural Clinical School (BRCS), School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - David Simmons
- Macarthur Diabetes Endocrinology Metabolism Services, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Department of Rural Health, University of Melbourne, Shepparton, VIC 3632, Australia
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11
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Rana K, Chimoriya R, Haque NB, Piya MK, Chimoriya R, Ekholuenetale M, Arora A. Prevalence and Correlates of Underweight among Women of Reproductive Age in Nepal: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:11737. [PMID: 36142012 PMCID: PMC9516984 DOI: 10.3390/ijerph191811737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to examine the prevalence of underweight and determine the sociodemographic and household environmental correlates of underweight among women of reproductive age in Nepal. This study also compared the time trends in the prevalence of underweight with the trends in the prevalence of overweight and obesity. This cross-sectional study was a secondary data analysis of the nationally representative population-based Nepal Demographic and Health Surveys (NDHSs). Firstly, the time trends of the prevalence of underweight (body mass index (BMI) < 18.5 kg/m2) among women aged 15-49 years were examined at five-year intervals, from the 1996, 2001, 2006, 2011, and 2016 NDHSs (n = 33,507). Secondly, the sociodemographic and household environmental correlates of underweight were examined from the latest NDHS 2016 (n = 6165). Univariable and multivariable logistic regression analyses were performed to examine the sociodemographic and household environmental correlates of underweight. From 1996 to 2016, the prevalence of underweight decreased from 25.3% (95% confidence interval (CI) 23.8%, 26.8%) to 16.9% (95%CI 16.0%, 17.8%), while the prevalence of overweight and obesity increased from 1.6% (95%CI 1.2%, 2.1%) to 15.6% (95%CI 14.7%, 16.5%) and 0.2% (95%CI 0.1%, 0.4%) to 4.1% (95%CI 3.6%, 4.6%), respectively. Sociodemographic factors, such as age, educational status, marital status, wealth index, and religion, were independently associated with the risk of underweight. Similarly, household environmental factors, such as province of residence, ecological zone, type of toilet facility, and household possessions, including television and mobile phone, were independently associated with the risk of underweight. Despite the declining trends, the prevalence of underweight among Nepalese women remains a public health challenge. Understanding the key sociodemographic and household environmental correlates of underweight may assist in streamlining the content of health promotion campaigns to address undernutrition and potentially mitigate adverse health outcomes.
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Affiliation(s)
- Kritika Rana
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
| | - Ritesh Chimoriya
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Nabila Binte Haque
- Department of Health Systems and Populations, Macquarie University, Macquarie Park, Sydney, NSW 2109, Australia
| | - Milan K. Piya
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
| | - Romila Chimoriya
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
- Department of Pediatrics, Nepal Medical College Teaching Hospital, Kathmandu 44600, Nepal
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan 200214, Nigeria
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia
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12
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Ralph AF, Brennan L, Byrne S, Caldwell B, Farmer J, Hart LM, Heruc GA, Maguire S, Piya MK, Quin J, Trobe SK, Wallis A, Williams-Tchen AJ, Hay P. Management of eating disorders for people with higher weight: clinical practice guideline. J Eat Disord 2022; 10:121. [PMID: 35978344 PMCID: PMC9386978 DOI: 10.1186/s40337-022-00622-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population. AIM The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. METHODS The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience. RECOMMENDATIONS Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed. CONCLUSIONS This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.
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Affiliation(s)
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Wodonga, Australia
| | - Sue Byrne
- Department of Psychology, University of Western Australia, Perth, Australia
| | | | - Jo Farmer
- Lived Experience Advocate, Melbourne, Australia
| | - Laura M. Hart
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Gabriella A. Heruc
- Eating Disorders and Nutrition Research Group (ENRG), School of Medicine, Western Sydney University, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, Sydney, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Macarthur Clinical School, Sydney, Australia
- Camden and Campbelltown Hospitals, Sydney, Australia
| | - Julia Quin
- Lived Experience Advocate, Melbourne, Australia
| | - Sarah K. Trobe
- National Eating Disorders Collaboration, Sydney, Australia
| | - Andrew Wallis
- Sydney Children’s Hospitals Network, The Children’s Hospital Westmead, Sydney, Australia
| | | | - Phillipa Hay
- Eating Disorders and Body Image (EDBI), Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- South Western Sydney Local Health District, Sydney, Australia
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Affiliation(s)
- Claire J Foldi
- Department of Physiology, Monash University, Clayton, VIC, Australia,Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Morgan H James
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA,Brain Health Institute, Rutgers University, Piscataway, NJ, USA
| | - Robyn M Brown
- Department of Biochemistry and Pharmacology, University of Melbourne, Parkville, VIC, Australia,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia,Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
| | - Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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14
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Piya MK, Fletcher T, Myint KP, Zarora R, Yu D, Simmons D. The impact of nursing staff education on diabetes inpatient glucose management: a pilot cluster randomised controlled trial. BMC Endocr Disord 2022; 22:61. [PMID: 35272649 PMCID: PMC8911103 DOI: 10.1186/s12902-022-00975-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND An increasing number of patients in hospital have diabetes, with most of them cared for by non-specialist staff. The effect of diabetes education for staff on patient outcomes, as well as the most effective method of staff education is unclear. Therefore, the aim of this study was to compare diabetes outcomes in medical wards where nursing staff were offered one face-to-face (F2F) session followed by access to online education (online), F2F education only, or standard care (control). METHODS We conducted a pilot cluster randomised controlled trial involving 16-weeks baseline/rollout followed by a 28-week post-intervention period across three medical wards (clusters) in a Sydney Teaching Hospital. The online ward provided an online competency-based diabetes education program and 1-h F2F teaching from a diabetes nurse educator (DNE), the F2F ward provided four separate 1-h teaching sessions by a DNE, with no additional sessions in the control ward. The primary outcome was length of stay (LOS); secondary outcomes included good diabetes days (GDD), hypoglycaemia and medication errors. Poisson and binary logistic regression were used to compare clusters. RESULTS Staff attendance/completion of ≥ 2 topics was greater with online than F2F education [39/48 (81%) vs 10/33 (30%); p < 0.001]. Among the 827/881 patients, there was no difference in LOS change between online [Median(IQR) 5(2-8) to 4(2-7) days], F2F [7(4-14) to 5(3-13) days] or control wards [5(3-9) to 5(3-7) days]. GDD improved only in the online ward 4.7(2.7-7.0) to 6.0(2.3-7.0) days; p = 0.038. Total patients with hypoglycaemia and appropriately treated hypoglycaemia increased in the online ward. CONCLUSIONS The inclusion of online education increased diabetes training uptake among nursing staff. GDD and appropriate hypoglycaemia management increased in the online education wards. TRIAL REGISTRATION Prospectively registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) on 24/05/2017: ACTRN12617000762358 .
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Affiliation(s)
- Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia.
| | - Therese Fletcher
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
| | - Kyaw P Myint
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Reetu Zarora
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
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Kodsi R, Chimoriya R, Medveczky D, Grudzinskas K, Atlantis E, Tahrani AA, Kormas N, Piya MK. Clinical Use of the Edmonton Obesity Staging System for the Assessment of Weight Management Outcomes in People with Class 3 Obesity. Nutrients 2022; 14:967. [PMID: 35267942 PMCID: PMC8912843 DOI: 10.3390/nu14050967] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to assess weight loss and metabolic outcomes by severity of weight-related complications following an intensive non-surgical weight management program (WMP) in an Australian public hospital. A retrospective cohort study of all patients aged ≥18 years with body mass index (BMI) ≥ 40 enrolled in the WMP during March 2018−March 2019 with 12-month follow-up information were stratified using the Edmonton Obesity Staging System (EOSS). Of 178 patients enrolled in the WMP, 112 (62.9%) completed at least 12 months’ treatment. Most patients (96.6%) met EOSS-2 (56.7%) or EOSS-3 (39.9%) criteria for analysis. Both groups lost significant weight from baseline to 12 months; EOSS-2: 139.4 ± 31.8 kg vs. 131.8 ± 31.8 kg (p < 0.001) and EOSS-3: 141.4 ± 24.2 kg vs. 129.8 ± 24.3 kg (p < 0.001). After adjusting for baseline age, sex and employment status, mean weight loss was similar but a greater proportion of EOSS-3 achieved >10% weight loss compared to EOSS-2, (40% vs. 15.9%, p = 0.024). Changes in metabolic parameters including HbA1c, BP and lipids did not differ between EOSS-2 and 3. Despite increased clinical severity, adult patients with class 3 obesity achieved clinically meaningful weight loss and similar improvements in metabolic parameters compared to patients with less severe complications after 12 months in an intensive non-surgical WMP.
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Affiliation(s)
- Raymond Kodsi
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
| | - David Medveczky
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Nepean, NSW 2747, Australia
| | - Abd A. Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK;
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham B15 2TT, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Trust, Birmingham B15 2TT, UK
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
| | - Milan K. Piya
- South Western Sydney Metabolic Rehabilitation and Bariatric Program (SWS MRBP), Camden and Campbelltown Hospitals, Camden, NSW 2570, Australia; (R.K.); (K.G.); (N.K.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (D.M.)
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Osuagwu UL, Xu M, Piya MK, Agho KE, Simmons D. Factors associated with long intensive care unit (ICU) admission among inpatients with and without diabetes in South Western Sydney public hospitals using the New South Wales admission patient data collection (2014-2017). BMC Endocr Disord 2022; 22:27. [PMID: 35057791 PMCID: PMC8781508 DOI: 10.1186/s12902-022-00933-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long stay in intensive care unit (ICU) is associated with poor outcomes, particularly in people with diabetes. It increases the financial burden of care and this is a challenge to the South Western Sydney region, which is already a hotspot for diabetes in Australia. This study compared ICU admission characteristics of people with and without diabetes and the factors associated with long ICU stay among patients admitted to public hospitals in this metropolitan health district from 2014 to 2017. METHODS Cross-sectional datasets on 187,660, including all ICU admissions in the New South Wales Admitted Patient Data Collection (APDC) from June 2014 - July 2017 in public hospital were extracted. Data on demographic and health insurance status, primary admission diagnosis using ICD-10, comorbidities including death among hospital inpatients aged ≥18 years residing in SWS were analysed. The ICU length of stay was the outcome variable and were classified into short stay (≤48 h) and long stay (> 48 h), and were examined against potential confounding factors using bivariate and multiple logistic regression analyses. RESULTS Our results showed higher ICU admissions in patients with diabetes than in those without diabetes (5% vs. 3.3%, P < 0.001) over three years. The median and interquartile range (IQR) of length of the ICU stay were similar in both groups [diabetes: 40 h, IQR = 16-88 h vs. non-diabetes: 43 h, IQR = 19-79 h]. The prevalence of long ICU stays among people with and without diabetes were 44.9% [95% CI 42.1, 47.7%] and 43.6% [95% CI 42.2, 44.9%], respectively. For both groups, increased odds of long ICU stay were associated with death and circulatory system disease admissions, while musculoskeletal disease admissions were associated with lower risk of long ICU stay. In the non-diabetes group, male sex, nervous system disease admissions and living in peri-urban areas were associated with higher odds of long ICU stay. CONCLUSIONS The rate of ICU admissions among inpatients remain higher in people with diabetes. One in every two admissions to ICU had a long stay. Additional care for those admitted with circulatory system diseases are needed to reduce long ICU stay related deaths in SWS.
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Affiliation(s)
- Uchechukwu L Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa.
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Matthew Xu
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Milan K Piya
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Macarthur Diabetes Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - David Simmons
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Macarthur Diabetes Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
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17
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Ee CC, Armour M, Piya MK, McMorrow R, Al-Kanini I, Sabag A. Mindfulness-based interventions for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2021. [DOI: 10.1002/14651858.cd014881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Carolyn C Ee
- NICM Health Research Institute; Western Sydney University; Penrith Australia
| | - Mike Armour
- NICM Health Research Institute; Western Sydney University; Penrith Australia
| | - Milan K Piya
- School of Medicine; Western Sydney University; Campbelltown Australia
| | - Rita McMorrow
- The Department of General Practice; The University of Melbourne; Melbourne Australia
| | - Ieman Al-Kanini
- School of Medicine, Western Sydney University; Penrith Australia
| | - Angelo Sabag
- NICM Health Research Institute; Western Sydney University; Penrith Australia
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18
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Kobuch S, Tsang F, Chimoriya R, Gossayn D, O’Brien S, Jamal J, Laks L, Tahrani A, Kormas N, Piya MK. Obstructive sleep apnoea and 12-month weight loss in adults with class 3 obesity attending a multidisciplinary weight management program. BMC Endocr Disord 2021; 21:227. [PMID: 34774056 PMCID: PMC8590787 DOI: 10.1186/s12902-021-00887-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although there is a strong association between obesity and obstructive sleep apnoea (OSA), the effects of OSA and CPAP therapy on weight loss are less well known. The aim of this study in adults with class 3 obesity attending a multidisciplinary weight management program was to assess the relationship between OSA and CPAP usage, and 12-month weight change. METHODS A retrospective cohort study of all patients commencing an intensive multidisciplinary publicly funded weight management program in Sydney, Australia, between March 2018 and March 2019. OSA was diagnosed using laboratory overnight sleep studies. Demographic and clinical data, and use of CPAP therapy was collected at baseline and 12 months. CPAP use was confirmed if used ≥4 h on average per night on download. RESULTS Of the 178 patients who joined the program, 111 (62.4 %) completed 12 months in the program. At baseline, 63.1 % (n=70) of patients had OSA, of whom 54.3 % (n=38) were using CPAP. The non-OSA group had more females compared to the OSA with CPAP group and OSA without CPAP group (90.2 % vs. 57.9 % and 62.5 %, respectively; p=0.003), but there were no significant baseline differences in BMI (50.4±9.3 vs. 52.1±8.7 and 50.3±9.5 kg/m2, respectively; p=0.636). There was significant weight loss across all three groups at 12 months. However, there were no statistically significant differences across groups in the percentage of body weight loss (OSA with CPAP: 6.3±5.6 %, OSA without CPAP: 6.8±6.9 %, non-OSA: 7.2±6.5 %; p=0.844), or the proportion of patients who achieved ≥5 % body weight loss (OSA with CPAP: 57.9 %, OSA without CPAP: 59.4 %, non-OSA: 65.9 %; p=0.743). In patients with T2DM, there was a significant reduction in HbA1c from baseline to 12 months (7.8±1.7 % to 7.3±1.4 %, p=0.03), with no difference between groups (p=0.997). CONCLUSIONS This multidisciplinary weight management program resulted in significant weight loss at 12 months, regardless of OSA diagnosis or CPAP use in adults with class 3 obesity. Larger studies are needed to further investigate the effects of severity of OSA status and CPAP use in weight management programs. Until completed, this study suggests that the focus should remain on implementing lifestyle changes and weight management regardless of OSA status.
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MESH Headings
- Adult
- Aged
- Case-Control Studies
- Cholesterol/metabolism
- Continuous Positive Airway Pressure/methods
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Female
- Humans
- Hypoglycemic Agents/therapeutic use
- Lipoproteins, HDL/metabolism
- Lipoproteins, LDL/metabolism
- Male
- Middle Aged
- Obesity, Morbid/complications
- Obesity, Morbid/metabolism
- Obesity, Morbid/therapy
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Triglycerides/metabolism
- Weight Loss
- Weight Reduction Programs/methods
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Affiliation(s)
- Sophie Kobuch
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Fiona Tsang
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales Australia
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Daniel Gossayn
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Sarah O’Brien
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Javeria Jamal
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Leon Laks
- Australian Sleep Diagnostics, Campbelltown, New South Wales Australia
| | - Abd Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales Australia
- Macarthur Clinical School, Western Sydney University, Parkside Crescent, 2560 Campbelltown, NSW Australia
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19
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Gao T, Agho KE, Piya MK, Simmons D, Osuagwu UL. Analysis of in-hospital mortality among people with and without diabetes in South Western Sydney public hospitals (2014-2017). BMC Public Health 2021; 21:1991. [PMID: 34732173 PMCID: PMC8567571 DOI: 10.1186/s12889-021-12120-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/25/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and data on hospital outcomes and/or what common factors influence mortality rate in people with and without diabetes in Australia using a representative sample is lacking. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. METHODS Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 1 July 2014-30 June 2015 to 1 July 2016-30 June 2017). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. RESULTS Over three years, 8.7% (48,038 people) of admissions involved people with diabetes. This increased from 8.4% in 2014-15 to 8.9% in 2016-17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3-21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5-12.1) and more in men than women (23.1, 95%CI 21.2-25.0 vs 17.9, 95%CI 16.2-19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78-4.48) and 1.79 (95%CI 0.77-2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: older age (> 54 years), male sex, marital status (divorced/widowed), length of stay in hospital (staying longer than 4 days), receiving intensive care in admission and being admitted due to primary respiratory and cardiovascular diagnoses. The odds of death in admission was increased in polymorbid patients without diabetes (28.68, 95%CI 23.49-35.02) but not in those with diabetes. CONCLUSIONS In-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes, but significantly more people with diabetes had two or more co-morbidities, suggesting that hospital mortality may be driven by those with pre-existing health/comorbidities. Urgent measures in primary care to prevent admissions among people with multiple co-morbidities are needed.
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Affiliation(s)
- Tina Gao
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Milan K Piya
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - David Simmons
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - Uchechukwu L Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa.
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20
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Piya MK. Metabolic syndrome, rheumatoid and psoriatic arthritis: Managing cardiovascular risk. Int J Rheum Dis 2021; 24:1103-1105. [PMID: 34469059 DOI: 10.1111/1756-185x.14197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Milan K Piya
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Camden and Campbelltown Hospitals, Sydney, NSW, Australia
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21
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Osuagwu UL, Sharma S, Silva D, Saunders J, Pillay J, Piya MK, Simmons D. Assessment of diabetes knowledge, screening and uptake of community diabetes programs in a peri-urban region in Australia. Diabetes Metab Syndr 2021; 15:102257. [PMID: 34425557 DOI: 10.1016/j.dsx.2021.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
AIMS The Wollondilly Diabetes Program (WDP) is testing ways to improve uptake of diabetes prevention services. This project evaluated the reach of WDP in diabetes promotion while assessing diabetes knowledge and risk among residents. METHODS A WDP member travelled in the DW weekly to community events including outreach programs between October 2016 and June 2019. Data from diabetes knowledge questionnaire (DKQ), the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), HbA1c and Random Blood Glucose (RBG) measurements obtained from participants who attended community events and road shows. RESULTS Over the 32 months period, WDP attended 32 community events reaching 1415 people (∼3% of the Wollondilly adult population). DKQ was completed by 154 people (52.9% females, 78% Australian born, median age 69 years), 39% had diabetes and their mean score (25.0 ± 3.1, maximum possible score = 31) was similar to those without diabetes (24.0 ± 4.6, p = 0.093). AUSDRISK assessment was completed by 166 people with 85% at intermediate or high risk of diabetes. There were 65% results above range for RBG (≥5.5 mmol/l) and/or HbA1c (≥5.7%,39 mmol/mol). CONCLUSION A community outreach team set up in partnership with local stakeholders that offers opportunistic diabetes screening, is an effective way of engaging with the community to increase diabetes awareness and knowledge.
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Affiliation(s)
- Uchechukwu Levi Osuagwu
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560 Australia.
| | - Suryansh Sharma
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Dilan Silva
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - James Saunders
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Jayeshwari Pillay
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Milan K Piya
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Campbelltown Hospital, Campbelltown, NSW, 2560, Australia.
| | - David Simmons
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Campbelltown Hospital, Campbelltown, NSW, 2560, Australia.
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22
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Piya MK, Chimoriya R, Yu W, Grudzinskas K, Myint KP, Skelsey K, Kormas N, Hay P. Improvement in Eating Disorder Risk and Psychological Health in People with Class 3 Obesity: Effects of a Multidisciplinary Weight Management Program. Nutrients 2021; 13:nu13051425. [PMID: 33922623 PMCID: PMC8146717 DOI: 10.3390/nu13051425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 01/06/2023] Open
Abstract
This study aimed to evaluate the risk of eating disorders, psychological distress, and health-related quality of life (HRQoL) in people with class 3 obesity (body mass index (BMI) ≥ 40 kg/m2), and the effect of multidisciplinary weight management over 12 months. This retrospective cohort study included all adults with class 3 obesity who enrolled in a weight management program from March 2018 to December 2019. Questionnaires included the Eating Disorder Examination Questionnaire Short (EDE-QS), Kessler Psychological Distress Scale (K10), and 36-Item Short Form Survey (SF-36) for HRQoL. Physical and Mental Component Summary scores (PCS and MCS) were derived from the SF-36. Of 169 participants who completed 12 months in the program, 65.7% (n = 111) completed questionnaires at baseline and 12 months, with 6.0 ± 6.8% weight loss over this period. Compared to baseline, there was significant improvement at 12 months in EDE-QS (15.7 ± 6.6 vs. 13.6 ± 6.2, p = 0.002), K10 (25.7 ± 9.7 vs. 21.2 ± 9.4, p < 0.001), PCS (29.4 ± 10.1 vs. 36.1 ± 10.9, p < 0.001), and MCS scores (40.2 ± 12.4 vs. 44.0 ± 13.4, p = 0.001). All, apart from EDE-QS scores, remained significant after adjusting for weight change. This study highlights the importance of multidisciplinary management in people with class 3 obesity to help reduce eating disorder risk and psychological distress, and improve HRQoL, in addition to weight loss.
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Affiliation(s)
- Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- Correspondence:
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
| | - William Yu
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Kyaw Phone Myint
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
| | - Kathryn Skelsey
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (K.P.M.); (P.H.)
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, Camden, NSW 2570, Australia; (W.Y.); (K.G.); (K.S.); (N.K.)
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
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23
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Zarora R, MacMillan F, Piya MK, Fernandes B, Simmons D. Effectiveness of a locality-based integrated diabetes care service on clinical outcomes. Intern Med J 2021; 52:975-981. [PMID: 33471370 DOI: 10.1111/imj.15211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the effectiveness of a new locality-based integrated diabetes care service for people with Type 2 diabetes in an inner regional area. METHODS A quasi-experimental evaluation comparing baseline and follow up clinical data collected from general practices and specialist services participating in an integrated diabetes care programme in an inner-regional area. Patients had at least one specialist service consultation. The primary outcome was glycated haemoglobin (HbA1c). RESULTS Clinical data were collected for 178/239 patients (74.5% participation; aged 65± 11(SD) years, 46% female; median [interquartile range (IQR)] diabetes duration 19 (11.0-24.0) years from seven general practices over 33 months (median 18.5 months). There were reductions in HbA1c -0.7±1.6 % (8±18 mmol/mol) (p<0.001), systolic blood pressure -5.8±19.5 mmHg (p<0.001), diastolic blood pressure -2.4±14.3 mmHg (p=0.04), total cholesterol -0.5±1.3 mmol/l (p<0.001), low-density lipoprotein (LDL) -0.4±0.9 mmol/l (p<0.001), Body Mass Index -0.5±1.6 kg/m2 (p<0.001), weight -1.8±4.7 kg (p<0.001). Urine albumin creatinine ratio [median (IQR)] at baseline was 3.0 mg/mmol (0.7-7) vs follow up 1.9 mg/mmol (0.8-5.5) p< 0.54). CONCLUSIONS Glycaemia and cardiovascular risk factors can be reduced in patients with long-standing Type 2 diabetes by moving to a locality based integrated primary-secondary care diabetes care service. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Reetu Zarora
- Doctor of Philosophy student, School of Medicine, Western Sydney University.,Diabetes Obesity and Metabolism Translational Research Unit.,Macarthur Clinical School, Campbelltown, New South, Wales.,Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia
| | - Freya MacMillan
- Diabetes Obesity and Metabolism Translational Research Unit.,Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia.,Senior Lecturer, School of Health Science.,The Translational Health Research Institute.,Western Sydney University, Campbelltown, New South, Wales
| | - Milan K Piya
- Diabetes Obesity and Metabolism Translational Research Unit.,Macarthur Clinical School, Campbelltown, New South, Wales.,Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia.,Senior Lecturer in Diabetes, School of Medicine, Western Sydney University
| | - Brunelle Fernandes
- Diabetes Obesity and Metabolism Translational Research Unit.,Registered Nurse/Credentialed Diabetes Educator.,Campbelltown Hospital, Campbelltown, New South Wales, 2751, Australia
| | - David Simmons
- Diabetes Obesity and Metabolism Translational Research Unit.,Macarthur Clinical School, Campbelltown, New South, Wales.,Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia.,The Translational Health Research Institute.,Professor of Medicine, School of Medicine, Western Sydney University
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24
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Medveczky DM, Kodsi R, Skelsey K, Grudzinskas K, Bueno F, Ho V, Kormas N, Piya MK. Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss. J Diabetes Res 2020; 2020:9327910. [PMID: 32832564 PMCID: PMC7422012 DOI: 10.1155/2020/9327910] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Class 3 obesity (BMI ≥ 40 kg/m2) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months. METHODS All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI ≥ 40 kg/m2 and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months. RESULTS Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4.2 ± 4.9% vs. 3.6 ± 4.7%, p = 0.35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p < 0.01) and a reduction in the number of medications from baseline to 6 months (1.8 ± 1.0/patient vs. 1.0 ± 1.2/patient, p < 0.001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7.7 ± 5.3% vs. 2.4 ± 3.8%, p = 0.015). CONCLUSIONS Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM.
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Affiliation(s)
| | - Raymond Kodsi
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Kathryn Skelsey
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Kathy Grudzinskas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Flavia Bueno
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Vincent Ho
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, NSW, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden Hospital, NSW, Australia
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Abbott S, Dindol N, Tahrani AA, Piya MK. Binge eating disorder and night eating syndrome in adults with type 2 diabetes: a systematic review. J Eat Disord 2018; 6:36. [PMID: 30410761 PMCID: PMC6219003 DOI: 10.1186/s40337-018-0223-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/02/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2DM) is increasing in prevalence worldwide, and is closely linked to obesity. Binge Eating Disorder (BED) and Night Eating Syndrome (NES) are eating disorders that are common in obesity, and may affect the management as well as long term outcomes of T2DM. Therefore, the aim of this review was to assess the prevalence and associations of BED or NES in adults with T2DM. METHODS We conducted a systematic review. The databases MEDLINE, CINAHL and AMED were searched for articles which met the inclusion criteria; including patients > 18 years old, with T2DM, and BED and/or NES. The reference lists of included studies were also searched. Meta-analysis was not attempted due to the limited number of studies that measured the outcomes of interest. RESULTS A total of 10 studies (2 included NES) were included in this systematic review. The number screened for BED and NES were 6527 and 1039 participants, respectively. Point prevalence was 1.2-8.0% for BED and 3.8-8.4% for NES. Patients with T2DM and BED had higher BMI than patients with T2DM without BED in the two studies that reported BMI. There was no statistically significant difference in HbA1c between patients with and without BED in the two studies that measured HbA1c. CONCLUSIONS BED and NES are common in adults with T2DM, and BED is associated with higher BMI in patients with T2DM. However, only two studies reported important outcomes measures such as BMI and HbA1c in patients with T2DM. Hence, further well-designed studies are needed to assess the impact of BED and NES in patients with T2DM. Health Care Professionals should consider the diagnosis of BED and NES in patients with T2DM.
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Affiliation(s)
- Sally Abbott
- 1Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,2Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Centre of Endocrinology and Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Naomi Dindol
- 1Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Abd A Tahrani
- 1Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,2Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Centre of Endocrinology and Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Milan K Piya
- 4Macarthur Clinical School, School of Medicine, Western Sydney University, Campbelltown, NSW Australia.,5Macarthur Diabetes Service, Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown, NSW Australia
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Amin A, Ali A, Altaf QA, Piya MK, Barnett AH, Raymond NT, Tahrani AA. Prevalence and Associations of Obstructive Sleep Apnea in South Asians and White Europeans with Type 2 Diabetes: A Cross-Sectional Study. J Clin Sleep Med 2017; 13:583-589. [PMID: 28162147 DOI: 10.5664/jcsm.6548] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/02/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES To assess and compare obstructive sleep apnea (OSA) prevalence in South Asians and White Europeans with type 2 diabetes mellitus (T2DM). Secondary aims included exploring possible causes for observed ethnic differences. METHODS A cross-sectional study of patients with T2DM recruited from secondary care diabetes clinics. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/h using home-based, multi-channel respiratory monitoring. RESULTS Two hundred thirty-four patients (105 South Asian and 129 White Europeans) were studied. The prevalence of mild, moderate, and severe OSA in South Asians was 36.2% (n = 38/105), 9.5% (n = 10/105), and 5.7% (n = 6/105) respectively. After adjustment, OSA was associated with a higher body mass index in South Asians. OSA was significantly less common in South Asians compared to White Europeans (51.4% [54/105] versus 75.2% [97/129], P < .001). OSA was also less severe in South Asians compared to White Europeans (median [interquartile range]: AHI 5.1 [1.4-11.5] versus 8.5 [5.0-20.7] events/h, P < .001; time spent with oxygen saturations < 90% 0.5 [0.0-2.9]% versus 4.0 [0.7-14.4]%, P < .001). Logistic regression showed that only obesity measures explained the ethnic differences in OSA. CONCLUSIONS South Asians with T2DM are at considerable risk of OSA. OSA in South Asians was associated with obesity. However, OSA prevalence was lower in South Asians than in White Europeans. Obesity measures accounted for the observed ethnic differences. Examining factors contributing to ethnic differences will be important to inform screening and treatment strategies.
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Affiliation(s)
- Amin Amin
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Asad Ali
- Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Quratul A Altaf
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Milan K Piya
- Department of Diabetes, Derby Teaching Hospitals NHS Foundation NHS Trust, Derby, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anthony H Barnett
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.,Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Neil T Raymond
- Independent Epidemiology and Statistical Consultant, Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, United Kingdom
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
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Tahrani AA, Altaf QA, Piya MK, Barnett AH. Peripheral and Autonomic Neuropathy in South Asians and White Caucasians with Type 2 Diabetes Mellitus: Possible Explanations for Epidemiological Differences. J Diabetes Res 2017; 2017:1273789. [PMID: 28409160 PMCID: PMC5376938 DOI: 10.1155/2017/1273789] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/01/2017] [Accepted: 02/19/2017] [Indexed: 02/06/2023] Open
Abstract
Objectives. To compare the prevalence of diabetic peripheral neuropathy (DPN) and that of cardiac autonomic neuropathy (CAN) between South Asians and White Caucasians with type 2 diabetes and to explore reasons for observed differences. Methods. A cross-sectional study of casually selected South Asian and White Caucasian adults attending a hospital-based diabetes clinic in the UK. DPN and CAN were assessed using the Michigan Neuropathy Screening Instrument (MNSI) and heart rate variability testing, respectively. Results. Patients (n = 266) were recruited (47.4% South Asians). DPN was more common in White Caucasians compared to South Asians (54.3% versus 38.1%, p = 0.008). Foot insensitivity as assessed by 10 g monofilament perception was more common in White Caucasians (43.9% versus 23.8%, p = 0.001). After adjustment for confounders, White Caucasians remained twice as likely to have DPN as South Asians, but the impact of ethnicity became nonsignificant after adjusting for adiposity measures or height. No difference in prevalence of standardized CAN test abnormalities was detected between ethnicities. Skin microvascular assessment demonstrated that South Asians had reduced heating flux but preserved acetylcholine response. Conclusions. South Asians with type 2 diabetes have fewer clinical signs of DPN compared to White Caucasians. Differences in adiposity (and its distribution) and height appear to explain these differences.
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Affiliation(s)
- Abd A. Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
- Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- *Abd A. Tahrani:
| | - Q. A. Altaf
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Milan K. Piya
- Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Anthony H. Barnett
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
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Altaf QA, Sadiqi H, Piya MK, Tahrani AA. Foot insensitivity is associated with renal function decline in patients with type 2 diabetes: a cohort study. BMC Endocr Disord 2016; 16:64. [PMID: 27876022 PMCID: PMC5120531 DOI: 10.1186/s12902-016-0147-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 11/18/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Identifying patients with diabetes at increased risk of chronic kidney disease (CKD) is essential to prevent/slow the progression to end-stage renal disease (ESRD). CKD and diabetic peripheral neuropathy (DPN) share common mechanisms. Hence, we aimed to examine the relationship between foot insensitivity and CKD in patients with Type 2 diabetes. METHODS A prospective observational cohort study in adults with Type 2 diabetes. Patients with ESRD were excluded. Foot insensitivity was assessed using the 10-g monofilament test. Renal function was assessed using estimated glomerular filtration rate (eGFR) based on the MDRD equation. Albuminuria was defined as the presence of urinary albumin/creatinine ratio (ACR) >3.4 mg/mmol. RESULTS Two hundred and twenty eight patients were recruited and followed-up for 2.5 years. One hundred and ninety patients (83.4%) had eGFR ≥ 60 ml/min/1.73 m2. Seventy six (33.3%) patients had foot insensitivity (i.e. abnormal monofilament test). Patients with foot insensitivity had lower eGFR and higher prevalence of albuminuria compared to patients with normal monofilament test. After adjustment for age, gender, ethnicity, diabetes duration, HbA1c, body mass index, insulin treatment, number of anti-hypertensives, history of peripheral vascular disease, and baseline eGFR (R2 0.87), baseline foot insensitivity was associated with study-end eGFR (B = -3.551, p = 0.036). CONCLUSIONS Patients with Type 2 diabetes and foot insensitivity are at increased risk of eGFR decline. Identifying these patients offers an opportunity to intensify metabolic and blood pressure control to prevent/retard the development of CKD. Future studies of larger sample size and longer follow up from multiple centres are needed to assess the diagnostic performance of our findings in predicting CKD development, and to compare the performance of the monofilament test with albuminuria.
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Affiliation(s)
- Quratul A. Altaf
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Hamed Sadiqi
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Milan K. Piya
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Abd A. Tahrani
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TT UK
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Altaf QAA, Ali A, Piya MK, Raymond NT, Tahrani AA. The relationship between obstructive sleep apnea and intra-epidermal nerve fiber density, PARP activation and foot ulceration in patients with type 2 diabetes. J Diabetes Complications 2016; 30:1315-20. [PMID: 27324704 DOI: 10.1016/j.jdiacomp.2016.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/03/2016] [Accepted: 05/28/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with increased nitrosative stress, endothelial dysfunction, and peripheral neuropathy in patients with type 2 diabetes. We hypothesized that OSA is associated with Poly ADP ribose polymerase (PARP) activation, lower intra-epidermal nerve fiber density (IENFD), and diabetic foot ulceration (DFU). METHODS A cross-sectional study of adults with type 2 diabetes recruited from a secondary care hospital in the UK. OSA was assessed by multi-channel home-based cardio-respiratory device (Alice PDX, Philips Respironics). DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI). IENFD and % PAR stained nuclei were assessed using immunohistochemistry staining on skin biopsies. DFU was assessed based on MNSI. RESULTS Skin biopsies and DFU data were available from 52 and 234 patients respectively. OSA was associated with lower IENFD (12.75±1.93 vs. 10.55±1.62 vs. 9.42±1.16 fibers/mm of epidermis for no OSA, mild OSA and moderate to severe OSA respectively, p<0.001). Following adjustment, mild (B=-2.19, p=0.002) and moderate to severe OSA (B=-3.45, p<0.001) were independently associated with IENFD. The apnea hypopnea index (AHI) was associated with IENFD following adjustment (B=-2.45, p<0.001). AHI was associated with percentage of PAR stained nuclei following adjustment (B=13.67, p=0.025). DFU prevalence was greater in patients with OSA (7.1% vs. 28.1% vs. 26.2% for patients with no OSA, mild OSA and moderate to severe OSA respectively, p=0.001). Following adjustment, OSA was associated with DFU (OR 3.34, 95% CI 1.19-9.38, p=0.022). CONCLUSIONS OSA is associated with lower IENFD, PARP activation and DFU in patients with type 2 diabetes. Our findings suggest that OSA is associated with small fiber neuropathy. PARP activation is a potential mechanisms linking OSA to DPN and endothelial dysfunction in patients with type 2 diabetes. Whether OSA treatment will have a favorable impact on these parameters and DFU requires interventional studies.
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Affiliation(s)
- Quratul-Ain Altaf Altaf
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Asad Ali
- Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Milan K Piya
- Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Neil T Raymond
- Independent Epidemiology and Statistical Consultant, Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, UK
| | - Abd A Tahrani
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Al-Daghri NM, Alokail MS, Rahman S, Amer OE, Al-Attas OS, Alfawaz H, Tripathi G, Sabico S, Chrousos GP, McTernan PG, Piya MK. Habitual physical activity is associated with circulating irisin in healthy controls but not in subjects with diabetes mellitus type 2. Eur J Clin Invest 2015; 45:775-81. [PMID: 26011590 DOI: 10.1111/eci.12468] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/19/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Irisin, a novel myokine, has been shown to increase following vigorous exercise, with studies suggesting that it mediates some of the beneficial effects of exercise. Irisin might play a role in 'browning' of white adipocytes, thus increasing energy expenditure. The role of irisin in exercise and energy expenditure in subjects with diabetes mellitus type 2 (DMT2) remains largely unknown. We aimed to investigate the association between circulating irisin and habitual physical activity in subjects with and without DMT2. MATERIAL AND METHODS In this cross-sectional study, 164 Saudi adults: 81 non-DMT2 controls [age: (mean ± SD) 51.6 ± 10.9; BMI: 29.6 ± 4.3 kg/m(2) ] and 83 DMT2 subjects [age: 54.3 ± 10.3 year; BMI: 29.4 ± 4.7 kg/m(2) ] were studied. Anthropometric and fasting serum biochemical data were collected. Circulating irisin was measured using an enzyme-linked immunosorbent assay (ELISA). Frequency intensity time (FIT) index was used to assess the level of habitual physical activity. RESULTS We observed significantly higher levels of irisin in DMT2 subjects than in controls (P < 0.001). FIT index was positively associated (r = 0.20, P = 0.03) with circulating irisin in controls only. Additionally, irisin levels were significantly higher in tertile 3 (0.75 ± 0.07 μg/mL) than tertile 1 (0.49 ± 0.06 μg/mL) of the FIT index in healthy controls, whilst no such relation with physical activity was observed in DMT2 subjects. CONCLUSION This cross-sectional study has shown a weak association of irisin with physical activity levels in healthy controls but not in DMT2 subjects, suggesting the possibility of discordant regulation in the condition of DMT2.
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Affiliation(s)
- Nasser M Al-Daghri
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Majed S Alokail
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Shakilur Rahman
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Osama E Amer
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Omar S Al-Attas
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Alfawaz
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Department of Food Science and Nutrition, College of Food Science and Agriculture, King Saud University, Riyadh, Saudi Arabia
| | - Gyanendra Tripathi
- Division of Translational and Systems Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Shaun Sabico
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - George P Chrousos
- First Department of Pediatrics, Athens University Medical School, Athens, Greece
| | - Philip G McTernan
- Division of Translational and Systems Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Milan K Piya
- Division of Translational and Systems Medicine, Warwick Medical School, University of Warwick, Coventry, UK
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Saboor Aftab SA, Halder L, Piya MK, Reddy N, Fraser I, Menon V, Bridgwater S, Kendrick D, Kumar S, Barber TM. Predictors of weight loss at 1 year after laparoscopic adjustable gastric banding and the role of presurgical quality of life. Obes Surg 2015; 24:885-90. [PMID: 24442423 DOI: 10.1007/s11695-014-1184-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is uncertainty regarding preoperative predictors of a successful outcome for bariatric surgery (BarSurg), on which to determine appropriateness for such a procedure. Our aims were to identify preoperative clinical and psychosocial predictors of success following BarSurg and to explore the influence of body mass index (BMI) on these parameters. METHODS Preoperative data, including Impact of Weight on Quality of Life-Lite (IWQOL-Lite) scores transformed to Health-Related Quality of Life (HRQOL) scores, were accrued from 76 morbidly obese adults awaiting BarSurg. Pre- and postoperative data were also accrued for 26 patients who had completed 1-year follow-up post-bariatric surgery (laparoscopic adjustable gastric banding-LAGB). Statistical analysis was performed to assess the relationships between preoperative HRQOL scores, preoperative BMI and excess weight loss 1 year following BarSurg (EWL-1 year). RESULTS Preoperative BMI showed a significant independent, negative linear correlation with the public distress domain of preoperative quality of life (QOL) (r = -0.368, p = 0.001; β = -0.245, p = 0.009). Preoperative BMI had a significant, positive and independent association with EWL-1 year (r = 0.499, p = 0.009; β = 0.679, p = 0.015). Preoperative QOL scores had no association with EWL-1 year. CONCLUSIONS Preoperative BMI appears to predict EWL-1 year following restrictive bariatric surgery (LAGB). Preoperatively, patients with higher BMI appear to manifest greater public distress. Preoperative QOL scores, however, do not appear to have any predictive value for EWL-1 year post-LAGB. Preoperative BMI should therefore be employed as a predictor of EWL-1 year post-LAGB. Other measures of successful outcomes of bariatric surgeries (such as effects on QOL scores at 1 year) should be explored in future, larger and longer term studies.
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Affiliation(s)
- S A Saboor Aftab
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Clinical Sciences Research Laboratories, Clinical Sciences Building, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
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Reddy NL, Peng C, Carreira MC, Halder L, Hattersley J, Piya MK, Tripathi G, Randeva HS, Casanueva FF, McTernan PG, Kumar S, Barber TM. Enhanced thermic effect of food, postprandial NEFA suppression and raised adiponectin in obese women who eat slowly. Clin Endocrinol (Oxf) 2015; 82:831-7. [PMID: 25369176 DOI: 10.1111/cen.12652] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/12/2014] [Accepted: 10/31/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Meal duration may influence cardiometabolic health. The aim of this study was to explore postprandial effects of meal duration on human metabolism and appetite. DESIGN Postprandial comparisons following a standard meal eaten slowly over 40 min ('D40') and the same meal eaten quickly over 10 min ('D10') on a different day. Each participant therefore acted as their own control, thereby limiting confounding factors. PATIENTS Obese premenopausal Caucasian women (n = 10) with confirmed normoglycaemia were recruited from an obesity clinic at UHCW, Coventry UK. Subjects underwent whole-body calorimetry (8-h) on two separate days. MEASUREMENTS Following standard lunch (D40 vs D10), 4-h postprandial analysis included thermic effect of food (TEF) and bloods taken at predefined times (including baseline fasting). Analytes included lipid profile, adiponectin, insulin, glucose, ghrelin, leptin, endotoxin, gut and pancreatic hormones. Appetite was measured using visual-analogue scales and ad libitum food intake at subsequent meal. Paired sample t-tests [including area under the curve (AUC)] were used to compare D40 and D10 trials. RESULTS Postprandial TEF (over 240-min) was significantly greater for D40 than D10 [mean (SEM): 80·9 kcal (3·8) vs 29·9 kcal (3·4); 10·6% vs 3·9%, respectively, P = 0·006; AUC 71·7 kcal.h vs 22·4 kcal.h, respectively, P = 0·02]. Postprandial plasma NEFA was significantly lower, and adiponectin levels were significantly higher for D40 than D10 [AUC (SEM): NEFA 627 μmol.h/l (56) vs 769 μmol.h/l (60), respectively, P = 0·02; adiponectin 33·4 μg.h/ml (3·9) vs 27·3 μg.h/ml (3·8), respectively, P = 0·04]. Other postprandial analytes and appetite measures were equivalent. CONCLUSIONS In obese women, eating slowly associates with enhanced TEF, elevated serum adiponectin and suppressed NEFA.
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Affiliation(s)
- Narendra L Reddy
- Division of Translational and Systems Medicine, Warwick Medical School, The University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Chenjing Peng
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Marcos C Carreira
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III (ISCIII), Santiago de Compostela, Spain
| | - Louise Halder
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - John Hattersley
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Milan K Piya
- Division of Translational and Systems Medicine, Warwick Medical School, The University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Gyanendra Tripathi
- Division of Translational and Systems Medicine, Warwick Medical School, The University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Harpal S Randeva
- Division of Translational and Systems Medicine, Warwick Medical School, The University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Felipe F Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III (ISCIII), Santiago de Compostela, Spain
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain
| | - Philip G McTernan
- Division of Translational and Systems Medicine, Warwick Medical School, The University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Sudhesh Kumar
- Division of Translational and Systems Medicine, Warwick Medical School, The University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Thomas M Barber
- Division of Translational and Systems Medicine, Warwick Medical School, The University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
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Schwander F, Kopf-Bolanz KA, Buri C, Portmann R, Egger L, Chollet M, McTernan PG, Piya MK, Gijs MAM, Vionnet N, Pralong F, Laederach K, Vergères G. A dose-response strategy reveals differences between normal-weight and obese men in their metabolic and inflammatory responses to a high-fat meal. J Nutr 2014; 144:1517-23. [PMID: 24812072 PMCID: PMC4162475 DOI: 10.3945/jn.114.193565] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A dose-response strategy may not only allow investigation of the impact of foods and nutrients on human health but may also reveal differences in the response of individuals to food ingestion based on their metabolic health status. In a randomized crossover study, we challenged 19 normal-weight (BMI: 20-25 kg/m(2)) and 18 obese (BMI: >30 kg/m(2)) men with 500, 1000, and 1500 kcal of a high-fat (HF) meal (60.5% energy from fat). Blood was taken at baseline and up to 6 h postprandially and analyzed for a range of metabolic, inflammatory, and hormonal variables, including plasma glucose, lipids, and C-reactive protein and serum insulin, glucagon-like peptide-1, interleukin-6 (IL-6), and endotoxin. Insulin was the only variable that could differentiate the postprandial response of normal-weight and obese participants at each of the 3 caloric doses. A significant response of the inflammatory marker IL-6 was only observed in the obese group after ingestion of the HF meal containing 1500 kcal [net incremental AUC (iAUC) = 22.9 ± 6.8 pg/mL × 6 h, P = 0.002]. Furthermore, the net iAUC for triglycerides significantly increased from the 1000 to the 1500 kcal meal in the obese group (5.0 ± 0.5 mmol/L × 6 h vs. 6.0 ± 0.5 mmol/L × 6 h; P = 0.015) but not in the normal-weight group (4.3 ± 0.5 mmol/L × 6 h vs. 4.8 ± 0.5 mmol/L × 6 h; P = 0.31). We propose that caloric dose-response studies may contribute to a better understanding of the metabolic impact of food on the human organism. This study was registered at clinicaltrials.gov as NCT01446068.
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Affiliation(s)
- Flurina Schwander
- Institute of Food Science, Agroscope, Federal Office of Agriculture, Berne, Switzerland
| | - Katrin A. Kopf-Bolanz
- Institute of Food Science, Agroscope, Federal Office of Agriculture, Berne, Switzerland
| | - Caroline Buri
- Division of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital of Berne, Berne, Switzerland
| | - Reto Portmann
- Institute of Food Science, Agroscope, Federal Office of Agriculture, Berne, Switzerland
| | - Lotti Egger
- Institute of Food Science, Agroscope, Federal Office of Agriculture, Berne, Switzerland
| | - Magali Chollet
- Institute of Food Science, Agroscope, Federal Office of Agriculture, Berne, Switzerland
| | - Philip G. McTernan
- Division of Metabolic and Vascular Health, University of Warwick, Coventry, United Kingdom
| | - Milan K. Piya
- Division of Metabolic and Vascular Health, University of Warwick, Coventry, United Kingdom
| | - Martin A. M. Gijs
- Laboratory of Microsystems 2, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; and
| | - Nathalie Vionnet
- Service of Endocrinology, Diabetes, and Metabolism, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - François Pralong
- Service of Endocrinology, Diabetes, and Metabolism, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kurt Laederach
- Division of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital of Berne, Berne, Switzerland
| | - Guy Vergères
- Institute of Food Science, Agroscope, Federal Office of Agriculture, Berne, Switzerland
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Tahrani AA, Dubb K, Raymond NT, Begum S, Altaf QA, Sadiqi H, Piya MK, Stevens MJ. Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study. Diabetologia 2014; 57:1249-56. [PMID: 24623102 DOI: 10.1007/s00125-014-3211-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/21/2014] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to assess the impact of cardiac autonomic neuropathy (CAN) on the development and progression of chronic kidney disease (CKD) in patients with type 2 diabetes. METHODS We conducted a cohort study in adults with type 2 diabetes. Patients with end-stage renal disease were excluded. CKD was defined as the presence of albuminuria (albumin/creatinine ratio GFR > 3.4 mg/mmol) or an estimated (eGFR) < 60 ml min(-1) 1.73 m(-2). CKD progression was based on repeated eGFR measurements and/or the development of albuminuria. CAN was assessed using heart rate variability. RESULTS Two hundred and four patients were included in the analysis. At baseline, the prevalence of CKD and CAN was 40% and 42%, respectively. Patients with CAN had lower eGFR and higher prevalence of albuminuria and CKD. Spectral analysis variables were independently associated with eGFR, albuminuria and CKD at baseline. After a follow-up of 2.5 years, eGFR declined to a greater extent in patients with CAN than in those without CAN (-9.0 ± 17.8% vs -3.3 ± 10.3%, p = 0.009). After adjustment for baseline eGFR and baseline differences, CAN remained an independent predictor of eGFR decline over the follow-up period (β = -3.5, p = 0.03). Spectral analysis variables were also independent predictors of eGFR decline. CONCLUSIONS/INTERPRETATION CAN was independently associated with CKD, albuminuria and eGFR in patients with type 2 diabetes. In addition, CAN was an independent predictor of the decline in eGFR over the follow-up period. CAN could be used to identify patients with type 2 diabetes who are at increased risk of rapid decline in eGFR, so that preventative therapies might be intensified.
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Affiliation(s)
- Abd A Tahrani
- Centre of Endocrinology, Diabetes and Metabolism, Institute of Biomedical Research, The Medical School, University of Birmingham, Birmingham, B15 2TT, UK,
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Piya MK, Harte AL, Sivakumar K, Tripathi G, Voyias PD, James S, Sabico S, Al-Daghri NM, Saravanan P, Barber TM, Kumar S, Vatish M, McTernan PG. The identification of irisin in human cerebrospinal fluid: influence of adiposity, metabolic markers, and gestational diabetes. Am J Physiol Endocrinol Metab 2014; 306:E512-8. [PMID: 24398403 DOI: 10.1152/ajpendo.00308.2013] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Peripheral action of irisin improves glucose homeostasis and increases energy expenditure, with no data on a central role of irisin in metabolism. These studies sought to examine 1) presence of irisin in human cerebrospinal fluid (CSF) and banked human hypothalamic tissue, 2) serum irisin in maternal subjects across varying adiposities with or without gestational diabetes (GDM), and 3) their respective neonate offspring. CSF, serum, and neonatal cord serum were collected from 91 pregnant women with and without GDM attending for an elective cesarean section [body mass index (BMI): 37.7 ± 7.6 kg/m(2); age: 32 ± 8.3 yr]. Irisin was assessed by ELISA and correlated with biochemical and anthropometric data. Irisin expression was examined in human hypothalamus by immunohistochemical staining. Serum irisin in pregnant women was significantly lower in nonobese compared with obese and GDM subjects, after adjusting for BMI, lipids, and glucose. Irisin was present in neonatal cord serum (237 ± 8 ng/ml) and maternal CSF (32 ± 1.5 ng/ml). CSF irisin correlated positively with serum irisin levels from nonobese and obese pregnant women (P < 0.01), with CSF irisin significantly raised in GDM subjects (P < 0.05). Irisin was present in human hypothalamic sections in the paraventricular neurons, colocalized with neuropeptide Y. Irisin was detectable in CSF and in paraventricular neurons. Maternal serum irisin was lower in nonobese pregnant women after adjusting for BMI and a number of metabolic parameters. These studies indicate that irisin may have a central role in metabolism in addition to the known peripheral role. Further studies investigating the central action of irisin in human metabolic disease are required.
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Affiliation(s)
- Milan K Piya
- Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Clinical Sciences Research Laboratories, Coventry, United Kingdom
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Al-Daghri NM, Alkharfy KM, Rahman S, Amer OE, Vinodson B, Sabico S, Piya MK, Harte AL, McTernan PG, Alokail MS, Chrousos GP. Irisin as a predictor of glucose metabolism in children: sexually dimorphic effects. Eur J Clin Invest 2014; 44:119-24. [PMID: 24188288 DOI: 10.1111/eci.12196] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/29/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Irisin, a novel myokine, increases energy expenditure and glucose tolerance and, thus, improves carbohydrate homeostasis in humans. This hormone has potential therapeutic applications for weight loss and improvement in insulin resistance in subjects with obesity and diabetes mellitus type 2 (T2DM). In this cross-sectional study, we aimed to associate circulating levels of irisin and several anthropometric and metabolic parameters among Arab children. METHODS A cohort of 153 Saudi children, 81 boys [age: 12·4 ± 3·2 years; BMI: 19·5 ± 5·9 kg/m(2) ] and 72 girls: [age: 12·9 ± 3·2 years; BMI: 20·6 ± 5·2], were examined. Anthropometry was obtained, and fasted bloods were collected for biochemical analyses. Irisin was assessed by a specific enzyme-linked immunosorbent assay (ELISA). RESULTS Girls had higher circulating irisin levels than boys (P = 0·04). There were several significant correlations between circulating irisin and fasting blood glucose (FBG) (r = -0·35, P < 0·001), sagittal abdominal diameter (SAD) (r = -0·34, P < 0·001) and HDL cholesterol (r = 0·17, P = 0·04) across the entire cohort studied. Notably in girls, but not in boys, HOMA-IR correlated negatively with irisin levels (r = -0·32, P = 0·02), as previously noted in adults. FBG was a significant predictor of circulating irisin (R(2) = 0·16) followed by SAD. In multivariate linear regression analysis, after controlling for potential confounders such as gender, age and BMI, irisin levels were independently associated with FBG (β = -0·34, P = 0·01), particularly in girls. CONCLUSION Serum irisin levels were higher in girls than in boys and correlated negatively with HOMA-IR. They were also independently associated with FBG predominantly in girls, suggesting that this hormone may play a crucial role in glucose metabolism from an early age.
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Affiliation(s)
- Nasser M Al-Daghri
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia; Biochemistry Department, Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
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Abstract
OBJECTIVE Diabetic nephropathy (DN) is a leading cause of end-stage renal disease (ESRD). Obstructive sleep apnea (OSA) is common in type 2 diabetes and increases oxidative stress. Hence, OSA could promote the development and progression of DN. RESEARCH DESIGN AND METHODS This was a cohort study in adults with type 2 diabetes. Patients with known OSA or ESRD were excluded. DN was defined as the presence of albuminuria or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. DN progression was based on eGFR measurements. OSA was defined as apnea hypopnea index (AHI) ≥5 events/h. Serum nitrotyrosine abundance (a marker of nitrosative stress) was measured by ELISA. RESULTS A total of 224 patients were included. OSA and DN prevalence was 64.3 and 40.2, respectively. DN prevalence was higher in patients with OSA (OSA+) compared with those without OSA (OSA-) (49.3% vs. 23.8%, P < 0.001). After adjustment, OSA (odds ratio 2.64 [95% CI 1.13-6.16], P = 0.02) remained independently associated with DN. After an average follow-up of 2.5 (0.7) years, eGFR decline was greater in OSA+ compared with OSA- patients (median -6.8% [interquartile range -16.1 to 2.2] vs. -1.6% [-7.7 to 5.3%], P = 0.002). After adjusting, both baseline OSA (B = -3.8, P = 0.044) and AHI (B = -4.6, P = 0.02) remained independent predictors of study-end eGFR. Baseline serum nitrotyrosine abundance (B = -0.24, P = 0.015) was an independent predictor of study-end eGFR after adjustment. CONCLUSIONS OSA is independently associated with DN in type 2 diabetes. eGFR declined faster in patients with OSA. Nitrosative stress may provide a pathogenetic link between OSA and DN. Interventional studies assessing the impact of OSA treatment on DN are needed.
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Harte AL, Tripathi G, Piya MK, Barber TM, Clapham JC, Al-Daghri N, Al-Disi D, Kumsaiyai W, Saravanan P, Fowler AE, O'Hare JP, Kumar S, McTernan PG. NFκB as a potent regulator of inflammation in human adipose tissue, influenced by depot, adiposity, T2DM status, and TNFα. Obesity (Silver Spring) 2013; 21:2322-30. [PMID: 23408599 DOI: 10.1002/oby.20336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/26/2012] [Accepted: 12/11/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Central obesity and sub-clinical inflammation increase metabolic risk, this study examined the intracellular inflammatory pathways in adipose tissue (AT) that contribute to this risk. DESIGN AND METHODS This study therefore addressed the influence of NFκB and JNK activation in human abdominal subcutaneous (AbdSc) and omental (Om) AT, the effect of adiposity, T2DM status and the role of TNFα in vitro, using molecular biology techniques. RESULTS Our data showed NFκB activity is increased in Om AT versus AbdSc AT (P<0.01), which was reversed with respect to depot specific activation of JNK (P<0.01). However, T2DM status appeared to preferentially activate NFκB (P<0.001) over JNK. Furthermore, in vitro studies showed recombinant human (rh) TNFα treated AbdSc adipocytes increased NFκB activity over time (2-48 h, P<0.05) whilst JNK activity reduced (2 h, 4 h, P<0.05); inhibitor studies supported a preferential role for NFκB as a modulator of TNFα secretion. CONCLUSIONS These studies suggest distinct changes in NFκB and JNK activation, dependent upon AT depot, adiposity and T2DM status, with in vitro use of rh TNFα leading to activation of NFκB. Consequently NFκB appears to play a central role in inflammatory mediated metabolic disease over JNK, highlighting NFκB as a potential key target for therapeutic intervention.
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Affiliation(s)
- Alison L Harte
- Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, UK
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Abstract
PURPOSE OF REVIEW This article reviews the evidence linking gut bacteria, endotoxin, and its circulating levels with inflammatory induced obesity and metabolic disease (metabolic endotoxaemia). RECENT FINDINGS Gut flora analyses have allowed gut microbiota signatures (GMS) to be observed in animal studies of obesity/metabolic disease. In these studies, specific GMS result in a change in obesity and metabolic disease state whereas in humans, analysis remains unclear. Serum studies, examining metabolic endotoxaemia as a biomarker, appear to link long-term cardiovascular disease and type 2 diabetes mellitus (T2DM) through activation of inflammatory pathways. More recent studies note the importance of diet, which shows the dramatic rise in endotoxin following acute or long-term high-fat diet, with the effects exacerbated in T2DM. SUMMARY Gut flora appears to act as an important determinant in the pathogenesis of inflammatory induced obesity/T2DM. Endotoxin may act as the systemic insult, impacted by a high-fat diet, which may regulate this effect, combined with an altered GMS. As such, clinical and dietary intervention to affect this process - on the gut flora, the 'leaky' mucosal membrane and endotoxin coupled lipid absorption or removal of circulating endotoxin - could reduce the progression of inflammatory induced metabolic disease.
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Affiliation(s)
- Milan K Piya
- Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Clinical Sciences Research Laboratories, Coventry, UK
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Abstract
Adipose tissue is an active endocrine organ, and our knowledge of this secretory tissue, in recent years, has led us to completely rethink how our body functions and becomes dysregulated with weight gain. Human adipose tissue appears to act as a multifunctional secretory organ with the capacity to control energy homoeostasis through peripheral and central regulation of energy homoeostasis. It also plays an important role in innate immunity. However, the capability to more than double its original mass to cope with positive energy balance in obesity leads to many pathogenic changes. These changes arise within the adipose tissue as well as inducing secondary detrimental effects on other organs like muscle and liver, including chronic low-grade inflammation mediated by adipocytokines (adipokine inflammation). This inflammation is modulated by dietary factors and nutrients including glucose and lipids, as well as gut bacteria in the form of endotoxin or LPS. The aim of this current review is to consider the impact of nutrients such as glucose and lipids on inflammatory pathways, specifically within adipose tissue. Furthermore, how nutrients such as these can influence adipokine inflammation and consequently insulin resistance directly through their effects on secretion of adipocytokines (TNFα, IL6 and resistin) as well as indirectly through increases in endotoxin is discussed.
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Affiliation(s)
- M K Piya
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories, Warwick Medical School, University Hospital Site, University of Warwick, Coventry CV2 2DX, UK.
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Tahrani AA, Zeng W, Shakher J, Piya MK, Hughes S, Dubb K, Stevens MJ. Cutaneous structural and biochemical correlates of foot complications in high-risk diabetes. Diabetes Care 2012; 35:1913-8. [PMID: 22751961 PMCID: PMC3424985 DOI: 10.2337/dc11-2076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Impairment of skin quality may contribute to diabetic foot ulceration (DFU). Our goal was to determine whether high-risk patients exhibited specific skin structural and metabolic deficits that could predispose to foot complications. RESEARCH DESIGN AND METHODS A total of 46 patients comprising 9 diabetic control subjects, 16 with diabetic peripheral neuropathy (DPN) alone, and 21 with recurrent DFUs (including 9 with Charcot neuroarthropathy [CNA]) were recruited and compared with 14 nondiabetic control (NDC) subjects. DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Skin punch biopsies (3 mm) were performed on upper and lower leg skin for measurements of intraepidermal nerve fiber density (IENFD), structural analysis, type 1 procollagen abundance, tissue degrading matrix metalloproteinases (MMPs), and poly(ADP-ribose) (PAR) immunoreactivity. RESULTS MNSI scores were comparable across DPN groups. IENFD was decreased by diabetes and DPN but did not differ between neuropathic groups. Skin structural deficit scores were elevated in all neuropathic subjects, particularly in the DFU group. Type 1 procollagen abundance was reduced in DFU subjects 387 ± 256 units (mean ± 1 SD) compared with NDC subjects (715 ± 100, P < 0.001). MMP-1 and MMP-2 were activated by diabetes. PAR immunoreactivity was increased in DFU (particularly in the CNA group; P < 0.01) compared with other DPN subjects. CONCLUSIONS Increased PAR, reduced type 1 procollagen abundance, and impaired skin structure are associated with foot complications in diabetes. The potential of therapies that improve skin quality to reduce DFU needs to be investigated.
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Tahrani AA, Ali A, Raymond NT, Begum S, Dubb K, Mughal S, Jose B, Piya MK, Barnett AH, Stevens MJ. Obstructive sleep apnea and diabetic neuropathy: a novel association in patients with type 2 diabetes. Am J Respir Crit Care Med 2012; 186:434-41. [PMID: 22723291 DOI: 10.1164/rccm.201112-2135oc] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Diabetic peripheral neuropathy is common and causes significant morbidity. Obstructive sleep apnea (OSA) is also common in patients with type 2 diabetes. Because OSA is associated with inflammation and oxidative stress, we hypothesized that OSA is associated with peripheral neuropathy in type 2 diabetes. OBJECTIVES To assess the relationship between OSA and peripheral neuropathy in patients with type 2 diabetes. METHODS A cross-sectional study of adults with type 2 diabetes recruited randomly from the diabetes clinic of two UK hospitals. MEASUREMENTS AND MAIN RESULTS Peripheral neuropathy was diagnosed using the Michigan Neuropathy Screening Instrument. OSA (apnea-hypopnea index ≥ 5 events/h) was assessed using home-based, multichannel respiratory monitoring. Serum nitrotyrosine was measured by ELISA, lipid peroxide by spectrophotometer, and microvascular function by laser speckle contrast imaging. Two hundred thirty-four patients (mean [SD] age, 57 [12] yr) were analyzed. OSA prevalence was 65% (median apnea-hypopnea index, 7.2; range, 0-93), 40% of which were moderate to severe. Neuropathy prevalence was higher in patients with OSA than those without (60% vs. 27%, P < 0.001). After adjustment for possible confounders, OSA remained independently associated with diabetic neuropathy (odds ratio, 2.82; 95% confidence interval, 1.44-5.52; P = 0.0034). Nitrotyrosine and lipid peroxide levels (n = 102, 74 with OSA) were higher in OSA and correlated with hypoxemia severity. Cutaneous microvascular function (n = 71, 47 with OSA) was impaired in OSA. CONCLUSIONS We describe a novel independent association between diabetic peripheral neuropathy and OSA. We identified increased nitrosative/oxidative stress and impaired microvascular regulation as potential mechanisms. Prospective and interventional studies are needed to assess the impact of OSA and its treatment on peripheral neuropathy development and progression in patients with type 2 diabetes.
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Affiliation(s)
- Abd A Tahrani
- Centre of Endocrinology, Diabetes, and Metabolism, University of Birmingham, Birmingham, United Kingdom.
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Piya MK, Shivu GN, Tahrani A, Dubb K, Abozguia K, Phan TT, Narendran P, Pop-Busui R, Frenneaux M, Stevens MJ. Abnormal left ventricular torsion and cardiac autonomic dysfunction in subjects with type 1 diabetes mellitus. Metabolism 2011; 60:1115-21. [PMID: 21306747 PMCID: PMC3142285 DOI: 10.1016/j.metabol.2010.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/03/2010] [Accepted: 12/10/2010] [Indexed: 12/16/2022]
Abstract
Left ventricular torsion is increased and cardiac energetics are reduced in uncomplicated type 1 diabetes mellitus (T1DM). Our aim was to determine the relationships of these abnormalities to cardiovascular autonomic neuropathy (CAN) in subjects with T1DM. A cross-sectional study was conducted in 20 subjects with T1DM free of known coronary heart disease attending an outpatient clinic. Cardiovascular autonomic neuropathy was assessed using heart rate variability studies and the continuous wavelet transform method. Left ventricular function was determined by speckle tracking echocardiography. Magnetic resonance spectroscopy and stress magnetic resonance imaging were used to measure cardiac energetics and myocardial perfusion reserve index, respectively. Twenty subjects (age, 35 ± 8 years; diabetes duration, 16 ± 9 years; hemoglobin A(1c), 8.0% ± 1.1%) were recruited. Forty percent of the subjects exhibited definite or borderline CAN. Log peak radial strain was significantly increased in subjects with CAN compared with those without (1.56 ± 0.06 vs 1.43 ± 0.14, respectively; P = .011). Data were adjusted for log duration of diabetes, and log left ventricular torsion correlated (r = 0.593, P = .01) with log low-frequency to high-frequency ratio during the Valsalva maneuver. Log isovolumic relaxation time correlated significantly with log Valsalva ratio and log proportion of differences in consecutive RR intervals of normal beats greater than 50 milliseconds during deep breathing. However, CAN did not correlate with cardiac energetics or myocardial perfusion reserve index. Spectral analysis of low-frequency to high-frequency ratio power during the Valsalva maneuver is associated with altered left ventricular torsion in subjects with T1DM. Parasympathetic dysfunction is closely associated with diastolic deficits. Cardiovascular autonomic neuropathy is not however the principal cause of impaired cardiac energetics. The role of CAN in the development of cardiomyopathy warrants further evaluation.
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Affiliation(s)
- Milan K Piya
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Abstract
Type 2 diabetes mellitus (T2DM) is rapidly increasing in prevalence and is a major public health problem. It is a progressive disease which commonly requires multiple pharmacotherapy. Current options for treatment may have undesirable side effects (particularly weight gain and hypoglycaemia) and contraindications, and little effect on disease progression. Incretin based therapy is one of several newer therapies to improve glycaemia and is available in two different forms, dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) agonists. Use of these agents results in a 'glucose-dependant' increase in insulin secretion and glucagon suppression resulting in improved glycaemia with low incidence of hypoglycaemia. DPP-4 inhibitors are oral drugs which are weight neutral, while GLP-1 agonists are injected subcutaneously and help promote weight loss while improving glycaemia. GLP-1 agonists have also been shown to increase beta cell mass in rat models. Bariatric surgery is another option for the obese patient with T2DM, with blood glucose normalizing in over half of the patients following surgery. Other therapies in development for the treatment of T2DM include sodium-glucose transporter 2 (SGLT-2) inhibitors, glucagon receptor antagonists, glucokinase activators and sirtuins. In this article, we will review the various existing and emerging treatment options for T2DM.
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Affiliation(s)
- Milan K Piya
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, University of BirminghamBirmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of BirminghamBirmingham, UK
| | - Abd A Tahrani
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, University of BirminghamBirmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of BirminghamBirmingham, UK
| | - Anthony H Barnett
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, University of BirminghamBirmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of BirminghamBirmingham, UK
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Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a complex disorder in which interactions between environmental and genetic factors result in the development of insulin resistance (in most cases) and progressive pancreatic β-cell failure. The currently available oral anti-diabetes treatments are effective as monotherapy; however, due to the progressive decline in β-cell function, most patients will require the use of combination therapy and eventually insulin to reach glycemic targets. These therapeutic options are not without undesirable side effects such as weight gain and hypoglycemia. Furthermore, T2DM is associated with impaired quality of life (QOL) and poor compliance with treatment. Hence, there is a need for anti-diabetes agents that result in sustained improvements in glycemic control without hypoglycemia or weight gain and have a positive impact on patients QOL and thereby hopefully improve compliance. Incretin-based therapy is the latest addition to anti-diabetes treatments which addresses some of the shortcomings of older treatments. AIMS To review the evidence for the use of exenatide once-weekly. METHODS We have searched Medline using the terms "exenatide", "exenatide once-weekly", and "exenatide LA". RESULTS Exenatide once-weekly is an incretin mimetic that is currently undergoing phase 3 clinical trials, and has been shown to improve glycemic parameters (HbA(1c) and fasting and postprandial glucose levels), with low risk of hypoglycemia, causes weight loss, and use was associated with improvements in patient satisfaction which might have a positive impact on treatment compliance. CONCLUSIONS Exenatide once-weekly is effective, well tolerated in patients with T2DM and should be a useful addition to the available range of anti-diabetes treatments.
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Affiliation(s)
- Biju Jose
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Abd A Tahrani
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Milan K Piya
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Anthony H Barnett
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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Abstract
Type 2 diabetes is a very common worldwide disorder, with major consequences for patients, society, and health care services. Good glycemic control is an important aspect of diabetes management because it has a significant impact on diabetes-related microvascular and possibly macrovascular complications. Based on our understanding of the pathogenesis of diabetes, multiple pharmacological interventions have been developed in the past 60 years. Although effective, none have had a lasting effect on glycemic control because of the progressive nature of type 2 diabetes requiring combination therapies and insulin treatment. In addition, several pharmacologic interventions have undesirable side effects, including hypoglycemia and weight gain. Drugs targeting the incretin pathway are the latest addition to the available antidiabetes agents. Incretin-based therapy is either delivered orally (dipeptidyl peptidase-4 [DPP-4]) inhibitors or injected subcutaneously (glucagon-like peptide-1 [GLP-1] mimetics and analogues). Dipeptidyl peptidase-4 inhibitors are effective either as a single or combination therapy in lowering glycated hemoglobin, fasting and postprandial glucose levels, with a low incidence of hypoglycemia and no weight gain. There are 3 DPP-4 inhibitors currently available (sitagliptin, saxagliptin, and vildagliptin), with more expected to be available in the future. In this article, we review the scientific background for incretin-based therapy and the available evidence regarding the role and efficacy of DPP-4 inhibitors in the treatment of patients with type 2 diabetes.
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Affiliation(s)
- Anna I Palalau
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
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Tahrani AA, Piya MK, Kennedy A, Barnett AH. Glycaemic control in type 2 diabetes: targets and new therapies. Pharmacol Ther 2009; 125:328-61. [PMID: 19931305 DOI: 10.1016/j.pharmthera.2009.11.001] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 11/02/2009] [Indexed: 12/16/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a worldwide public health challenge. Despite the availability of many antidiabetes agents and pharmacotherapies targeting cardiovascular risk factors, the morbidity, mortality and economic consequences of T2DM are still a great burden to patients, society, health care systems and the economy. The need for new therapies for glycaemic control is compounded by the fact that existing treatments have limitations either because of their side effects (particularly weight gain and hypoglycaemia) or contraindications that limit their use. Furthermore, none of the current therapies have a significant impact on disease progression. Incretin-based therapies offer a new therapeutic approach to the management of T2DM, and there are also several even newer therapies in development. There are two groups of incretin-based therapies currently available; dipeptidyl peptidase-4 (DPP-4) inhibitors and GLP-1 analogues/mimetics. The former are given orally while the latter subcutaneously. These drugs result in glucose-dependent insulin secretion and glucose-dependent glucagon suppression, with consequent low risk of hypoglycaemia when used as mono- or combination therapy (except when used with sulphonylureas). In addition, they are either weight neutral in the case of DPP-4 inhibitors or cause weight loss in the case of incretin mimetics/analogues. Furthermore, animal studies have shown that these agents prolong beta cell survival which offers the theoretical possibility of slowing the progression to T2DM. In this article we will review the currently available antidiabetes agents with particular emphasis on incretin-based and future therapies. In addition, we will review and discuss the evidence relating to glycaemic control and cardiovascular disease.
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Affiliation(s)
- Abd A Tahrani
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK.
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Tahrani AA, Piya MK, Barnett AH. Saxagliptin: a new DPP-4 inhibitor for the treatment of type 2 diabetes mellitus. Adv Ther 2009; 26:249-62. [PMID: 19330494 DOI: 10.1007/s12325-009-0014-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Indexed: 12/25/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a global epidemic with increasing impact on individuals and healthcare providers. Available treatments (such as metformin, sulfonylureas, glitazones, and insulin) have proven unsatisfactory in producing a long-lasting impact on glycemic control. In addition, most of these treatments have undesirable side effects such as weight gain and hypoglycemia. As a result, exploring new treatment targets and new therapies is mandatory in order to treat this condition. The incretin pathway, in particular glucagon-like peptide (GLP-1), plays an important pathological role in the development of T2DM, and treatments targeting the incretin system have recently become available. These can mainly be divided into two broad categories; GLP-1 agonists/analogs (exenatide, liraglutide), and dipeptidyl peptidase-4 (DPP-4; the enzyme responsible for rapid inactivation of incretins) inhibitors (sitagliptin, vildagliptin). Saxagliptin is a novel DPP-4 inhibitor that has recently completed phase 3 studies. Saxagliptin is a potent and specific inhibitor of DPP-4 (in comparison with other dipeptidyl peptidase enzymes) that is given once daily. Current data suggest that saxagliptin as monotherapy or in combination with metformin, glyburide, or a glitazone results in significant reductions in fasting and postprandial plasma glucose and hemoglobin A(1c) (HbA(1c)). Saxagliptin is well tolerated and does not increase hypoglycemia compared with the placebo, and is probably weight neutral. Saxagliptin will be a new effective drug in the currently available variety of antidiabetic medications for patients with T2DM.
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49
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Abstract
The single-tablet combination of vildagliptin and metformin addresses key defects of type 2 diabetes for improved glycemic control. By inhibiting the dipeptidyl peptidase-4 (DPP-4) enzyme, vildagliptin raises the levels of the active incretin hormones, glucagon-like peptide 1 and glucose-dependent insulinotropic peptide. This leads to increased synthesis and release of insulin from the pancreatic beta cells and decreased release of glucagon from the pancreatic alpha cells. The combination tablet also contains metformin, which addresses insulin resistance. The complementary mechanisms of action of the two agents in combination have been shown to provide additive and sustained reductions in hemoglobin A(1c) compared with metformin monotherapy. In active-controlled trials, the vildagliptin-metformin combination has been shown to produce equivalent reductions in hemoglobin A(1c) to pioglitazone-metformin and glimepiride-metformin combinations, without significant risk of hypoglycemia and without causing weight gain. In clinical trials, the overall incidence of any adverse event was similar in patients randomized to vildagliptin plus metformin and placebo plus metformin. Available data support the use of vildagliptin in combination with metformin as a promising second-line treatment for the management of type 2 diabetes and this is reflected in the latest UK National Institute for Health and Clinical Excellence draft guideline for consultation on new agents for blood glucose control in type 2 diabetes.
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Affiliation(s)
- Abd A Tahrani
- NIHR Research Training Fellow, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK.
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50
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Abstract
Exenatide is the first in a novel class of drugs that mimics naturally occurring glucagon-like peptide 1. In patients with Type 2 diabetes mellitus (T2DM), control of both glycemia and bodyweight are important to minimize the risk of diabetes complications. Exenatide improves glycemic control through glucose-dependent insulin secretion, suppression of glucagon secretion, delaying gastric emptying and suppressing appetite. Exenatide therapy significantly reduced glycated hemoglobin (HbA1c) and fasting and postprandial plasma glucose when added to metformin and/or sulfonylureas, with an average weight loss of 2 kg. Furthermore, exenatide-treated patients sustained the reductions achieved in HbA1c at 12 weeks with a progressive reduction in bodyweight during 3-year follow-up. Exenatide is generally well tolerated; nausea is the most common side effect but significantly reduces over time and with gradual dose titration. Hypoglycemia at a rate greater than placebo only occurred in combination with sulfonylureas. Exenatide may enable patients with T2DM to improve glycemic control while reducing the risk of hypoglycemia and provoking weight loss.
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Affiliation(s)
- Abd A Tahrani
- a Division of Medical Sciences, University of Birmingham and Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK.
| | - Milan K Piya
- b Division of Medical Sciences, University of Birmingham and Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK.
| | - Anthony H Barnett
- c Division of Medical Sciences, University of Birmingham and Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK.
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