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Jiwani R, Serra M, Espinoza S, Berndt A, Patel D. The Impact of Behavioral Lifestyle Intervention on Inflammatory Cytokines in Older Adults Living With Type 2 Diabetes: A Feasibility Study. Inquiry 2024; 61:469580241248126. [PMID: 38642046 PMCID: PMC11032638 DOI: 10.1177/00469580241248126] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE This study investigates the effects of a behavioral lifestyle intervention on inflammatory cytokines and frailty in older adults (≥ 65 years) with type 2 diabetes (T2D). METHOD We conducted a single-arm, 6-month intervention supplemented with diet and activity self-monitoring technology. We assessed frailty using Fried criteria and quantified inflammatory cytokines (interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating-factor [GM-CSF], interferon [IFN-γ], tumor necrosis factor [TNF-α]) using a multiplex assay. We used paired t-tests with significance at P < .05. We calculated the Spearman correlation and evaluated the relationship between frailty, BMI, and inflammatory cytokines. RESULTS Eighteen participants completed the study (mean ± SD: 71.5 ± 5.3 years; BMI: 34 ± 6 kg/m2). At baseline, we had 4 frail, 13 pre-frail, and 1 non-frail participant. At 6 months, we observed the therapeutic effects of the intervention on frailty score, BMI, IL-2, IFN-y, and GM-CSF. DISCUSSION The study highlights the importance of behavioral lifestyle intervention in improving inflammatory cytokines and frailty in older adults.
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Affiliation(s)
- Rozmin Jiwani
- University of Texas Health Science Center at San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Monica Serra
- University of Texas Health Science Center at San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Sara Espinoza
- University of Texas Health Science Center at San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Cedars-Sinai Medical Center
| | - Andrea Berndt
- University of Texas Health Science Center at San Antonio, TX, USA
| | - Darpan Patel
- University of Texas Health Science Center at San Antonio, TX, USA
- The University of Texas Medical Branch, Galveston, TX, USA
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Robbins RN, Cortes T, O'Connor JC, Jiwani R, Serra MC. The Influence of Branched-Chain Amino Acid Supplementation on Fatigue and Tryptophan Metabolism After Acute and Chronic Exercise in Older Adults: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e52199. [PMID: 37910166 PMCID: PMC10652194 DOI: 10.2196/52199] [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: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Fatigue is a strong predictor of negative health outcomes in older adults. Kynurenine, a metabolite of tryptophan, is strongly associated with fatigue. Reductions in fatigue are observed with exercise; however, exercise training does not completely alleviate symptoms. Branched-chain amino acids (BCAAs) have been shown to have advantageous effects on exercise performance and compete with kynurenine for transport into the central nervous system. Thus, the combination of BCAA and exercise may exert synergized effects of mental and physical fatigue. Therefore, we hypothesize that BCAA added to exercise will shift kynurenine metabolism toward enhanced synthesis of kynurenic acid, thereby reducing fatigue. OBJECTIVE This randomized, double-blind, placebo-controlled trial aims to compare the effects of acute (approximately 45 min) and chronic (8 wk) exercise with and without BCAA supplementation on mental and physical fatigue and assess whether the hypothesized outcomes are modulated by changes in kynurenine metabolism in 30 older adults (n=15, 50% per group). METHODS Older adults (aged 60-80 y) who do not exercise >2 days per week and self-report fatigue (≥3 on a scale of 1-10) will be recruited. Participants will be randomized to either the exercise+BCAA group or exercise+placebo group. Participants will engage in high-volume, moderate-intensity, whole-body exercise training (aerobic and resistance exercise; either in-person or web-based sessions) 3 times per week for 8 weeks. In addition, participants will consume daily either 100 mg/kg body weight of BCAA (2:1:1 leucine:isoleucine:valine) or placebo (maltodextrin) throughout the 8-week intervention. BCAA and placebo powders will be identical in color and dissolved in 400 mL of water and 2.5 g of a calorie-free water flavor enhancer. Muscle biopsies will be collected before and after the intervention after a 12-hour fast to examine changes in the biomarkers of tryptophan metabolism and inflammation. Our primary outcomes include changes in mental and physical fatigue and metabolism after the 8-week exercise training between the 2 groups. Mental and physical fatigue will be measured before and after the intervention. Mental fatigue will be subjectively assessed through the completion of validated questionnaires. Physical fatigue will be measured by isometric handgrip, 1-repetition maximum, chair rise, 400-meter walk, and cardiopulmonary exercise tests. RESULTS The study was funded in March 2022, with an anticipated projected data collection period lasting from January 2023 through December 2023. CONCLUSIONS The discovery that kynurenine concentrations are associated with fatigue and are responsive to BCAA supplementation during exercise training could have important implications for the development of future interventions, both lifestyle and pharmacologic, to treat fatigue in older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05484661; https://www.clinicaltrials.gov/study/NCT05484661. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52199.
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Affiliation(s)
- Ronna N Robbins
- Department of Nutrition and Food Science, Texas Woman's University, Denton, TX, United States
- South Texas Veterans Health Care System, Geriatric Research Education and Clinical Center, San Antonio, TX, United States
| | - Tiffany Cortes
- South Texas Veterans Health Care System, Geriatric Research Education and Clinical Center, San Antonio, TX, United States
- Sam & Ann Barshop Institute for Longevity & Aging Studies, Department of Medicine, University of Texas Health Health Science Center San Antonio, San Antonio, TX, United States
| | - Jason C O'Connor
- South Texas Veterans Health Care System, San Antonio, TX, United States
- Department of Pharmacology, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Rozmin Jiwani
- South Texas Veterans Health Care System, Geriatric Research Education and Clinical Center, San Antonio, TX, United States
- School of Nursing, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Monica C Serra
- South Texas Veterans Health Care System, Geriatric Research Education and Clinical Center, San Antonio, TX, United States
- Sam & Ann Barshop Institute for Longevity & Aging Studies, Department of Medicine, University of Texas Health Health Science Center San Antonio, San Antonio, TX, United States
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Jiwani R, Serra M, Espinoza S, Patel D. THE IMPACT OF BEHAVIORAL LIFESTYLE INTERVENTION ON INFLAMMATORY CYTOKINES IN OLDER ADULTS WITH TYPE 2 DIABETES. Innov Aging 2022. [PMCID: PMC9767122 DOI: 10.1093/geroni/igac059.2172] [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] [Indexed: 12/24/2022] Open
Abstract
Chronic inflammation, a hallmark of type 2 diabetes (T2D) and adiposity, increases the risk for age-related co-morbidities, including physical frailty. This study aimed to examine the effects of a mobile technology-enhanced behavioral lifestyle educational intervention on frailty and associated clinical, inflammatory, and laboratory outcomes in overweight older adults with T2D. Twenty participants (≥65 years, BMI ≥25 kg/m2) with T2D were recruited to complete a single-arm 6-month lifestyle intervention modified from the Action for Health in Diabetes (Look AHEAD) study, enhanced with technology for self-monitoring of diet and physical activity. Clinical assessments were collected at baseline and end of the study and analyzed with paired t-tests. Inflammatory cytokines (interleukin [IL]2, IL4, IL6, IL8, IL10, granulocyte-macrophage colony-stimulating-factor [GM-CSF], interferon [IFNγ], tumor necrosis factor [TNFα]) were quantified using a commercially available multiplex kit (Millipore Sigma, Burlington, MA, USA). Clinical lab analysis was performed by Quest Diagnostics (Dallas, TX, USA). Eighteen participants completed the study (71.5±5.3 years; 56% female; 50% Hispanic). At baseline, 13 participants were pre-frail, 4 were frail based on Fried frailty criteria. Inflammatory cytokines and liver enzymes values were within normal limits. At follow-up, the following outcomes significantly improved: frailty score -44% (p=0.01), BMI -3% (P< 0.00), alanine transaminase -18% (p=0.03), aspartate aminotransferase -13% (p< 0.00), IL2 -33% (p=0.01), IL4 -31% (p=0.05), IFNγ -36% (p=0.03), GM-CSF -43% (p=0.03). No other significant differences were observed. The results suggest the efficacy of a technology-enhanced lifestyle intervention on frailty and associated clinical, inflammatory, and laboratory outcomes in overweight older adults with T2D.
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Affiliation(s)
| | - Monica Serra
- UT Health San Antonio, San Antonio, Texas, United States
| | - Sara Espinoza
- Sam and Ann Barshop Institute, UT Health San Antonio, San Antonio, Texas, United States
| | - Darpan Patel
- UT Health San Antonio, San Antonio, Texas, United States
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Jiwani R, Dennis B, Neri AL, Bess C, Espinoza S, Wang J, Serra MC. Type 2 Diabetes Independent of Glycemic Control is Associated With Cognitive Impairments: Findings From NHANES. Clin Nurs Res 2022; 31:1225-1233. [PMID: 35614549 PMCID: PMC10845167 DOI: 10.1177/10547738221100344] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Examine the association between glycemic control and cognition. Included subjects ≥60 years who participated in the 2013 to 2014 National Health and Nutrition Examination Survey and completed one of the followings: Consortium to Establish a Registry for Alzheimer's Disease Word List (CERAD-WL), Animal Fluency (AF), Digit Symbol Substitution Test (DSST), and CERAD-Delayed Recall (CERAD-DR). Stratified participants into: No type 2 diabetes (T2D; N = 557), Controlled T2D (N = 41), Uncontrolled T2D (N = 120), and Untreated T2D (N = 86). Multiple regression was used to examine the association between variables. After adjusting for demographics and cardiovascular risk factors, Uncontrolled T2D was associated with lower DSST (β = -3.164, p = .04), and Untreated T2D was associated with a trend for having lower CERAD-DR (β = -.496, p = .06) scores. T2D, independent of glycemic control, is associated with cognitive impairment and this relationship is influenced by modifiable and non-modifiable risk factors.
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Affiliation(s)
- Rozmin Jiwani
- University of Texas Health Science Center at San Antonio, USA
- Geriatric Research Education & Clinical Center at South Texas Veterans Health Care System, San Antonio, USA
| | - Brittany Dennis
- University of Texas Health Science Center at San Antonio, USA
| | - Alfonso L Neri
- University of Texas Health Science Center at San Antonio, USA
| | | | - Sara Espinoza
- University of Texas Health Science Center at San Antonio, USA
- Geriatric Research Education & Clinical Center at South Texas Veterans Health Care System, San Antonio, USA
| | - Jing Wang
- Florida State University, Tallahassee, USA
| | - Monica C Serra
- University of Texas Health Science Center at San Antonio, USA
- Geriatric Research Education & Clinical Center at South Texas Veterans Health Care System, San Antonio, USA
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Robbins RN, Serra MC, Kilpela LS, Parker EA, Jiwani R, Addison O. Intervention in Older Urban-Dwelling Veterans With Dysmobility: Protocol for a Pilot Feasibility Clinical Trial. JMIR Res Protoc 2022; 11:e39192. [PMID: 35830251 PMCID: PMC9330205 DOI: 10.2196/39192] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The majority of older veterans do not meet the minimum healthy diet or physical activity recommendations despite known benefits. Identifying ways to increase adherence to programs that improve dietary quality and physical activity may reduce the risk of disability in older veterans. Peer-based interventions may be one method for facilitating lasting behavior change because peers often share a common culture and knowledge regarding problems their community experiences. OBJECTIVE This study aims to develop, pilot, and evaluate a theory-driven, 12-week, peer-led nutrition and exercise intervention that targets older veterans with dysmobility and assess its feasibility in 2 diverse urban areas with underrepresented populations. METHODS Community-dwelling veterans aged >65 years with self-reported dysmobility (defined as difficulty in at least 1 of the following: walking quickly across a street, walking a mile, ascending a flight of stairs, rising from a chair without the use of arms, or a fear of falling) from 2 Department of Veterans Affairs Geriatric Research, Education, and Clinic Centers (Baltimore, Maryland, and San Antonio, Texas) will be eligible to participate. First, this study will use validated mixed methods via web-based surveys (n=50 per site) to assess potential physical, social or environmental, and behavioral or lifestyle barriers that affect physical activity and dietary quality (phase 1). Next, we will use knowledge gained from these assessments and feedback from a focus group (n=10 per site) to adapt established Department of Veterans Affairs diet and exercise program materials to develop peer-led intervention materials and train peer leaders (n=3 per site). Finally, we will determine the feasibility and acceptability of the intervention to assess reach (recruitment and retention), adoption (satisfaction, perceived utility, attendance, and engagement), and implementation (fidelity of intervention), as well as the estimated magnitude and potential impact on selected outcomes (ie, diet quality and mobility) in 20 older veterans with dysmobility (n=10 per site). RESULTS The study was funded on January 1, 2022, with a projected data collection period of June 1, 2022, to December 31, 2023. CONCLUSIONS This study offers an innovative approach to identifying strategies that increase long-term adherence to lifestyle modification programs that improve dietary quality and physical activity in older veterans with dysmobility. TRIAL REGISTRATION ClinicalTrials.gov NCT04994938; https://clinicaltrials.gov/ct2/show/NCT04994938. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/39192.
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Affiliation(s)
- Ronna N Robbins
- San Antonio Geriatric, Research, Education, and Clinic Center, South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Monica C Serra
- San Antonio Geriatric, Research, Education, and Clinic Center, South Texas Veterans Health Care System, San Antonio, TX, United States
- Division of Geriatrics, Gerontology and Palliative Medicine and Barshop Institute for Longevity & Aging Studies, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, United States
| | - Lisa S Kilpela
- Department of Psychiatry & Behavioral Sciences and Barshop Institute for Longevity & Aging Studies, University of Texas Health Science Center, San Antonio, TX, United States
| | - Elizabeth A Parker
- Baltimore Geriatric Research, Education, and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rozmin Jiwani
- San Antonio Geriatric, Research, Education, and Clinic Center, South Texas Veterans Health Care System, San Antonio, TX, United States
- School of Nursing, University of Texas Health Science Center, San Antonio, TX, United States
| | - Odessa Addison
- Baltimore Geriatric Research, Education, and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
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Jiwani R, Robbins R, Neri A, Renero J, Lopez E, Serra MC. Effect of Dietary Intake Through Whole Foods on Cognitive Function: Review of Randomized Controlled Trials. Curr Nutr Rep 2022; 11:146-160. [PMID: 35334104 DOI: 10.1007/s13668-022-00412-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This review evaluated recent randomized controlled trials (RCTs) examining the chronic intake of whole foods associated with the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurogenerative Delay (MIND), and ketogenic (KETO) diets on cognitive function. RECENT FINDINGS We identified RCTs related to olive oil (N = 3), nuts (N = 7), fatty fish (N = 1), lean meats (N = 4), fruits and vegetables (N = 9), legumes (N = 1), and low-fat dairy (N = 4), with 26/29 reporting positive results on at least one measure of cognition. We also identified 6 RCTs related to whole food-induced KETO diets, with half reporting positive effects on cognition. Variations in study design (i.e., generally the studies are < 6 months and include middle-aged and older, cognitively intact participants) and small sample sizes make it difficult to draw conclusions across studies; however, the current evidence from RCTs generally supports individual component intakes of these dietary patterns as an effective, nonpharmacological approach to improve cognitive health in adults.
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Affiliation(s)
- Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Ronna Robbins
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Alfonso Neri
- School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jose Renero
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Emme Lopez
- Dolph Briscoe, Jr. Library, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Monica C Serra
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA
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Patel DI, Gonzalez A, Moon C, Serra M, Bridges PB, Hughes D, Clarke G, Kilpela L, Jiwani R, Musi N. Exercise and Creatine Supplementation to Augment the Adaptation of Exercise Training Among Breast Cancer Survivors Completing Chemotherapy: Protocol for an Open-label Randomized Controlled Trial (the THRIVE Study). JMIR Res Protoc 2022; 11:e26827. [PMID: 35363152 PMCID: PMC9015753 DOI: 10.2196/26827] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 08/24/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In breast cancer survivors, chemotherapy-induced muscle loss has been shown to be attenuated with structured resistance exercise. Creatine supplementation can increase bioenergetics in skeletal muscle, which helps to improve overall strength and endurance and reduce muscular fatigue. Therefore, we hypothesize that adding creatinine supplementation to exercise training will accelerate improvements in strength, endurance, and bioenergetics in breast cancer survivors. OBJECTIVE The primary objective is to determine the effects of combining creatine supplementation with exercise on modulating strength and physical function in breast cancer survivors by comparing these effects to those of exercise alone. The secondary objectives are to determine if creatine supplementation and exercise can increase the intramuscular storage of creatine and improve body composition by comparing this intervention to exercise alone. METHODS We aim to test our hypothesis by conducting an open-label randomized controlled trial of 30 breast cancer survivors who have completed chemotherapy within 6 months of enrollment. Eligible participants will be equally randomized (1:1) to either a creatine and exercise group or an exercise-only group for this 12-week intervention. Individuals who are randomized to receive creatine will be initially dosed at 20 g per day for 7 days to boost the availability of creatine systemically. Thereafter, the dose will be reduced to 5 g per day for maintenance throughout the duration of the 12-week protocol. All participants will engage in 3 center-based exercise sessions, which will involve completing 3 sets of 8 to 12 repetitions on chest press, leg press, seated row, shoulder press, leg extension, and leg curl machines. The primary outcomes will include changes in strength, body composition, and physical function in breast cancer survivors. The secondary outcomes will be intramuscular concentrations of creatine and adenosine triphosphate in the vastus lateralis, midthigh cross-sectional area, and quality of life. RESULTS As of October 2021, a total of 9 patients have been enrolled into the study. No unexpected adverse events have been reported. CONCLUSIONS Creatine is being studied as a potential agent for improving strength, endurance, and bioenergetics in breast cancer survivors following chemotherapy. The findings from our trial may have future implications for supporting breast cancer survivors in reversing the muscle loss experienced during chemotherapy and improving their physical function and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT04207359; https://clinicaltrials.gov/ct2/show/NCT04207359. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/26827.
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Affiliation(s)
- Darpan I Patel
- Biobehavioral Research Laboratory, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Angela Gonzalez
- Biobehavioral Research Laboratory, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Crisann Moon
- Biobehavioral Research Laboratory, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Monica Serra
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Preston Blake Bridges
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Daniel Hughes
- Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Geoffrey Clarke
- Research Imaging Institute, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Lisa Kilpela
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Rozmin Jiwani
- Biobehavioral Research Laboratory, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Nicolas Musi
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Jiwani R, Wang J, Li C, Dennis B, Patel D, Gelfond J, Liu Q, Siddiqui N, Bess C, Monk S, Serra M, Espinoza S. A Behavioral Lifestyle Intervention to Improve Frailty in Overweight or Obese Older Adults with Type 2 Diabetes: A Feasibility Study. J Frailty Aging 2022; 11:74-82. [PMID: 35122094 PMCID: PMC8068458 DOI: 10.14283/jfa.2021.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Older adults with Type 2 diabetes (T2D) are more likely to be frail, which increases the risk for disability and mortality. OBJECTIVES To determine the feasibility of a behavioral lifestyle intervention, enhanced with mobile health technology for self-monitoring of diet and activity, to improve frailty in overweight/obese older adults (≥65 years) diagnosed with T2D. DESIGN, SETTING, AND PARTICIPANTS Single arm, 6-month study of a behavioral lifestyle intervention in 20 overweight/obese (BMI>25) older adults (≥ 65 years) with self-reported T2D diagnosis who owned a smartphone. A Fitbit tracker was provided to all participants for self-monitoring of diet and physical activity. Our primary outcome of feasibility was measured by session attendance, adherence to Fitbit usage to self-monitor diet and physical activity, and study retention. Secondary outcomes included the preliminary efficacy of the intervention on frailty, physical function, quality of life, and T2D-related outcomes. RESULTS Eighteen participants completed the study. The mean age was 71.5 (SD ± 5.3) years, 56% were female, and half were Hispanic. At baseline, 13 (72%) were pre-frail, 4 (22%) were frail, and 1 (6%) were non-frail. At follow-up, frailty scores improved significantly from 1.61 ± 1.15 to 0.94 ± 0.94 (p=0.01) and bodyweight improved from 205.66 ± 45.52 lbs. to 198.33 ± 43.6 lbs. (p=<0.001). CONCLUSION This study provides evidence for the feasibility of a behavioral lifestyle intervention in overweight/obese older adults with T2D and preliminary results support its potential efficacy in improving frailty score.
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Affiliation(s)
- R Jiwani
- Rozmin Jiwani, PhD, RN, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, Phone: 210-450-8498, Fax: 210-567-5822,
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Jiwani R, Espinoza S, Wang J, Serra M. Relationship Between Type 2 Diabetes Control and Cognition in Older Adults: Findings From NHANES. Innov Aging 2021. [PMCID: PMC8969761 DOI: 10.1093/geroni/igab046.2612] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cognitive health has emerged as an important public health concern for America’s aging population. Type 2 Diabetes (T2D) may be associated with an exacerbated decline in cognitive performance. This study aimed to examine the relationship between T2D control and cognitive performance in older adults (≥60 years) using the 2013-2014 National Health and Nutrition Examination Surveys. Participants who completed the following cognitive assessments were included: 1) Consortium to Establish a Registry for Alzheimer’s Disease Word List (CERAD-WL), 2) Animal Fluency (AF), 3) Digit Symbol Substitution Test (DSST) (higher scores associated with better cognition). Participants were stratified by four groups: no T2D (N=557), treated/controlled T2D (controlled; N=41), treated/uncontrolled T2D (uncontrolled; N=120), untreated T2D (N=86), based on self-reported T2D treatment, fasting plasma glucose, and hemoglobin A1c. Logistic regression was used to examine the relationship between T2D control and cognition. We observed that those with uncontrolled and untreated T2D each had ~15% lower DSST than those with no T2D (P<0.01). CERAD-WL and AF were similar across all groups. Unadjusted analyses showed that individuals with 1) lower CERAD-WL were more likely to have controlled and untreated T2D, 2) lower AF were more likely to have controlled and uncontrolled T2D, and 3) lower DSST were more likely to have uncontrolled and untreated T2D (P’s<0.05). After adjusting for significant demographics and cardiovascular risk factors, only having uncontrolled T2D was associated with lower DSST (β=-3.164, P=0.04). These data indicate the need for longitudinal studies to further explore dynamic relationship and causal pathway between T2D control and cognitive impairment.
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Affiliation(s)
- Rozmin Jiwani
- University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
| | - Sara Espinoza
- University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
| | - Jing Wang
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Monica Serra
- UT Health San Antonio - Barshop Institute, San Antonio, Texas, United States
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Jiwani R, Wang CP, Orsak B, MacCarthy D, Kellogg D, Powers B, Wang J, Padala P, Padala K, Espinoza S. A geriatrics walking clinic improves hemoglobin A1c and timed gait in older veterans with type 2 diabetes. Geriatr Nurs 2021; 42:566-569. [PMID: 33158625 PMCID: PMC11103742 DOI: 10.1016/j.gerinurse.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/03/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
Over one quarter of older adults in the U.S. has diabetes; and, physical activity is important for the promotion of healthy aging in this population. The purpose of this clinical demonstration project is to evaluate the effect of physical activity in the form of walking on glycemic control and timed gait in older Veterans with type 2 diabetes (T2D). Veterans aged ≥60 years were enrolled in the Geriatrics Walking Clinic (GWC), a clinical demonstration project, at South Texas Veterans Health Care System. GWC is a 6-week clinical program that promotes physical activity and is delivered by a registered nurse/diabetes educator and geriatrician. Veterans were recruited from the VA clinics. Enrolled patients received a pedometer at an initial face-to-face visit, were followed with weekly phone calls to monitor steps/day, received encouragement, and participated in a final face-to-face visit at the end of 6 weeks. In a sub-set of patients with T2D, we performed a chart review and recorded Hemoglobin A1c (HbA1c) at 3, 6, and 12 months after completion of the program. Timed Gait, a major characteristic of frailty, was measured at baseline and after completing the program. Change in HbA1c and timed gait compared to baseline was examined using paired t-tests. Sixty-two patients had HbA1c values available and were included in this analysis. Of these, 36, 52, and 61 patients had repeat HbA1c at 3, 6, and 12 months after the intervention, respectively. Mean age was 68 ± 6 years, 58% were Hispanic, and 92% males. HbA1c improved at 3 months (-0.49, 95% CI: -0.87 to -0.12, p=0.013), at 6 months (-0.40, 95% CI: -0.68 to -0.12, p=0.006), and at 12 months (-0.30, 95% CI: -0.57 to -0.029, p=0.031) compared to baseline. Timed Gait also improved (9.3 ±1.7 vs. 10.2 ±1.8, p<0.001). The finding highlights that older patients with T2D benefit from a GWC with improved glycemic control and timed gait.
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Affiliation(s)
- Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7875, San Antonio, TX 78229, USA; Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Chen-Pin Wang
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, TX, USA; Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, TX, USA
| | - Beverly Orsak
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA; Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, TX, USA
| | - Daniel MacCarthy
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, TX, USA; Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, TX, USA
| | - Dean Kellogg
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA; Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, TX, USA; Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Texas Health Science Center at San Antonio, TX, USA
| | - Becky Powers
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA; Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, TX, USA; Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Texas Health Science Center at San Antonio, TX, USA
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7875, San Antonio, TX 78229, USA
| | - Prasad Padala
- GRECC, Central Arkansas Veterans Healthcare System, Little Rock, USA; Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Kalpana Padala
- GRECC, Central Arkansas Veterans Healthcare System, Little Rock, USA; Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sara Espinoza
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA; Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, TX, USA; Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Texas Health Science Center at San Antonio, TX, USA.
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11
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Jiwani R, Dennis B, Bess C, Monk S, Meyer K, Wang J, Espinoza S. Assessing acceptability and patient experience of a behavioral lifestyle intervention using fitbit technology in older adults to manage type 2 diabetes amid COVID-19 pandemic: A focus group study. Geriatr Nurs 2021; 42:57-64. [PMID: 33248357 PMCID: PMC7933081 DOI: 10.1016/j.gerinurse.2020.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023]
Abstract
Type 2 diabetes (T2D) contributes to reduced quality of life in older adults, especially in those with comorbidities such as being overweight or obese. Personal fitness technology (Fitbit ®) has the potential to improve the management of T2D. Using a semi-structured interview guide, focus groups were conducted to explore participants' acceptability and experiences following a behavioral lifestyle intervention that integrated Fitbit in overweight/obese older adults with T2D amid the COVID-19 pandemic which began during the time of this study. Focus group transcripts were transcribed and analyzed using thematic analysis. Eighteen (18) of the 20 participants completed the program and focus group interviews. Overall, we observed high acceptability of the program, and participants reported favorable experiences such as increased knowledge of health behaviors, improved diabetes management, and improved quality of life following the behavioral lifestyle intervention, even under stressful life circumstances from COVID-19.
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Affiliation(s)
- Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA.
| | - Brittany Dennis
- Graduate School of Biomedical Sciences, University of Texas Health Science Center at San Antonio, San Antonio,Texas, USA; Center on Smart and Connected Health Technologies at University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Chandler Bess
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Siler Monk
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Center on Smart and Connected Health Technologies at University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Sara Espinoza
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA; Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Sam & Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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12
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Jiwani R, Wang J, Li C, Espinoza S. Evaluating a Mobile-Health-Enhanced Behavioral Lifestyle Intervention for Frailty in Diabetes: A Feasibility Study. Innov Aging 2020. [PMCID: PMC7743348 DOI: 10.1093/geroni/igaa057.1292] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Type 2 diabetes (T2D) and overweight are significant predictors of frailty in older adults. There are no widely accepted intervention strategies for frailty. The Look AHEAD (Action for Health in Diabetes) trial demonstrated the efficacy of behavioral lifestyle intervention on weight loss and glycemic control in overweight older adults with T2D. It is unknown whether this intervention can prevent/delay frailty in older adults. We designed a feasibility study examining the effect of a behavioral lifestyle intervention enhanced with mobile technology (Fitbit) for self-monitoring of diet and physical activity on frailty and T2D outcomes over 6 months in overweight older adults diagnosed with T2D. Forty older adults were randomized to receive either 10 group sessions vs. one condensed session plus monthly phone calls for 6 months. In this analysis, we are reporting on Fitbit wear adherence and weight changes on the 20 participants in the group session for the first 6 group sessions. The study sample was aged 72.3±6.4 years; 62% female; 52% Hispanic; BMI 33.7±5.9 kg/m2; hemoglobin A1c 7.2%; frailty score 1.1±1.0 kg/m2. Thirteen (65%) are pre-frail, 6 (30%) are non-frail, and 1 (5%) is frail (using Fried criteria). Their weight (lbs.) changed from session 1 (210.2±42.5) to session 6 (196.8±44.2). Ten participants wore Fitbit every day between sessions, averaged at 92±12%. The preliminary evaluation showed the feasibility of using Fitbit to promote self-monitoring adherence in a behavioral lifestyle intervention and a positive trend for weight loss. Evaluating intervention effect on frailty at 6 months will provide us further insights.
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Affiliation(s)
- Rozmin Jiwani
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Jing Wang
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Chengdong Li
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Sara Espinoza
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
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Du Y, Dennis B, Rhodes SL, Sia M, Ko J, Jiwani R, Wang J. Technology-Assisted Self-Monitoring of Lifestyle Behaviors and Health Indicators in Diabetes: Qualitative Study. JMIR Diabetes 2020; 5:e21183. [PMID: 32857056 PMCID: PMC7486673 DOI: 10.2196/21183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Self-monitoring is key to successful behavior change in diabetes and obesity, and the use of traditional paper-based methods of self-monitoring may be time-consuming and burdensome. OBJECTIVE This study aimed to explore participant experiences while using technology-assisted self-monitoring of lifestyle behaviors and health indicators among overweight or obese adults with type 2 diabetes. METHODS Qualitative data collected from the intervention group of a 6-month, three-arm (control, paper diary, and technology-assisted self-monitoring groups) randomized clinical trial were analyzed. Study participants in the intervention group monitored their diet, exercise, and weight using the LoseIt! app, and their blood glucose levels using a glucometer and the Diabetes Connect app. Semistructured group discussions were conducted at 6 weeks (n=10) from the initiation of the behavioral lifestyle intervention and again at 6 months (n=9). All group interviews were audiotaped and transcribed verbatim. Using a combination of thematic and comparative analysis approaches, two trained professionals coded the transcriptions independently and then discussed and concluded common themes for the 6-week and 6-month discussions separately. RESULTS The sample (n=10), which primarily involved African American participants (n=7) and female participants (n=8), had a mean age of 59.4 years. The following eight themes emerged: (1) perceived benefits of technology-assisted self-monitoring; (2) perceived ease of use (eg, barriers: technical difficulties and lack of self-discipline; facilitators: help from family, friends, and the program); (3) use of technology-assisted self-monitoring; (4) facilitators of engaging in healthy lifestyle behaviors (eg, visualization and awareness of calorie input/expenditure); (5) positive lifestyle change; (6) barriers of engaging in healthy lifestyle behaviors (eg, event influence); (7) learning curve; and (8) monitored data sharing. The first six of these themes were shared between the 6-week and 6-month timepoints, but the codes within these themes were not all the same and differed slightly between the two timepoints. These differences provide insights into the evolution of participant thoughts and perceptions on using technology for self-monitoring and subsequent behavioral lifestyle changes while participating in lifestyle interventions. The findings from the 6-week and 6-month data helped to paint a picture of participant comfort and the integration of technology and knowledge overtime, and clarified participant attitudes, difficulties, behavioral processes, and modifications, as well as health indicators that were experienced throughout the study. CONCLUSIONS Although there were some barriers, participants were able to identify various individual and external facilitators to adjust to and engage in technology-assisted self-monitoring, and it was concluded that the technology-assisted self-monitoring approach was beneficial, safe, and feasible to use for positive lifestyle change. These patient perspectives need to be considered in future research studies when investigating the effectiveness of using technology-assisted self-monitoring, as well as in clinical practice when recommending technology-assisted self-monitoring of lifestyle behaviors and health indicators to improve health outcomes.
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Affiliation(s)
- Yan Du
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Brittany Dennis
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Shanae Lakel Rhodes
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Michelle Sia
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jisook Ko
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Jiwani R, Wang J, Berndt A, Ramaswamy P, Mathew Joseph N, Du Y, Ko J, Espinoza S. Changes in Patient-Reported Outcome Measures With a Technology-Supported Behavioral Lifestyle Intervention Among Patients With Type 2 Diabetes: Pilot Randomized Controlled Clinical Trial. JMIR Diabetes 2020; 5:e19268. [PMID: 32706652 PMCID: PMC7414397 DOI: 10.2196/19268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/31/2020] [Accepted: 06/21/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In the United States, more than one-third of the adult population is obese, and approximately 25.2% of those aged ≥65 years have type 2 diabetes (T2D), which is the seventh leading cause of death. It is important to measure patient-reported outcomes and monitor progress or challenges over time when managing T2D to understand patients' perception of health and quantify the impact of disease processes or intervention effects. The evaluation of patient-reported outcome measures (PROMs) is especially important among patients with multiple chronic conditions in which clinical measures do not provide a complete picture of health. OBJECTIVE This study examined the feasibility of collecting Patient-Reported Outcome Measurement Information System (PROMIS) measures, and preliminarily evaluated changes in PROMIS scores and compared the scores with standard scores of the general US population. The parent study is a pilot randomized controlled clinical trial testing three different modes (mobile health [mHealth], paper diary, and control) of self-monitoring in a behavioral lifestyle intervention among overweight or obese patients with T2D. METHODS Patients with comorbid overweight or obesity and a diagnosis of T2D for at least 6 months were recruited from a diabetes education program. Participants were randomized to the following three groups: mHealth, paper diary, and control (standard of care) groups. Paper diary and mHealth experimental groups received additional behavioral lifestyle intervention education sessions, as well as tools to self-monitor weight, physical activity, diet, and blood glucose. All participants completed PROMIS-57 and PROMIS-Global Health (GH) version 1.0 questionnaires during visits at baseline, 3 months, and 6 months. The PROMIS-57 includes the following seven domains: anxiety, depression, fatigue, pain interference, physical function, satisfaction with participation in social roles, and sleep disturbance. The PROMIS-GH is composed of the following two domains: global mental health and global physical health. RESULTS A total of 26 patients (mHealth, 11; paper diary, 9; control, 6) were included in our analysis. The study sample was predominantly African American (68%) and female (57%), with a mean age of 54.7 years and a mean BMI of 37.5 kg/m2. All patients completed the PROMIS-57 and PROMIS-GH questionnaires, and we compared the mean scores of the three groups to investigate potential differences. No relevant differences were noted across the groups. However, positive trends were noted in both intervention (mHealth and paper diary) groups in the middle (month 3) and end (month 6) of the study. CONCLUSIONS Our pilot study provides evidence for the feasibility of using PROMIS questionnaires to record important components of T2D-related symptoms among overweight or obese individuals. The results from our study support the use of PROMIS questionnaires to provide clinicians and researchers with a benchmark for assessing the overall need for symptom management and determining the success or challenges of an intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT02858648; https://clinicaltrials.gov/ct2/show/NCT02858648.
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Affiliation(s)
- Rozmin Jiwani
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Andrea Berndt
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Padmavathy Ramaswamy
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nitha Mathew Joseph
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yan Du
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jisook Ko
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Sara Espinoza
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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15
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Espinoza SE, Musi N, Wang CP, Michalek J, Orsak B, Romo T, Powers B, Conde A, Moris M, Bair-Kelps D, Li Y, Ganapathy V, Jergensen TE, Kelly LC, Jiwani R. Rationale and Study Design of a Randomized Clinical Trial of Metformin to Prevent Frailty in Older Adults With Prediabetes. J Gerontol A Biol Sci Med Sci 2020; 75:102-109. [PMID: 30888034 PMCID: PMC7175970 DOI: 10.1093/gerona/glz078] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 06/06/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome that leads to poor health outcomes with aging. Previous studies have demonstrated that insulin resistance and inflammation predict frailty onset. Metformin is a widely used, well-tolerated drug that improves insulin sensitivity and displays anti-inflammatory properties. It is also known to prevent diabetes onset in adults with prediabetes. We hypothesize that metformin in older adults with prediabetes will promote healthy aging and prevent frailty. Here we describe an ongoing placebo-controlled, double-blinded clinical trial of metformin for the prevention of frailty in older adults with prediabetes. METHODS Older adults aged more than 65 years are randomized to metformin or placebo and are followed for 2 years. Prediabetes, required for inclusion, is assessed by 2-hour oral glucose tolerance test. Exclusion criteria are baseline frailty (Fried criteria), diabetes, dementia, untreated depression, active malignancy, or severe cardiovascular, pulmonary, and neurologic diseases. Primary outcome is frailty; secondary outcomes are physical function (Short Physical Performance Battery), systemic and skeletal muscle tissue inflammation, muscle insulin signaling, insulin sensitivity (insulin clamp), glucose tolerance (oral glucose tolerance test), and body composition (dual-energy x-ray absorptiometry). Subjects are followed every 3 months for safety assessments and every 6 months for frailty assessment (Fried criteria) and oral glucose tolerance test, and every 12 or 24 months for secondary outcomes. Enrollment of 120 subjects (completers) will take place over a 2-year period. CONCLUSION Metformin is being examined in this study as a potential therapeutic agent to prevent frailty in older adults with prediabetes. Findings from this trial may have future implications for the screening and potential treatment of prediabetes in older patients with metformin for the prevention of frailty.
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Affiliation(s)
- Sara E Espinoza
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Nicolas Musi
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
- Division of Diabetes, Department of Medicine, Texas
| | - Chen-pin Wang
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Epidemiology and Biostatistics, Texas
| | | | - Beverly Orsak
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
- Division of Diabetes, Department of Medicine, Texas
| | - Terry Romo
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Becky Powers
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Alice Conde
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Melody Moris
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Darcy Bair-Kelps
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Yan Li
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Vinutha Ganapathy
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Tyson E Jergensen
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Lauri C Kelly
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Rozmin Jiwani
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
- School of Nursing, University of Texas Health Science Center at San Antonio, Texas
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Espinoza SE, Jiwani R, Wang J, Wang CP. Review of Interventions for the Frailty Syndrome and the Role of Metformin as a Potential Pharmacologic Agent for Frailty Prevention. Clin Ther 2019; 41:376-386. [DOI: 10.1016/j.clinthera.2019.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/25/2022]
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