Blood Hemoglobin A1c Research Articles

One Month Whole Food Plant-Based Nutrition Educational Program Lowers LDL, A1C, and Decreases Inflammatory Markers.

Lifestyle-related chronic disease increases in the United States have led to the need for innovative programs targeting dietary choices. Based on growing evidence supporting whole food plant-based (WFPB) nutrition to improve overall health, we devised a one-month WFPB intervention program, Jumpstart Your Health! (JYH), to introduce and encourage adoption of the WFPB dietary lifestyle. This paper investigates its effects on various health indicators associated with cardiovascular and metabolic diseases. Among the total of 150 participants, before and after physical measurements and blood chemistries demonstrate significant (p< 0.05) decreases in weight (-4.2 pounds), cholesterol (-25.3mg/dl), LDL (-19.0mg/dl), HDL (-5.6mg/dl), hemoglobin A1c (-0.2%), and hsCRP (-1.9mg/L). Among the high-risk participants, we found significant decreases in systolic blood pressure (-10mmHg), diastolic blood pressure (-8.7mmHg), weight (-4.3pounds), cholesterol (-38.8mg/dl), LDL (-22.7mg/dl), HDL (-2.8mg/dl), hemoglobin A1c (-0.2 %), and hsCRP (-2.3mg/L). We demonstrate that a simple WFPB intervention implemented over one month resulted in significant reductions in physical measurements and blood chemistries that could translate to lowered risk or improvement for obesity, cardiovascular disease, and type-2 diabetes.

Metabolically healthy obesity and cardiovascular outcomes

Abstract Obesity increases cardiovascular risk through a deterioration of the metabolic profile. However, obesity is not always accompanied by a worsening metabolic profile. This longitudinal study aimed to determine whether obesity with a normal metabolic profile, i.e. metabolically healthy obesity, increases the risk of cardiovascular disease. We analyzed a health insurance data of Shizuoka prefecture resident. This data includes data from annual health check-ups performed for insured persons. This study analyzed data from 168,699 individuals aged &amp;lt;65 years. Obesity was defined as ≥ 25 kg/m2 body mass index. Metabolically healthy was defined as ≤ 1 metabolic risk factors (high blood pressure, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, or high hemoglobin A1c). Incidence rate of cardiovascular diseases (stroke and myocardial infarction), and all-cause mortality identified from the insurance data were compared between clinical profile-matched metabolically healthy obesity and non-obesity groups (n = 8,644 each). Clinical parameters, namely systolic blood pressure (standard mean difference = 0.03), HDL cholesterol (0.01), LDL cholesterol (0.01), and hemoglobin A1c (0.01) did not differ among the metabolically healthy obesity and non-obesity groups. The incident rate of stroke (obesity: 9.2 per 10,000 person-years; non-obesity: 10.5; log-rank test P = 0.595), myocardial infarction (obesity: 3.7; non-obesity: 3.1; P = 0.613), and all-cause mortality (obesity: 26.6; nonobesity: 23.2; P = 0.304) also did not differ significantly among the groups even when abdominal obesity was considered in the analysis, though the population with metabolically healthy obesity reported negligibly worse metabolic profiles than the population with nonobese at the 5.6-year follow-up. Obesity, when accompanied by a healthy metabolic profile, did not increase the risk of cardiovascular outcomes and all-cause mortality. Key messages • Metabolically healthy obesity did not increase cardiovascular disease risks. • Metabolically healthy obesity was associated with worse metabolic profiles after a few years later.

Impact of Melatonin Supplementation on Glycemic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta-analysis.

Several previous studies indicated that melatonin supplementation may positively affect glycemic control in patients with diabetes. However, research on the influence of melatonin supplementation on glycemic parameters remains inconclusive. Therefore, this study aimed to assess the impacts of melatonin supplementation on glycemic parameters in type 2 diabetes by conducting a meta-analysis. PubMed/Medline, Scopus, and Web of Science were comprehensively searched until July 2024 to find eligible randomized clinical trials (RCTs). The overall effect sizes were estimated by using the randomeffect model and presented as weighted mean differences (WMD) with a 95% confidence interval (CI). Furthermore, the heterogeneity among the included trials was assessed by performing the Cochran Q test and interpreted based on the I² statistic. Of the 1361 papers, eight eligible RCTs were included in this meta-analysis. Our findings indicated that melatonin supplementation significantly decreased fasting blood glucose (WMD = -12.65 mg/dl; 95% CI: -20.38, -4.92; P = 0.001), insulin (WMD = -2.30 μU/ml; 95% CI: -3.20, -1.40; P < 0.001), hemoglobin A1c (WMD = -0.79 %; 95% CI: -1.28, -0.29; P = 0.002), and HOMA-IR (WMD, -0.83; 95% CI: -1.59 to - 0.07; P = 0.03). According to the results of the current meta-analysis, persons with type 2 diabetes who supplement with melatonin had improved glycemic control. It looks that supplementing with melatonin at a dose exceeding 6 mg daily for over a period of 12 weeks may be more successful than other forms of intervention. Nevertheless, further research with larger sample sizes is necessary to draw definitive conclusions.

Impact of physical activity levels on the association between air pollution exposures and glycemic indicators in older individuals

BackgroundAir pollution may exacerbate diabetes-related indicators; however, the longitudinal associations between air pollutant concentrations and glycemic markers remain unclear. In this prospective cohort study, we examined the longitudinal associations between air pollution and glycemic indicators among older individuals with normoglycemia at baseline and determined whether these associations differed according to changes in physical activity levels.MethodsOverall, 1,856 participants (mean age, 70.9 years) underwent baseline and 4-year follow-up surveys. We used linear mixed-effect models to examine the associations between previous 1-year exposures to air pollutants and glycemic indicators. We further investigated associations between previous 5-year exposures to air pollutants and glycemic indicators after the inverse probability of treatment weighting (IPTW). We explored effect modifications by the level of physical activity maintenance and changes in metabolic equivalent of task (METs) for physical activity.ResultsLevels of particulate matter with aerodynamic diameters ≤ 10 μm (PM10) and ≤ 2.5 μm, and nitrogen dioxide (NO2) were significantly associated with increased fasting blood glucose, Hemoglobin A1c, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR) values. After IPTW, the associations remained significant for PM10 and NO2. The positive associations of NO2 with insulin and HOMA-IR remained significant in the maintained inactive group, but not in the maintained moderate-to-vigorous active group. The positive associations of PM10 or NO2 with insulin and HOMA-IR remained significant in the group with increased METs, but not in those with decreased METs. In the post-hoc analysis of non-linear relationships between an increase in METs and glycemic indicators, insulin and HOMA-IR remarkably increased in the higher PM10 and NO2 exposure group from the point of 12,000 and 13,500 METs-min/week increase, respectively.ConclusionsWe demonstrated longitudinal associations between air pollution exposures and increased insulin resistance in older individuals. Maintaining moderate-to-vigorous physical activity may mitigate the adverse effects of air pollution on insulin resistance. In older individuals dwelling in highly polluted areas, an increase of less than 12,000 METs-min/week may be beneficial for insulin resistance.

Cutoff Values for Glycated Albumin, 1,5-Anhydroglucitol, and Fructosamine as Alternative Markers for Hyperglycemia.

Glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), and fructosamine have attracted considerable interest as markers of hyperglycemia. This study aimed to evaluate the optimal cutoff values for GA, 1,5-AG, and fructosamine and to determine their respective diagnostic efficacies in relation to hyperglycemia. We enrolled 6012 individuals who had undergone fasting blood glucose (FBG) and Hemoglobin A1c (HbA1c) tests along with at least one alternative glycemic marker. Receiver operating characteristic (ROC) curves and the upper or lower limit of the reference range (97.5 or 2.5 percentiles) were used to ascertain the optimal cutoff values. Follow-up data from healthy individuals were used to identify patients who developed diabetes mellitus (DM). The ROC cutoff values for GA, 1,5-AG, and fructosamine were 13.9%, 13.3 μg/mL, and 278 μmol/L, respectively, with corresponding area under the curve (AUC) values of 0.860, 0.879, and 0.834. The upper limits of the reference intervals for GA and fructosamine were 15.1% and 279 μmol/L, respectively, and the lower limit for 1,5-AG was 5.3 μg/mL. Among the GA cutoff values, the ROC cutoff had the highest sensitivity. Analyzing the follow-up data showed that lowering the GA cutoff from 16.0% to 13.9% identified an additional 40 people with DM progression. Lowering the GA cutoff values significantly increased the sensitivity of DM diagnosis and enhanced its potential as a screening marker by identifying more individuals with diabetes progression. Conversely, modifications to the cutoff values for 1,5-AG and fructosamine did not confer any discernible diagnostic or predictive advantages.

Impact of Co-Management Mode on Diagnosis and Treatment Compliance in Community-Level Diabetic Patients with Retinopathy.

Aims/Background To implement a co-management mode among community-level diabetes patients and analyze its impact on diagnosis and treatment compliance and diabetic retinopathy of the patients. Methods A total of 80 patients who underwent diabetic retinopathy examination in Lanxi People's Hospital from January 2021 to March 2022 were retrospectively selected as the study objects. The clinical data of the patients were analyzed, including 40 patients who adopted the conventional diabetes management mode from January 2021 to August 2021 as the control group. From September 2021 to March 2022, 40 patients in the county medical service community diabetes management team model were adopted as the management group. The two groups of patients were compared in terms of diabetic retinopathy indictors, biochemical examination indicators, self-management ability, and nursing management satisfaction. Results Number of patients complying with treatment protocols in the management group was higher than that in the control group (p < 0.05). The blood spot area, macular thickness, hemangioma volume, and visual-field grayscale value in the management group at the last follow-up were all lower than those in the control group (p < 0.05). The levels of diastolic blood pressure (DBP), systolic blood pressure (SBP), fasting blood glucose (FBG), hemoglobin A1C (HbA1c), total cholesterol (TC), and triglyceride (TG) in the management group at the last follow-up were all lower than those in the control group (p < 0.05). The scores of disease cognition ability, self-management ability, and nursing management satisfaction in the management group were all higher than those in the control group (p < 0.05). Conclusion By changing management concept and implementing the whole-process management and treatment mode for diabetic patients within the scope of the county medical service community, the diagnosis and treatment compliance of the patients can be improved, and the effective control of blood glucose, blood pressure, and blood lipid levels can be achieved, thereby improving the self-management ability and nursing management satisfaction of the patients and providing a new nursing mode for chronic disease management.

6602 Classification of TSH Trajectories During Levothyroxine Treatment in the ELSA-Brasil Cohort

Abstract Disclosure: M.D. Ettleson: None. G.C. Penna: Consulting Fee; Self; Ipsen, Bayer, Inc.. W. Wan: None. I.M. Bensenor: None. N. Laiteerapong: None. A.C. Bianco: Consulting Fee; Self; Abbvie. Classification of TSH Trajectories During Levothyroxine Treatment in the ELSA-Brasil Cohort Introduction: Hypothyroidism is a common endocrine disorder for which levothyroxine (LT4) serves as the primary treatment. Periods during which thyroid stimulating hormone (TSH) levels are outside the normal range have been associated with adverse cardiovascular outcomes, including mortality. In practice, serial TSH levels are measured over time to ensure therapeutic LT4 treatment is maintained. However, there is no measure of the quality of treatment maintenance over time. TSH trajectory classification represents a novel approach to define the adequacy of LT4 treatment for hypothyroidism over time utilizing multiple observation points. Methods: With longitudinal clinical data, including thyroid function from a large prospective study, we aimed to define classes of TSH trajectories and examine changes in cardiovascular (CV) health markers over a 9 year study period with three observation points. Growth mixture modeling (GMM), including latent class growth analysis (LCGA), was used to classify LT4-treated individuals participating in the Longitudinal Study of Adult Health in Brazil (ELSA-Brasil) based on serial TSH levels. Repeated measure analyses were then utilized to measure within-class changes in blood pressure, lipid levels, hemoglobin A1c, and CV-related medication utilization. Results: From the 621 LT4-treated study participants, the best-fit GMM approach identified four TSH trajectory classes, as defined by their relationship to the normal TSH range: 1) High-high normal TSH, 2) Normal TSH, 3) Normal-to-low TSH, and 4) Low-to-normal TSH. Notably, the average baseline LT4 dose was lowest in the high-high normal TSH group (77.7 mcg, p &amp;lt;0.001). There were no significant differences in CV health markers between the classes at baseline. At least one significant difference in CV markers occurred in all classes, highlighted by the low-to-normal class, in which total and HDL cholesterol, triglycerides, and A1c all increased significantly (p = 0.049, p &amp;lt;0.001, p &amp;lt;0.001, and p = 0.001, respectively). Medication utilization increased in all classes over the study period. Conclusion: GMM/LCGA represents a viable approach to define and examine LT4 treatment by TSH trajectory. In the future, more comprehensive datasets will allow for more complex trajectory modeling and analysis of clinical outcome differences between trajectory classes. Defining the adequacy of LT4 treatment using a longitudinal scope could allow clinicians to more accurately communicate treatment progress and identify patients at risk for adverse CV outcomes. Presentation: 6/3/2024

6707 Preconception Lipids, Birthweight, And Pregnancy Outcomes In Pre-existing Diabetes

Abstract Disclosure: J. Chang: None. S. Hsu: None. T. Thaweethai: None. K.E. James: None. L.L. Shook: None. J. Maya: None. C.E. Powe: Consulting Fee; Self; Mediflix Inc. Other; Self; Wolters Kluwer, Up to Date Author. Objective Prior studies suggest that higher preconception triglycerides are associated with higher infant birthweight in people without pre-existing diabetes. People with pre-existing diabetes have high risk for dyslipidemia and large for gestational age (LGA) neonates; however, data is scarce on the association between preconception lipids and pregnancy outcomes in this population. Methods: We retrospectively analyzed pregnancies with pre-existing diabetes who had triglyceride levels available prior to conception. We used generalized estimating equations (GEE) for linear regression to examine the association of preconception log-transformed triglycerides with birthweight percentile (primary outcome) while accounting for pregnancies that occurred in the same person. We used logistic regression via GEE for other pregnancy outcomes, including LGA. We built unadjusted models and models adjusted for maternal age, race/ethnicity, parity, insurance status, marital status, first trimester blood pressure, and BMI and hemoglobin A1C at 12 weeks’ gestation. We assessed for effect modification by diabetes type via stratification and interaction models. Results: Among 217 pregnancies in 189 people, 27% had preconception triglycerides ≥150 mg/dL and 32% resulted in LGA infants. Log-transformed triglycerides were not significantly associated with birthweight percentile in the full cohort in either adjusted (P = 0.62) or unadjusted models (P = 0.35). However, in unadjusted analyses stratified by diabetes type, a one unit increase in log-transformed triglycerides was associated with a 10.4 percentile increase in birthweight in pregnancies with type 2 diabetes (T2D; N=137) (95% confidence interval [CI] [1.12, 19.63], P = 0.03) and a 16.0 percentile decrease in birthweight in those with type 1 diabetes (T1D; N=76) (95% CI [-30.03, -1.95], P = 0.03). These associations were significantly different from each other (P for interaction = 0.002). Associations were attenuated after multivariate adjustment (T2D: β = 6.62, 95% CI [-3.42, 16.66], P= 0.20; T1D: β = -11.12, 95% CI [-23.61, 1.37], P= 0.08). Analyses of LGA incidence were consistent with primary findings, as those with T2D and higher log-transformed triglyceride levels were more likely to have LGA infants (odds ratio [OR] = 3.84, 95% CI [1.71, 8.62], P= 0.001) while an inverse association was seen in T1D (OR = 0.35, 95% CI [0.13, 0.94], P= 0.04). After multivariate adjustment, the association with LGA persisted in T2D (OR = 4.03, 95% CI [1.42, 11.44], P= 0.01) but was attenuated in T1D (OR = 0.34, 95% CI [0.09, 1.27], P= 0.11). Conclusion: Higher preconception triglycerides are associated with higher infant birthweight in people with T2D, while the inverse may be seen in those with T1D. Mechanisms linking preconception triglycerides and birthweight in people with diabetes should be examined in future studies. Presentation: 6/2/2024

Non-ketotic hyperglycemia-induced hemichorea-hemiballism – A case presentation and literature review

Non-ketotic hyperglycemia-induced hemichorea-hemiballism (NKHHH) is an infrequent hyperkinetic movement disorder, also known as diabetic striatopathy or Chorea hyperglycemia basal ganglia syndrome (C-H-BG), characterized by repetitive, uncontrollable movements in the unilateral or bilateral limbs. An insult to the contralateral basal ganglia causes NKHHH to develop. NKHHH is caused by ischemia, followed by non-ketotic hyperglycemia and poorly controlled diabetes. NKHHH is a rare condition with a unique cause that only affects one side of the corpus striatum (caudate nucleus and putamen). Clinical events of hemichorea-hemiballism, laboratory tests (elevated blood glucose and hemoglobin A1c levels), and imaging modalities (computed tomography and magnetic resonance imaging) all contribute to diagnosing NKHHH. The objective of this case report is to represent cross-sectional imaging findings in a 55-year-old female who presented with hemichorea-hemiballism following non-ketotic hyperglycemia. In conclusion, the clinical manifestation of NKHHH and its computed tomography (CT) and magnetic resonance imaging (MRI) findings are crucial in determining the appropriate management.

Effects of probiotics supplementation on glycemic profile in adults with type 2 diabetes mellitus: A grade-assessed systematic review and dose–response meta-analysis of randomized controlled trials

BackgroundDisturbed glycemia and the resulting type 2 diabetes (T2D) are significant health concerns. Various approaches have been examined to improve glycemic control in patients with T2D. Modification of gut microbiome via administering probiotics has been extensively studied. The present study aims to sum up the existing literature which investigated the effect of probiotics on glycemic indices in individuals with T2D in the format of randomized controlled trials (RCTs). MethodsOnline medical databases (PubMed, Scopus, and Web of Science) were searched from inception to January 2024. Eligible studies were included using pre-defined inclusion and exclusion criteria. Outcome variables included fasting blood sugar (FBS), insulin, hemoglobin A1c (HbA1c), and homeostatic model of insulin resistance (HOMA-IR). Weighted mean differences (WMDs) were estimated. Subgroup and dose-response analyses were conducted. P-values <0.05 were considered as statistically significant. ResultsOut of 5,636 records retrieved by the initial search, thirty-two RCTs were included in the final analyses. Supplementation with probiotics was observed to significantly improve indices of glycemic control; including FBS (WMD: -13.27 mg/dl; 95% CI: -18.31, -8.22), HbA1c (WMD: -0.44 %; 95% CI: -0.59, -0.28), insulin (WMD: -1.33 μIU/ml; 95% CI: -2.57, -0.08), and HOMA-IR (WMD: -0.95; 95% CI: -1.71, -0.18). Dose-response analysis revealed that increased duration of intervention results in a larger reduction only in FBS. ConclusionSupplementation with probiotics seems to improve indices of glycemic control. Nonetheless, taken into account the notable heterogeneity (with regard to dosage, duration, and the species/strains used) between the included studies and low quality of evidence, caution must be considered, especially when long-term clinical implications are intended.

Heterogeneous effects of Medicaid coverage on cardiovascular risk factors: secondary analysis of randomized controlled trial

ObjectivesTo investigate whether health insurance generated improvements in cardiovascular risk factors (blood pressure and hemoglobin A1c (HbA1c) levels) for identifiable subpopulations, and using machine learning to identify characteristics of people...

Fasting blood glucose and hemoglobin a1c: measures of insulin sensitivity?

Measures used in clinical practice should be indicative of health or disease. Fasting blood glucose and hemoglobin a1c are used routinely in clinical practice to diagnose diabetes but the utility of fasting blood glucose and hemoglobin a1c as measures of tissue sensitivity to insulin is unreliable at best

Effect of Zinc Supplementation on Glycemic Control in Newly Diagnosed Patients With Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) is a spectrum of metabolic disorders primarily characterized by elevated blood glucose levels. Type 2 DM (T2DM), the most common form, often requires adjunctive therapies to improve glycemic control and mitigate associated risks. Zinc has been implicated in glucose metabolism and insulin function, prompting this study to evaluate the impact of zinc supplementation on glycemic control in newly diagnosed T2DM patients. A randomized, placebo-controlled trial was conducted involving 80 newly diagnosed T2DM patients. Participants were randomly assigned to receive either zinc supplementation (50 mg/day) or a placebo, in conjunction with standard oral hypoglycemic medication, metformin. Key indicators, including fasting blood glucose (FBG), postprandial blood glucose (PPBG), hemoglobin A1c (HbA1c), and lipid profiles, were measured at baseline and after the 12-month intervention period. The group receiving zinc supplementation demonstrated significant reductions in FBG, PPBG, and HbA1c levels compared to the placebo group. The mean FBG in the intervention group decreased by 21.52 mg/dL, PPBG decreased by 47.53 mg/dL, and HbA1c decreased by 0.79%. Additionally, zinc supplementation led to notable decreases in low-density lipoprotein (LDL) cholesterol by 25.06 mg/dL, triglycerides by 22.2 mg/dL, and total cholesterol levels by 26.67 mg/dL. However, no significant changes were observed in high-density lipoprotein (HDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol, or erythrocyte sedimentation rate (ESR). The findings suggest that zinc supplementation may be a beneficial adjunctive therapy in the early management of T2DM, contributing to improved glycemic control and favorable changes in lipid profiles. However, its effect on HDL, VLDL, and ESR was insignificant, indicating the need for further research to better understand the broader implications of zinc in T2DM management.

Comparison of Glucose and Immunoglobulin a Levels in Serum and Saliva of Patients with Type 1 and Type 2 Diabetes

Introduction: The monitoring and management of blood glucose levels are of significant importance in individuals diagnosed with diabetes mellitus. Accordingly, the objective of this study was to examine the potential of a non-invasive approach for the diagnosis and management of diabetes, through the measurement of glucose concentration and salivary IgA, and a comparison with fasting glucose and serum IgA levels in individuals with type 1 and 2 diabetes, in relation to a control group of healthy individuals. Methods: This case-control study was conducted on 76 individuals with diabetes (31 with type 1 diabetes and 45 with type 2 diabetes) and 24 healthy individuals. After obtaining the code of ethics and informed consent, serum and salivary IgA levels as well as fasting glucose, were measured for each participant. The data were analyzed using SPSS version 16 statistical software and the Spearman, Kruskal-Wallis, and Mann-Whitney tests. Results: The results showed a significant difference among the three groups (type 1 diabetes, type 2 diabetes, and healthy group) based on Fasting Blood Glucose, Hemoglobin A1c, Immunoglobulin A, salivary sugar, and salivary IgA (p&lt;0.001). Additionally, in the case group, parameters such as FBS, HbA1c, and salivary IgA showed a significant correlation with salivary sugar. Conversely, in the control group, only the salivary sugar level demonstrated a significant relationship with serum glucose level. The study's findings indicated that serum and salivary IgA levels were lower and higher, respectively, in the control subjects compared to the diabetic group (p&lt;0.001). Conclusion: In healthy individuals, salivary sugar can serve as an indicator to determine fasting blood sugar levels. In diabetic patients, salivary sugar can predict of FBS, HbA1c, and salivary IgA levels.

Addressing depression and comorbid health conditions through solution-focused brief therapy in an integrated care setting: a randomized clinical trial

BackgroundCo-occurring physical and mental health conditions are common, but effective and sustainable interventions are needed for primary care settings.PurposeOur paper analyzes the effectiveness of a Solution-Focused Brief Therapy (SFBT) intervention for treating depression and co-occurring health conditions in primary care. We hypothesized that individuals receiving the SFBT intervention would have statistically significant reductions in depressive and anxiety symptoms, systolic blood pressure (SBP), hemoglobin A1C (HbA1c), and body mass index (BMI) when compared to those in the control group. Additionally, we hypothesized that the SFBT group would have increased well-being scores compared to the control group.MethodsA randomized clinical trial was conducted at a rural federally qualified health center. Eligible participants scored ≥ 10 on the Patient Health Questionnaire (PHQ-9) and met criteria for co-occurring health conditions (hypertension, obesity, diabetes) evidenced by chart review. SFBT participants (n = 40) received three SFBT interventions over three weeks in addition to treatment as usual (TAU). The control group (n = 40) received TAU over three weeks. Measures included depression (PHQ-9) and anxiety (GAD-7), well-being (Human Flourishing Index), and SFBT scores, along with physical health outcomes (blood pressure, body mass index, and hemoglobin A1c).ResultsOf 80 consented participants, 69 completed all measures and were included in the final analysis. 80% identified as female and the mean age was 38.1 years (SD = 14.5). Most participants were white (72%) followed by Hispanic (15%) and Black (13%). When compared to TAU, SFBT intervention participants had significantly greater reductions in depression (baseline: M = 18.17, SD = 3.97, outcome: M = 9.71, SD = 3.71) and anxiety (baseline: M = 14.69, SD = 4.9, outcome: M = 8.43, SD = 3.79). SFBT intervention participants also had significantly increased well-being scores (baseline: M = 58.37, SD = 16.36, outcome: M = 73.43, SD = 14.70) when compared to TAU. Changes in BMI and blood pressure were not statistically significant.ConclusionThe SFBT intervention demonstrated efficacy in reducing depressive and anxiety symptoms and increasing well-being but did not affect cardio-metabolic parameters over a short period of intervention.Trial RegistrationThe study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 4/20/2023. *M = Mean, SD = Standard deviation.

Associations of urinary biomarkers of phthalates, phenols, parabens, and organophosphate esters with glycemic traits in pregnancy: The Healthy Start Study

BackgroundCertain endocrine-disrupting chemicals (EDCs) are widespread in consumer products and may alter glucose metabolism. However, the impact of EDC exposures on glucose and insulin regulation during pregnancy is incompletely understood, despite potential adverse consequences for maternal and infant health. We estimated associations between 37 urinary biomarkers of EDCs and glucose-insulin traits among pregnant women. MethodsSeventeen phthalate or phthalate substitute metabolites, six environmental phenols, four parabens, and ten organophosphate ester metabolites were quantified in mid-pregnancy urine from 298 participants in the Healthy Start Study. Fasting blood glucose, insulin, and hemoglobin A1c were assessed concurrently, and Homeostasis Model Assessment 2-Insulin Resistance (HOMA2-IR) was calculated. Gestational diabetes diagnoses and screening results were obtained from medical records for a subset of participants. We estimated associations between each EDC and outcome separately using linear and robust Poisson regression models and analyzed EDC mixture effects. ResultsThe EDC mixture was positively associated with glucose, insulin, and HOMA2-IR, although overall associations were attenuated after adjustment for maternal BMI. Two mixture approaches identified di(2-ethylhexyl) phthalate (DEHP) metabolites as top contributors to the mixture's positive associations. In single-pollutant models, DEHP metabolites were positively associated with fasting glucose, fasting insulin, and HOMA2-IR even after adjustment for maternal BMI. For example, each interquartile range increase in log2-transformed mono(2-ethyl-5-oxohexyl) phthalate was associated with 2.4 mg/dL (95% confidence interval (CI): 1.1, 3.6) higher fasting glucose, 11.8% (95%CI: 3.6, 20.5) higher fasting insulin, and 12.3% (95%CI: 4.2, 21.1) higher HOMA2-IR. Few EDCs were associated with hemoglobin A1c or with a combined outcome of impaired glucose tolerance or gestational diabetes. DiscussionExposures to phthalates and particularly DEHP during pregnancy are associated with altered glucose-insulin regulation. Disruptions in maternal glucose metabolism during pregnancy may contribute to adverse pregnancy outcomes including gestational diabetes and fetal macrosomia, and associated long-term consequences for maternal and child health.

Comprehensive Multiple Risk Factor Control in Type 2 Diabetes to Mitigate Heart Failure Risk: Insights From a Prospective Cohort Study.

The impact of comprehensive risk factor control on heart failure (HF) risk and HF-free survival time in individuals with type 2 diabetes (T2D) was evaluated in this study. This prospective study included 11,949 individuals diagnosed with T2D, matched with 47,796 non-T2D control study participants from the UK Biobank cohort. The degree of comprehensive risk factor control was assessed on the basis of the major cardiovascular risk factors, including blood pressure, BMI, LDL cholesterol, hemoglobin A1c, renal function, smoking, diet, and physical activity. Cox proportional hazards models were used to measure the associations between the degree of risk factor control and HF risk. Irwin's restricted mean was used to evaluate HF-free survival time. During a median follow-up of 12.3 years, 702 individuals (5.87%) with T2D and 1,402 matched control participants (2.93%) developed HF. Each additional risk factor controlled was associated with an average 19% lower risk of HF. Optimal control of at least six risk factors was associated with a 67% lower HF risk (hazard ratio [HR] 0.33; 95% CI 0.20, 0.54). BMI was the primary attributable risk factor for HF. Notably, the excess risk of HF associated with T2D could be attenuated to levels comparable to those of non-T2D control participants when individuals had a high degree of risk factor control (HR 0.66; 95% CI 0.40, 1.07), and they exhibited a longer HF-free survival time. Comprehensive management of risk factors is inversely associated with HF risk, and optimal risk factor control may prolong HF-free survival time among individuals with T2D.

Simulating the impact of greenspace exposure on metabolic biomarkers in a diverse population living in San Diego, California: A g-computation application.

Growing evidence exists that greenspace exposure can reduce metabolic syndrome risk, a growing public health concern with well-documented inequities across population subgroups. We capitalize on the use of g-computation to simulate the influence of multiple possible interventions on residential greenspace on nine metabolic biomarkers and metabolic syndrome in adults (N = 555) from the 2014-2017 Community of Mine Study living in San Diego County, California. Normalized difference vegetation index (NDVI) exposure from 2017 was averaged across a 400-m buffer around the participants' residential addresses. Participants' fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations, systolic and diastolic blood pressure, hemoglobin A1c (%), waist circumference, and metabolic syndrome were assessed as outcomes of interest. Using parametric g-computation, we calculated risk differences for participants being exposed to each decile of the participant NDVI distribution compared to minimum NDVI. Differential health impacts from NDVI exposure by sex, ethnicity, income, and age were examined. We found that a hypothetical increase in NDVI exposure led to a decrease in hemoglobin A1c (%), glucose, and high-density lipoprotein cholesterol concentrations, an increase in fasting total cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations, and minimal changes to systolic and diastolic blood pressure, waist circumference, and metabolic syndrome. The impact of NDVI changes was greater in women, Hispanic individuals, and those under 65 years old. G-computation helps to simulate the potential health benefits of differential NDVI exposure and identifies which subpopulations can benefit most from targeted interventions aimed at minimizing health disparities.

Effect of nano-curcumin supplementation on cardiometabolic risk factors, physical and psychological quality of life, and depression in patients with coronary slow flow phenomenon: a randomized double-blind clinical trial

BackgroundExtensive evidence has suggested the cardio-protective properties of the polyphenol curcumin. The aim of this study was to investigate the effects of a highly bioavailable curcumin supplement on cardiometabolic risk factors, health-related quality of life, and depression in patients with coronary slow flow phenomenon (CSFP).MethodsThis randomized double-blind placebo-controlled clinical trial was conducted in 42 patients with CSFP (age 35–70 years, 25 ≤ body mass index < 40 kg/m2). Patients received either 80 mg/day nano-curcumin or placebo for 12 weeks. Serum levels of visfatin, high-sensitivity C-reactive protein (hs-CRP), and glycemic indices were measured before and after the intervention. The short form 36-item quality of life (SF-36) and Beck’s Depression Inventory-II (BDI-II) questionnaires were assessed, as well.ResultsNo significant improvements were observed in circulating hs-CRP and visfatin following the intervention. A significant increase was observed in pre- to post-fasting blood glucose (− 0.9 ± 12.2 vs. 7.7 ± 12.4 mg/dl, p = 0.02) and hemoglobin A1C (− 0.1 ± 0.8 vs. 0.5 ± 0.8%, p = 0.04) levels, in the placebo compared with the intervention group. Physical (8.2 ± 8.1 vs. − 1.2 ± 6.5, p < 0.001) and mental (6.8 ± 11.8 vs. − 1.1 ± 10.4, p = 0.02) component summary scores were significantly improved in the nano-curcumin than the placebo group. Additionally, the number of patients with lower degrees of depression was significantly better in the intervention than the placebo group following the supplementation (p = 0.046).ConclusionCurcumin supplementation prevented deterioration of glycemic control and improved physical and psychological quality of life and depression in patients with CSFP.Trial registrationIranian Registry of Clinical Trials (IRCT20131125015536N8), June 19, 2019.

Cardiometabolic Risk Markers in Children With Obesity and Variants in MC4R Pathway-related Genes.

Variants in melanocortin 4 receptor (MC4R) pathway-related genes have been associated with obesity. The association of these variants with cardiometabolic parameters are not fully known. We compared the severity of obesity and cardiometabolic risk markers in children with MC4R pathway-related clinically reported genetic variants relative to children without these variants. A retrospective chart review was performed in children with obesity who underwent multigene panel testing for monogenic obesity. Data on a total of 104 children were examined, with 93 (89%) identified as White. Thirty-nine (37.5%) patients had clinically reported variants in the MC4R pathway, and the remaining 65 patients did not have reported MC4R pathway-related variants. Among the MC4R-related variants, PCSK1 risk alleles were most common, reported in 15 children (14%). The maximum body mass index percent of the 95th percentile was not different between groups (P = .116). Low-density lipoprotein cholesterol (LDL-C) was not different between groups (P = .132). However, subgroup analysis demonstrated higher LDL cholesterol in children with the PCSK1 c.661A>G risk allele relative to those with MC4R-related variant of uncertain significance (P = .047), negative genetic testing (P = .012), and those with non-MC4R related variants (P = .048). The blood pressure, fasting glucose, hemoglobin A1C, total cholesterol, alanine transaminase, and high-density lipoprotein cholesterol were not different between groups. Variants in the MC4R pathway-related genes were not associated with severity of obesity and cardiometabolic risk markers except for the c.661A>G PCSK1 risk allele, which was associated with higher LDL-C levels.