Diabetes In High-risk Individuals Research Articles

A Pilot Study on the Proteomics Profile of Serum Exosome-Enriched Extracellular Vesicles from Normal versus Individuals with Obesity-Related Insulin Resistance.

Circulating exosome-enriched extracellular vesicles (EVs) have drawn considerable importance in obesity-related insulin-resistance (IR). We sought to compare the proteomics profile of serum exosomes from normal individuals and those with obesity and IR. We isolated serum exosomes from male subjects with obesity and insulin resistance (Ob-IR, HOMA-IR > 2.0) and lean/overweight insulin-sensitive (Normal (N), HOMA-IR < 2.0) individuals. The differential protein expression between the two groups was detected by a label-free quantitative mass spectrometry analysis followed by GO annotation and ingenuity pathway analysis (IPA). We identified 23 upregulated and 46 downregulated proteins between Ob-IR and N groups. Some of these proteins are involved in altering insulin signaling (VPS13C, TBC1D32, TTR, and ADIPOQ), inflammation (NFκB and CRP), and B-cell proliferation/activation (IGLV4-69, IGKV1D-13, and IGHV4-28). GO analysis revealed that the differentially expressed proteins (DEPs) are mainly involved in regulating immune cell activation and are located in extracellular space. IPA analysis showed that top molecules mediating IR, inflammation and B-cell activation were upregulated in Ob-IR subjects compared to N subjects. Serum exosomal proteins can be used as biomarkers to identify the future risk of diabetes and a therapeutic target to prevent or slow down the progression of diabetes in high-risk individuals.

Differential management and associations of dyslipidaemia and hypertension by glycaemic status in urban South Africans

Background. Dyslipidaemia and hypertension care have not been reported in large samples of community-based participants with known diabetes (KD) nor compared with individuals at high risk for diabetes.Objectives. To describe the management and associations of dyslipidaemia and hypertension in adults with KD, newly diagnosed diabetes (NDD) and normoglycaemia. Methods. This urban population-based cross-sectional study comprised participants with KD, NDD and normoglycaemia. Participants at high risk for diabetes but without KD underwent oral glucose tolerance tests; those who were subsequently classified as NDD or normoglycaemic were included in this study. Data collection comprised administered questionnaires, clinical measurements and biochemical analyses. Multivariable logistic regressions determined the associations with hypertension and dyslipidaemia management in separate models. Results. Among 618 participants (82% women), aged median 58 years, there were 339 participants with KD, 70 with NDD and 209 with normoglycaemia. Prevalence of hypertension (BP ≥140/90 mmHg or on treatment) and dyslipidaemia (raised low-density lipoprotein cholesterol &gt;3 mmol/L or on treatment) was highest in KD (89% and 83%) compared with NDD (64% and 74%) and normoglycaemia (66% for both) (p&lt;0.001). Detected or known hypertension was highest in KD (97.4%), followed by NDD (88.9%) and normoglycaemia (80.3%). Among participants with known or detected hypertension, those with KD were most likely to be treated (90.2%) compared with NDD (77.5%) and normoglycaemia (74.5.%). Hypertension control among participants on treatment was highest in KD (69.5%) compared with NDD (51.6%) and normoglycaemia (61.0%). Participants with KD had significantly higher rates of previously detected dyslipidaemia (85.1%) compared with NDD (36.5%) and normoglycaemia (35.5%). KD participants were also more likely to be treated for their previously detected dyslipidaemia (85.4%) and to be controlled when on treatment (56.3%) compared with their counterparts (NDD: 63.2% and 33.3%, normoglycaemia: 61.2% and 43.3%, respectively). Diabetes control was poor; only 20% of those with KD had HbA1c &lt;7%. In the regression models, compared with normoglycaemia, KD was associated with hypertension detection (odds ratio (OR) 6.91, 95% confidence interval (CI) 2.25 - 21.22) and control (OR 2.05, 95% CI 1.04 - 4.02). KD compared with normoglycaemia was associated with dyslipidaemia detection (OR 10.29, 95% CI 5.21 - 20.32) and treatment (OR 3.94, 95% CI 1.68 - 9.27). Sociodemographic and cardiovascular disease risk factors were generally not associated with hypertension or dyslipidaemia management. Conclusion. Albeit that diabetes control was poor and required better management, dyslipidaemia and hypertension prevalence were higher and better managed in KD than NDD and normoglycaemia. Different approaches are required to improve glucose control in KD, better identify NDD and monitor and prevent diabetes in high-risk individuals. Also important would be to improve care of hypertension and dyslipidaemia in those without KD.

Comparison of the Efficacy of Metformin and Lifestyle Modification for the Primary Prevention of Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.

This meta-analysis aimed to compare the effectiveness of metformin versus lifestyle interventions in preventing diabetes in individuals with prediabetes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted a comprehensive search of databases (PubMed, Cochrane Library, EMBASE) up to September 1, 2023. Five eligible studies were included. The results showed that there was no significant difference in the risk of developing diabetes between the metformin and lifestyle intervention groups (RR: 1.14, 95% CI: 0.77-1.68). Similarly, when comparing metformin with lifestyle intervention, the risk of diabetes was slightly higher in the metformin group, but this difference was not statistically significant (RR: 1.31, 95% CI: 0.93-1.86). When comparing metformin with lifestyle intervention to lifestyle intervention alone, no significant difference was observed in the incidence of diabetes (RR: 0.88, 95% CI: 0.74-1.04). In conclusion, our analysis found that the incidence of type 2 diabetes was slightly higher in patients receiving metformin alone compared to lifestyle intervention, but this difference did not reach statistical significance. Further trials are necessary to better evaluate these interventions for preventing type 2 diabetes in high-risk individuals.

Understanding Providers' Readiness and Attitudes Toward Autoantibody Screening: A Mixed-Methods Study.

Screening for autoantibodies associated with type 1 diabetes can identify people most at risk for progressing to clinical type 1 diabetes and provide an opportunity for early intervention. Drawbacks and barriers to screening exist, and concerns arise, as methods for disease prevention are limited and no cure exists today. The availability of novel treatment options such as teplizumab to delay progression to clinical type 1 diabetes in high-risk individuals has led to the reassessment of screening programs. This study explored awareness, readiness, and attitudes of endocrinology providers toward type 1 diabetes autoantibody screening.

Infections in the first year of life and development of beta cell autoimmunity and clinical type 1 diabetes in high-risk individuals: the TRIGR cohort

Aims/hypothesisAccumulated data suggest that infections in early life contribute to the development of type 1 diabetes. Using data from the Trial to Reduce IDDM in the Genetically at Risk (TRIGR), we set out to assess whether children who later developed diabetes-related autoantibodies and/or clinical type 1 diabetes had different exposure to infections early in life compared with those who did not.MethodsA cohort of 2159 children with an affected first-degree relative and HLA-conferred susceptibility to type 1 diabetes were recruited between 2002 and 2007 and followed until 2017. Infections were registered prospectively. The relationship between infections in the first year of life and the development of autoantibodies or clinical type 1 diabetes was analysed using univariable and multivariable Cox regression models. As this study was exploratory, no adjustment was made for multiple comparisons.ResultsAdjusting for HLA, sex, breastfeeding duration and birth order, those who had seven or more infections during their first year of life were more likely to develop at least one positive type 1 diabetes-related autoantibody (p=0.028, HR 9.166 [95% CI 1.277, 65.81]) compared with those who had no infections. Those who had their first viral infection aged between 6 and 12 months were less likely to develop at least one positive type 1 diabetes-related antibody (p=0.043, HR 0.828 [95% CI 0.690, 0.994]) or multiple antibodies (p=0.0351, HR 0.664 [95% CI 0.453, 0.972]). Those who had ever had an unspecified bacterial infection were more likely to develop at least one positive type 1 diabetes-related autoantibody (p=0.013, HR 1.412 [95% CI 1.075, 1.854]), to develop multiple antibodies (p=0.037, HR 1.652 [95% CI 1.030, 2.649]) and to develop clinical type 1 diabetes (p=0.011, HR 2.066 [95% CI 1.182, 3.613]).Conclusions/interpretationWe found weak support for the assumption that viral infections early in life may initiate the autoimmune process or later development of type 1 diabetes. In contrast, certain bacterial infections appeared to increase the risk of both multiple autoantibodies and clinical type 1 diabetes.Graphical abstract

Anti-diabetic Activity of Partially Purified Santalin A from the Heartwood of Pterocarpus santalinus L.f. in Alloxan-induced Diabetic Wistar Rat

The ever-increasing use of plant-based pharmaceuticals as alternatives to conventional drugs for disease management demands identification, isolation, and characterization of novel compounds. Despite the potential of plant extracts to mitigate the morbidity of diseases, several active principles are preferred to avoid the interference of other compounds. The promising health benefits of the extracts and isolated compounds of Pterocarpus santalinus in the treatment of diabetes, cardiovascular disease, cancer, and infections have been described. However, such studies on the active principle, namely, santalins, are not reported. In this study, we standardized the isolation of a mixture of santalins A and B from the heartwood of P. santalinus by column chromatography followed by preparative TLC and HPLC. The partially purified santalins were characterized by LC-MS, HR-MS, and 1 H NMR analyses. The isolated combination of santalins displayed higher total antioxidant and DPPH free radical scavenging activity in vitro than the crude heartwood extracts. Administration of the mixture of santalins A and B did not exhibit any antihyperglycemic activity in the liver, kidney, and pancreas of alloxan-induced diabetic rats. However, pretreatment of rats with a mixture of santalins at a dose of 1.0 mg/kg body weight prevented alloxan-induced diabetes as indicated by the normal blood glucose levels. Hyperglycemia-associated lipid peroxidation was abrogated in santalin-pretreated rats that did not develop alloxan-induced diabetes. Furthermore, the alterations in catalase, glutathione peroxidase, and glutathione-S-transferase activities in the pancreas of santalinpretreated rats could be responsible for preventing damage to the pancreas and thus non-induction of diabetes following alloxan treatment. Therefore, for the first time, we report the simplified procedure for isolating a mixture of santalins, including their ability to prevent the induction of diabetes in Wistar rats. The outcome of our study has significant clinical importance to the fact that supplementation of santalins may potentially avoid or delay the onset of diabetes in high-risk individuals.

Prospective Assessment for Prediabetes and New-Onset Diabetes in High-Risk Individuals Undergoing Pancreatic Cancer Screening

See editorial on page 1379. Letter to the Editor Regarding Prospective Assessment for Prediabetes and New-Onset Diabetes in High-Risk Individuals Undergoing Pancreatic Cancer ScreeningGastroenterologyVol. 162Issue 6PreviewWe read with great interest the study by Shah et al1 entitled “Prospective Assessment for Prediabetes and New-Onset Diabetes in High-Risk Individuals Undergoing Pancreatic Cancer Screening.” The investigators researched the incidence of prediabetes and diabetes mellitus in high-risk individuals undergoing pancreatic cancer screening. Full-Text PDF

PREVALENCE AND FETO-MATERNAL OUTCOMES IN GESTATIONAL DIABETES MELLITUS AT A TERTIARY CARE HSOPITAL

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy with or without remission after the end of pregnancy. Worldwide prevalence of GDM is reported between 1.4 – 14 percent. The data regarding prevalence and outcomes of GDM will help in planning and allocation of resources and the preventive strategies at the hospital and community level. There are few studies conducted in this region describing the prevalence, associated risk factors, maternal and neonatal outcomes associated with GDM. This was retrospective study conducted at a tertiary care hospital in India. Data was obtained from January 2018 to January 2019. Women between 24-28 weeks of gestation were included in the study. The information collected included the following parameters: age, residence status, gravid status, family history of diabetes or history of diabetes in first degree relative, past history of GDM. Neonatal outcomes like stillbirths, macrosomia, hyperbilirubinemia were recorded. Most common age of presentation of GDM was 26-30 years. Gravida &lt; 3 accounted for most of the cases. Urban residents accounted for 55.8% of the cases. Most of the cases of GDM had at least one risk factor like history of hypertension or diabetes mellitus. Most common adverse maternal outcome was cephalopelvic disproportion followed by Casearean section and least common was abruptio placentae. Most common adverse fetal outcome was hyperbilirubinemia followed by macrosomia and least common was stillbirth. Early diagnosis and appropriate treatment of GDM will help in preventing maternal and fetal adverse outcomes and delay development of diabetes in high-risk individuals. The prevalence of GDM is going to increase in the near future exponentially, hence there is need for various community-based prevalence studies in different geographical regions of India to determine the exact prevalence and regional differences of GDM.

Pharmacological Primary Prevention of Diabetes Mellitus Type II: A Narrative Review.

The evolving epidemic of type 2 diabetes mellitus has challenged health-care professionals. It stands among the leading causes of mortality in the present world. It warrants new and versatile approaches to improve mortality and the associated huge quality-adjusted life years lost to it once diagnosed. A possible venue to lower the incidence is to assess the safety and efficacy of various diabetes prevention strategies. Diet and exercise have a well-developed role in the prevention of weight gain and, ultimately, diabetes mellitus type II in high-risk individuals. However, high-risk individuals can also benefit from adjunct pharmacotherapy. In light of this information, we decided to conduct a systematic review of randomized controlled trials. This article summarizes the evidence in the literature on the pharmacological prevention of diabetes in high-risk individuals.

Health Insurance for Diabetes Prevention Confers Health Benefits and Breaks Even on Cost Within 2 Years.

Diabetes and its predecessor prediabetes are huge and costly problems in the U.S., affecting 24.7 (1) and 84.1 million people (2), respectively. Treatment of prevalent diabetes is a leading contributor of rising U.S. health care costs (3), and the cost of treating prediabetes, diabetes, and gestational diabetes mellitus combined is $404 billion (4). Fortunately, there is strong evidence for prevention, or at least delay, of type 2 diabetes in high-risk individuals, especially those with impaired glucose tolerance (IGT), through lifestyle education programs, interventions that have been shown to be effective, cost-effective, and translatable in real-life settings (5–8). The challenge lies in scaling the implementation of proven programs like the U.S. Diabetes Prevention Program (DPP) at the community level with effective, easy, and low-cost ways to reach at-risk individuals and enroll, engage, and keep them in programs like the National DPP (9). In their article in this issue of Diabetes Care , Ackermann et al. (10) evaluated the costs and financial implications for commercial health care insurers offering reimbursements for the National DPP available at YMCAs, the YDPP. They report impressive results: the YDPP program had no effects on net health care costs at 2 years, with no difference between the mean per-person health expenditures between YDPP participants and matched control subjects. In addition, the authors report on the efficacy of workplace screening for identifying individuals with prediabetes for YDPP enrollment. They found that worksite screening, using the undescribed protocols set up by the individual worksites, were only able to identify 9.7% of the estimated …

2060-P: Serum Wnt Inhibitor DKK1 Is Associated with Adiposity and Insulin Resistance in Nondiabetic North Americans

Background: The Wnt pathway is known to influence body composition during early human development by regulating bone formation, myogenesis and adipogenesis. We have recently shown that DKK1 is related to measures of adiposity in nondiabetic African ancestry males. Whether these relationships are true across sexes and/or in other human populations remains unknown. In this study we evaluated the relationship of DKK1 with adiposity in a sample of male and female, mixed race, nondiabetic North American individuals. Methods: Fasting serum DKK1 levels were measured using ELISAs in 201 nondiabetic subjects (age range 30.7-60 years, BMI range 19.9-64.0 kg/m2) recruited from the general population via television advertisement and mass mailing. The subjects were predominantly female (85%) and Caucasian (63%). Anthropometrics were obtained and markers of inflammation and glucose metabolism were measured from fasting serum samples. Spearman and partial Spearman correlation analysis was used to determine the association of DKK1 with measures of adiposity and insulin resistance. Results: Circulating DKK1 was positively associated with BMI (r=0.30, p&amp;lt;0.001) and waist circumference (r=0.25, p&amp;lt;0.001), independent of age, race and sex. In addition, DKK1 was positively associated with fasting serum insulin level (r=0.18, p&amp;lt;0.01) and HOMA-IR (r=0.19, p&amp;lt;0.01) in age, sex and race adjusted models. However, these associations were no longer significant after adjustment for BMI. Conclusion: This is the first study looking at correlation of DKK1 with adiposity in North American nondiabetic individuals. Our findings suggest that the link between DKK1 and insulin resistance maybe mediated indirectly through total and regional adiposity and that DKK1 could be a potential early biomarker for diabetes in high risk individuals. These findings support our findings in African ancestry males and add to the evidence favoring potential role of Wnt modulators in adiposity regulation in humans. Disclosure H. Ali: None. E. Oczypok: None. I. Miljkovic: None. R. Cvejkus: None. J.M. Zmuda: None. J. DeLany: None. E.E. Kershaw: Research Support; Self; Regeneron Pharmaceuticals. Funding National Institutes of Health (T32DK007252); Endocrine Fellows Foundation

Successful treatment of prediabetes in clinical practice using physiological assessment (STOP DIABETES)

Of the 84 million American adults with prediabetes, over 5 to 7 years, about 28 million progress to type 2 diabetes. We aimed to assess whether a real-world, pathophysiology-based, therapeutic approach could prevent development of type 2 diabetes in high-risk individuals. We did a retrospective observational study of people at increased risk of type 2 diabetes from a community practice in southern California, USA. Participants had an oral glucose tolerance test and were assigned a risk stratification on the basis of presence and severity of insulin resistance, impaired β-cell function, and glycaemia (ie, 1-h plasma glucose concentration of more than 8·6 mmol/L during an oral glucose tolerance test). Treatment was recommended on the basis of risk: metformin, pioglitazone, glucagon-like peptide-1 (GLP-1) receptor agonist, and lifestyle therapy for participants at high risk of diabetes, and metformin, pioglitazone, and lifestyle therapy for those at intermediate risk. Individuals who refused pharmacological therapy were assigned to lifestyle therapy only. Participants were followed up every 6 months and oral glucose tolerance tests were repeated at 6 months and subsequently every 2 years or sooner. The primary outcome of our analysis was incidence of type 2 diabetes according to the American Diabetes Association criteria, within the study period (2009-16). This study is registered with ClinicalTrials.gov, number NCT03308773. Between Jan 1, 2009 and Dec 31, 2016, we assessed 1769 people at increased risk of diabetes, of which 747 (42%) were identified at high or intermediate risk and were recommended pharmacological treatment. Of 422 participants analysed, 28 (7%) progressed to type 2 diabetes (seven [5%] of 141 participants who received metformin, pioglitazone, and lifestyle therapy, none [0%] of 81 who received metformin, pioglitazone, GLP-1 receptor agonist, and lifestyle therapy, and 21 [11%] of 200 who received lifestyle therapy only) after mean follow-up of 32·09 months (SEM 1·24). Compared with participants who received lifestyle therapy only, the adjusted hazard ratio for progression to type 2 diabetes was 0·29 (95% CI 0·11-0·78, p=0·0009) in participants who received metformin and pioglitazone, and 0·12 (95% CI 0·02-0·94, p=0·04) in participants who received metformin, pioglitazone, and GLP-1 receptor agonist. Improved β-cell function was the strongest predictor of type 2 diabetes prevention. Progression to type 2 diabetes in people at high risk of diabetes can be markedly reduced with interventions designed to correct underlying pathophysiological disturbances (ie, impaired insulin secretion and resistance) in a real-world setting. None.

Cost-Effectiveness of Structured Lifestyle Programs for Diabetes Prevention in the Medicaid Population

Background: The Diabetes Prevention Program (DPP) showed that structured lifestyle interventions can delay or prevent onset of type 2 diabetes in high risk individuals. Despite disproportionate diabetes burdens in low-income individuals, there are no data regarding expected health and economic impacts of structured diabetes prevention in the Medicaid population. Objective: To examine the net costs and health benefits of extending coverage for structured lifestyle programs to the Medicaid population. Methods: We modelled a prevention strategy consisting of triannual screening for prediabetes (FPG?100 mg/dl or A1c?5.7%) followed by a DPP-like lifestyle program vs. routine care in non-disabled U.S. Medicaid beneficiaries aged 25-64 years. Medicaid population characteristics were extracted from 2006-2016 NHANES surveys. Costs of diabetes and its complications were estimated from Medicaid administrative claims data of 8 states comprising 52% of the U.S. adult Medicaid population. Based on DPP-like studies in Medicaid populations, we assumed the intervention will reduce diabetes incidence by 32% and will be delivered at costs defined in the Medicare Payment Scheme. We estimated incremental health benefits (in quality-adjusted life-years (QALYs)) gained and net costs (in 2016 U.S. dollars) of screening and delivering lifestyle programs and subtracted savings through prevention of diabetes from a Medicaid perspective over a 10 year time horizon. Results: Given a 25% screening and intervention uptake in approximately 27 million non-disabled Medicaid beneficiaries across 50 states, extending coverage could prevent or delay 135,000 cases of diabetes, gain 243,000 QALYs, and cost $1.35 billion (incremental cost effectiveness ratio $55,000 per QALY gained). Conclusions: Extending Medicaid coverage for life-style diabetes prevention programs might be a good use of health care resources and will potentially diminish the diabetes burden in low income individuals. Disclosure M. Laxy: None. P. Zhang: None. H. Shao: None. B. Ng: None. M.K. Ali: None. E.W. Gregg: None.

The 1-h post-load plasma glucose as a novel biomarker for diagnosing dysglycemia.

Identifying the earliest moment for intervention to avert progression to prediabetes and diabetes in high-risk individuals is a substantial challenge. As β-cell function is already compromised in prediabetes, attention should therefore be focused on identifying high-risk individuals earlier in the so-called pre-prediabetes stage. Biomarkers to monitor progression and identify the time point at which β-cell dysfunction occurs are therefore critically needed. Large-scale population studies have consistently shown that the 1-h plasma glucose (1-h PG)≥155mg/dl (8.6mmol/l) during the oral glucose tolerance test detected incident type 2 diabetes and associated complications earlier than fasting plasma glucose or 2-h plasma glucose levels. An elevated 1-h PG level appears to be a better alternative to HbA1c [5.7-6.4% (37-47mmol/mol)] or traditional glucose criteria for identifying high-risk individuals at a stage when ß-cell function is substantially more intact than in prediabetes. Diagnosing high-risk individuals earlier proffers the opportunity for potentially reducing progression to diabetes, development of microvascular complications and mortality, thereby advancing benefit beyond that which has been demonstrated in global diabetes prevention programs.

A High-Carbohydrate, High-Fiber, Low-Fat Diet Results in Weight Loss among Adults at High Risk of Type 2 Diabetes

Background: Weight loss is a key factor in reducing diabetes risk. The Diabetes Prevention Program (DPP) is a completed clinical trial that randomly assigned individuals at high risk of diabetes to a placebo (PLBO), metformin (MET), or intensive lifestyle intervention (ILS) group, which included physical activity (PA) and reduced dietary fat intake.Objective: We aimed to evaluate the associations between diet and weight at baseline and to identify specific dietary factors that predicted weight loss among DPP participants.Methods: Diet was assessed by a food frequency questionnaire. The associations between intakes of macronutrients and various food groups and body weight among DPP participants at baseline were assessed by linear regression, adjusted for race/ethnicity, age, sex, calorie intake, and PA. Models that predicted weight loss at year 1 were adjusted for baseline weight, change in calorie intake, and change in PA and stratified by treatment allocation (MET, ILS, and PLBO). All results are presented as estimates ± SEs.Results: A total of 3234 participants were enrolled in the DPP; 2924 had completed dietary data (67.5% women; mean age: 50.6 ± 10.7 y). Adjusted for calorie intake, baseline weight was negatively associated with carbohydrate intake (-1.14 ± 0.18 kg body weight/100 kcal carbohydrate, P < 0.0001) and, specifically, dietary fiber (-1.26 ± 0.28 kg/5 g fiber, P < 0.0001). Baseline weight was positively associated with total fat (1.25 ± 0.21 kg/100 kcal, P < 0.0001), saturated fat (1.96 ± 0.46 kg/100 kcal, P < 0.0001), and protein (0.21 ± 0.05 kg/100 kcal, P < 0.0001). For all groups, weight loss after 1 y was associated with increases in carbohydrate intake, specifically dietary fiber, and decreases in total fat and saturated fat intake.Conclusions: Higher carbohydrate consumption among DPP participants, specifically high-fiber carbohydrates, and lower total and saturated fat intake best predicted weight loss when adjusted for changes in calorie intake. Our results support the benefits of a high-carbohydrate, high-fiber, low-fat diet in the context of overall calorie reduction leading to weight loss, which may prevent diabetes in high-risk individuals. This trial was registered at clinicaltrials.gov as NCT00004992.

Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes

ObjectiveExplore the cost-effectiveness of lifestyle interventions and metformin in reducing subsequent incidence of type 2 diabetes, both alone and in combination with a screening programme to identify high-risk individuals.DesignSystematic review...

Occupation with grain crops is associated with lower type 1 diabetes incidence: Registry-based case-control study.

Intranasal administration of gliadin prevents autoimmune diabetes in non-obese diabetic mice. The current study was designed to investigate if bakers are intranasally exposed to gluten during work and whether occupation as baker is inversely associated with type 1 diabetes. Gliadin was measured in nasal swabs from eight bakers and butchers. The odds ratio of type 1 diabetes in selected profession groups was analysed in a registry-based case-control study with data from 1980 to 2010 derived from Statistics Denmark. The cohort included 1,210,017 Danish individuals, thereof 15,451 with type 1 diabetes (1.28%). Average nasal gliadin swab content after full working days was 6.3 μg (confidence interval (CI): 2.8 to 9.7) among bakers, while no nasal gliadin was detected among butchers. The odds ratio of type 1 diabetes was lower among bakers (OR = 0.57; CI: 0.52 to 0.62) and agriculture workers occupied with production of grains (OR = 0.65; CI: 0.56 to 0.75). Bakers had a lower odds ratio of type 1 diabetes, which potentially could be attributed to exposure of nasal mucosal gluten during work, as observed in this study. If other studies confirm the present observations, intranasal gliadin administration could possibly be an easy and safe approach for the prevention of type 1 diabetes in high-risk individuals or prediabetic subjects.

Determinants of lifestyle behavior change to prevent type 2 diabetes in high-risk individuals

BackgroundAlthough there are many effective lifestyle interventions for type 2 diabetes (T2DM) prevention, insight into effective intervention pathways, especially of long-term interventions, is often lacking. This study aims to provide insight into the effective intervention pathways of the SLIMMER diabetes prevention intervention using mediation analyses.MethodsIn total, 240 participants at increased risk of T2DM were included in the analyses over 18 months. The intervention was a combined lifestyle intervention with a dietary and a physical activity (PA) component. The primary and secondary outcomes were change in fasting insulin (pmol/L) and change in body weight (kg) after 18 months, respectively. Firstly, in a multiple mediator model, we investigated whether significant changes in these outcomes were mediated by changes in dietary and PA behavior. Secondly, in multiple single mediator models, we investigated whether changes in dietary and PA behavior were mediated by changes in behavioral determinants and the participants’ psychological profile. The mediation analyses used linear regression models, where significance of indirect effects was calculated with bootstrapping.ResultsThe effect of the intervention on decreased fasting insulin was 40% mediated by change in dietary and PA behavior, where dietary behavior was an independent mediator of the association (34%). The effect of the intervention on decreased body weight was 20% mediated by change in dietary and PA behavior, where PA behavior was an independent mediator (17%). The intervention significantly changed intake of fruit, fat from bread spread, and fiber from bread. Change in fruit intake was mediated by change in action control (combination of consciousness, self-control, and effort), motivation, self-efficacy, intention, and skills. Change in fat intake was mediated by change in action control and psychological profile. No mediators could be identified for change in fiber intake. The change in PA behavior was mediated by change in action control, motivation, and psychological profile.ConclusionThe effect of the SLIMMER intervention on fasting insulin and body weight was mediated by changes in dietary and PA behavior, in distinct ways. These results indicate that changing dietary as well as PA behavior is important in T2DM prevention.

Evaluation of a Technology to Support a Translational Diabetes Prevention Intervention.

Diabetes is now one of the greatest threats to our public health. There are now over 26 million Americans with diabetes, which exert considerable social and fiscal impact (1). More disturbingly, there are now more than 86 million people in the U.S. with prediabetes, a metabolic condition that significantly increases risk for developing type 2 diabetes (1,2). Fortunately, there is now substantial evidence that this risk can be significantly reduced by lifestyle interventions that result in modest reductions in weight and increased physical activity (3,4). Thus, there have been increasing efforts to translate these interventions into programs that can be more readily accessed by the public, and there is growing evidence that many are effective in producing weight loss that is associated with risk reduction (5). Unfortunately, many people, particularly low-income and minority populations, find it difficult to commit to a weight-loss intervention that requires structured attendance at specific venues (5,6). This has given rise to investigators trying new approaches for diabetes prevention, including the application of mobile technology, which is the basis of the study reported by Fischer et al. (7) in this issue of Diabetes Care . The Diabetes Prevention Program (DPP), a multicenter study of strategies to prevent type 2 diabetes in high-risk individuals, demonstrated that modest …

Utility of hypertriglyceridemic waist phenotype for predicting incident type2 diabetes: The Isfahan Diabetes Prevention Study.

Aim/IntroductionWe evaluated the association between hypertriglyceridemic waist (HTW) phenotype and the risks of type 2 diabetes in an Iranian high‐risk population.Materials and MethodsWe analyzed 7‐year follow‐up data (n = 1,865) in non‐diabetic first‐degree relatives of consecutive patients with type 2 diabetes aged 30–70 years. The primary outcome was the diagnosis of type 2 diabetes based on repeated oral glucose tolerance tests. We used multiple logistic regressions to estimate the odds ratio (OR) for incident type 2 diabetes across four groups according to baseline fasting serum triglycerides (TG) level and waist circumference (WC): normal WC and normal TG, normal WC and high TG, enlarged WC and normal TG, and HTW (enlarged WC high TG).ResultsThe HTW phenotype at baseline was associated with the incidence of type 2 diabetes. Those with HTW were 2.4‐fold (OR 2.36, 95% confidence interval 1.61–3.44), those with normal WC high TG were 1.9‐fold (OR 1.87, 95% confidence interval 1.29–2.70) and those with enlarged WC but normal TG were 2.8‐fold (OR 2.84, 95% confidence interval 1.96–4.13) more likely to develop type 2 diabetes than those with normal WC and normal TG.ConclusionsThese data provide further evidence that the HTW phenotype is a robust predictor of type 2 diabetes in high‐risk individuals in Iran, and the predictive power is not higher than that of simple enlarged WC and normal TG, emphasizing the importance of enlarged WC to the development of type 2 diabetes.