Effective Diabetes Prevention Research Articles

Pre-diabetes and NAFLD; A study of an Algerian population sample

IntroductionInsulin resistance is one of the most important mechanisms involved in the genesis of NAFLD (Non-Alcoholic Fatty Liver Disease), which explains the potential risk of diabetes in this population. The objective of our study was to compare the prevalence of pre-diabetes in people with metabolic steatopathy or NAFLD with that of a general population free from hepatic steatosis. Patients and methodsIt is a prospective case-control study which focused on non-diabetic patients aged between 30 and 70 years. A clinical and biological assessment was carried out for all patients. Hepatic steatosis was diagnosed by ultrasound. Insulinemia was measured by Fluorescence Enzyme Immunoassay (Tosoh AIA 360) expressed in µU /Ml. The insulin resistance calculation was done using the HOMA formula. Pre diabetes is defined by the American Diabetes Association (ADA) as a fasting blood sugar (8 hours) between 1 and 1.25 g / l. Statistical analyzes were performed using SPSS 21.0 software (IBM). Results426 patients aged 48.52 ± 10.13 years (226 women (53.6%)), including 213 with fatty liver disease, were enrolled. The mean fasting blood glucose in NAFLD patients was significantly higher (0.97 ± 0.13 213 Vs 0.92 ± 0.11, p <0.001). The prevalence of pre-diabetes was higher in the NAFLDs than in the control population (14.6% vs 8.9%, p <0.001), women were more affected than men (20.4% vs 8%, P <0.01). We noted a positive correlation between pre-diabetes and insulin resistance (n = 426, r = 0.124 P = 0.013). In multivariate analysis, the factors independently associated with pre-diabetes were metabolic syndrome, plasma cholesterol≥ 2g/l, and insulin resistance. ConclusionIn view of these results, we recommend systematic research for pre-diabetes in NAFLDs for effective prevention of diabetes and its complications. Its higher prevalence in this population is probably underpinned by insulin resistance.

Identifying Behaviour Change Techniques and Motivational Interviewing Techniques in Small Steps for Big Changes: A Community-Based Program for Adults at Risk for Type 2 Diabetes

BackgroundThe risk of developing type 2 diabetes (T2D) can be reduced through diet and exercise changes. Given the rapidly increasing prevalence of T2D and the associated burden on the health-care system, there is a need for affordable and scalable diet and exercise programs to be delivered in communities. Small Steps for Big Changes (SSBC) is an evidence-based diabetes prevention program for improving diet and exercise adherence in individuals at risk for developing T2D. Detailed reporting of intervention components as SSBC transitions from laboratory to communities is an essential step to understand its effectiveness and subsequent uptake. MethodsThe aim of this study was to identify comprehensively the behaviour change techniques (BCTs) and motivational interviewing techniques used within the community-based SSBC. Intervention components were extracted from the SSBC session protocols using the Behaviour Change Technique Taxonomy v1 and the Table of Motivational Interviewing Techniques. ResultsForty-three BCTs (interrater reliability [kappa]=0.77; prevalence and bias-adjusted kappa=0.78) and 20 MI techniques (kappa=0.63; prevalence and bias-adjusted kappa=0.64) were identified within SSBC session protocols (mean BCTs per session=30, mean MI techniques per session=16). ConclusionsConsistent and thorough reporting of intervention components as seen in the current analysis is crucial for future meta-analyses to accurately test which intervention components are eliciting change in desired outcomes and can inform which components should be adapted to different settings. SSBC sessions had an emphasis on BCT categories, including “Goals and Planning,” “Feedback and Monitoring” and “Repetition and Substitution,” and MI technique processes, including “Engaging” and “Evoking.” Use of these categories and processes can inform development of future effective diabetes prevention programs.

The Challenges in the Development of Diabetes Prevention and Care Models in Low-Income Settings.

In low- and middle-income countries (LMICs), the burden of non-communicable diseases such as diabetes is rapidly rising, overpassing the existing burden of communicable diseases. Patients with diabetes living in low-income communities face unique challenges related to lack of awareness, difficulty in accessing health care systems and medications, and consequently failure in achieving optimal diabetes management and preventing complications. Effective diabetes prevention and care models could help reduce the rising burden by standardizing guidelines for prevention and management, improving access to care, engaging community and peers, improving the training of professionals and patients and using the newest technology in the management of the disease. In this article, we review the latest research and evidence on effective models of diabetes prevention and diabetes care delivery in low- income settings. We also provide existing evidence relating to the effectiveness of these models in low-resource contexts, with the aim to highlight characteristics and strengths that make their implementation successful and long-lasting.

Factors influencing self-management behaviours among patients with type 2 diabetes mellitus in the Solomon Islands.

This study aims to explore the current state of self-management behaviours among persons with type 2 diabetes mellitus in the Solomon Islands and to discuss the factors influencing these behaviours. The prevalence of diabetes and diabetes complications is increasing in the Solomon Islands. However, the effective diabetes prevention and care are not provided in the country. This is a cross-sectional study. A convenience sample of 150 persons with type 2 diabetes mellitus was recruited from a hospital in the Solomon Islands from August 2017-September 2017. Self-report questionnaires were used to measure the self-management behaviours, diabetes knowledge and illness perception. In addition, the study adhered to the EQUATOR checklist, STROBE (see Appendix S1). The overall score for self-management was 56.9±13.2 and diabetes knowledge and illness perception, as influencing factors of self-management, earned total scores of 13.3±4.0 and 55.8±12.0, respectively. Stepwise regression analysis identified illness perception, diabetes knowledge and smoking as significant influencing factors, explaining 20.8% of the total variance in self-management. The level of diabetes self-management behaviours demonstrated by persons with type 2 diabetes mellitus in this study was rated as less than ideal. Diabetes knowledge and illness perception were the two main factors influencing patient self-management in the Solomon Islands. The study addressed the current state of the self-management behaviours of persons with diabetes and discussed the factors influencing these behaviours. The findings indicated that knowledge and illness perception of diabetes were the two main factors and provided baseline information for policymakers, health planners and healthcare providers highlighting diabetes as an important issue in Solomon Islands.

344. HIV and Diabetes in the Era of Antiretroviral Therapy

BackgroundWith advancements in ART, non-AIDS comorbidities are becoming more common among people living with HIV (PWH). In this analysis, we identified PWH followed at a single Ryan White HIV Clinic in Alabama and determined the overall prevalence of diabetes (DM). We then evaluated the cohort for risk factors associated with DM.MethodsThe records of all PWH who attended at least one routine care HIV primary provider visit from 2009 to 2018 at the UAB 1917 HIV Clinic in Birmingham, AL were abstracted. We defined DM as individuals having ≥1 of the following: (1) diagnosis of DM and receiving any diabetic medication, (2) Hgb A1c ≥ 6.5%, (3) any glucose >200 mg/dL. We evaluated the association of traditional, demographic, and HIV-specific risk factors with PWH with and without DM using Chi-square and Wilcoxon rank-sum testing. Univariate significance and amount of missing data were considered when constructing the multivariable logistic regression model to identify independent associations.ResultsOf the 5247 PWH assessed, 1178 were female (23%), 45 transgender persons (1%); 3235 (62%) black, 1834 (35%) white. At baseline, the median age was 37.5 years, median BMI 24.5 kg/m2, median CD4+ count 333 c/mm3. Overall, 1110 PWH developed DM (21%). By univariate analysis, numerous traditional, demographic and HIV-related risk factors were associated with diagnosis of DM (see Table 1). By multivariable analysis, the following factors were independently associated with DM: traditional (antihypertensive use, aspirin use, glucocorticoid use, statin use, comorbid CKD, comorbid liver disease), demographic (black race, female gender, older age), and HIV-related (nadir CD4) (P < 0.05 for all).ConclusionOver 20% of PWH had a diagnosis of DM. Both traditional and HIV-related factors were independently associated with DM. Notably, lower nadir CD4 and longer time to ART initiation were key HIV-related factors. Additionally, a majority of PWH with DM had multimorbidity (85%) and polypharmacy (90%). Despite the lower complexity of modern ART, the care of PWH remains challenging, partly because of cardiometabolic comorbidities, including DM. Effective diabetes prevention and treatment strategies for PWH should be prioritized. Disclosures All authors: No reported disclosures.

The risk, perceived and actual, of developing type 2 diabetes mellitus for mothers of preschool children in urban China.

BackgroundThe perceived risk of developing type 2 diabetes mellitus (T2DM) can motivate individuals to adopt preventive health behaviors. Compared with fathers, mothers of young children often experience unique risk factors for developing T2DM: pregnancy-related weight gain, lifestyle changes related to child care, and the increased incidence of gestational diabetes mellitus. Understanding how actual risk factors affect the perceived risk of developing T2DM can foster effective diabetes prevention interventions for this population. The aims of this study were to describe the risk, perceived and actual, of developing T2DM and to explore the influencing factors of perceived risk for Chinese mothers of preschool children in China.MethodsA multisite, cross-sectional survey was conducted and included 176 mothers (mean age of 31.19 years old) of preschool children (aged 3–7 years old) from four preschools in Changsha, the capital city of Hunan Province, China. The overall perceived risk of developing T2DM was measured by one item “Your own personal health risk is at almost no risk, slight risk, moderate risk or high risk from diabetes” from the Risk Perception Survey for Developing Diabetes (RPS-DD). PRS-DD and the Chinese version of the Canadian Diabetes Risk Assessment Questionnaire (CHINARISK) were used to assess perceived risk related worry, personal control, optimistic bias, and diabetes risk knowledge and actual risk of T2DM. Mothers also reported their height, weight, and waist circumference followed by the NIH protocol. Pearson correlation and stepwise multivariate linear regression were used to explore how the actual risk factors affected the perceived risk of developing diabetes (RPS-DD)).ResultsNearly 90% of mothers perceived almost no/slight risk for developing diabetes. Nearly half of the mothers had parents or siblings with diabetes. Roughly 70% of the mothers did not eat five servings of fruits and vegetables per day, and more than 50% did not exercise at least 30 minutes a day. In the five stepwise multivariate linear regression models, young mothers (95% CI .400–1.311) and those with a family history of diabetes (95% CI -0.74- .000) were founded a higher overall perceived risk. Mothers who reported more sedentary time (95% CI -0.029- -0.008) and less physical activity had less personal control (95% CI -0.354- -0.046). Mothers with more sedentary time had more worries about developing T2DM(95% CI 0.008–0.035) . Mothers who were older (95% CI -0.440–0.055) or had more physical activities (95% CI 0.003–0.048) had more optimistic bias of not developing T2DM. Mothers who had a higher education level (95% CI .354–1.422) and a family history of diabetes (95% CI .029–2.231) had more diabetes risk knowledge of developing T2DM.ConclusionThis study found that Chinese mothers of preschool children in urban areas reported low perceived risk of developing T2DM, although they have actual risk factors. These women did not associate anthropometric, health history, or health behavior factors with the risk of developing T2DM. Anthropometrics and risk factors associated with behavioral risk factors may be the focus of diabetes prevention programs.

Helicobacter pylori infection is associated with diabetes among Chinese adults.

Aims/IntroductionSeveral epidemiological studies investigated the effect of Helicobacter pylori infection on diabetes, but the conclusions remained inconsistent. We aimed to explore the relationship between H. pylori infection and diabetes, as well as glycemic metabolism profiles.Materials and MethodsA cross‐sectional study including 58,482 Chinese adults was carried out between January 2016 and December 2017. H. pylori infection was diagnosed by the 13C‐urea breath test. Multivariate regression analyses were carried out to evaluate the association of H. pylori infection with diabetes.ResultsOf the 58,482 participants, 3,449 (5.9%) had diabetes. The H. pylori‐positive participants had a higher rate of diabetes (7.3% vs 5.2%, P < 0.001), and higher levels of fasting plasma glucose (5.36 ± 1.12 mmol/L vs 5.28 ± 0.95 mmol/L, P < 0.001) and glycated hemoglobin A1c (5.63 ± 0.68% vs 5.57 ± 0.60%, P < 0.001) than the H. pylori negative group. Multivariate regression analyses showed that H. pylori infection was positively related to diabetes (odds ratio 1.25, 95% confidence interval 1.15–1.35). Among the H. pylori‐positive participants, the elevated levels of fasting plasma glucose and glycated hemoglobin A1c were 0.033 mmol/L (95% confidence interval 0.016–0.049 mmol/L) and 0.024% (95% confidence interval 0.008–0.041%), respectively. Additionally, H. pylori infection was significantly related to diabetes in participants aged ≥44 years, but not in participants aged <44 years.ConclusionsThe present study showed that H. pylori infection is associated with diabetes among Chinese adults. More attention should be paid to adults with H. pylori infection for effective prevention of diabetes.

Associations of childhood trauma with food addiction and insulin resistance in African-American women with diabetes mellitus

Food addiction (FA) describes a group of disordered eating behaviors. Childhood trauma has been associated with adult FA and trauma has known effects on the endocrine system, but it is unclear whether FA is associated with insulin resistance. We hypothesized that severity of childhood trauma will be associated with FA and higher insulin resistance (HOMA-IR) in a sample of obese women with type 2 diabetes mellitus (T2DM), and that FA will mediate the association between childhood trauma and HOMA-IR. Women with a diagnosis of T2DM (N = 73; MBMI = 35.86, SDBMI = 7.72; Mage = 50.59, SDage = 9.72) were recruited from a diabetes clinic at a county hospital. Participants completed the Childhood Trauma Questionnaire and the Yale Food Addiction Scale. Fasting blood samples were obtained from 64 participants to assess plasma hemoglobin A1c (HbA1c), insulin and glucose (used to calculate HOMA-IR); Oral Glucose Tolerance Test (OGTT) was performed to measure change in glucose and insulin secretion. 48% of the sample met diagnostic criteria for FA. Women with FA reported significantly higher HOMA-IR (F = 25.692, p < 0.001, df = 1,62), HbA1c (F = 4.358, p = 0.041, df = 1,62), and OGGT glucose (F = 5.539, p = 0.022, df = 1,62) as well as severity of childhood trauma (F = 10.453, p = 0.002, df = 1,71). In a hierarchical linear regression controlling for BMI, income level, and T2DM treatment, the severity of childhood trauma did not contribute to the prediction of HOMA-IR (β = −0.011, p = 0.942) whereas FA did (β = 0.422, p = 0.007). In a bootstrapped mediation analysis, the association between childhood trauma and HOMA-IR was mediated by FA severity (b = 0.596, p = 0.020). Understanding the psychological factors that contribute to HOMA-IR in an underserved population of African American women may lead to more effective diabetes management and prevention strategies.

Postprandial Glucose Levels Are Better Associated with the Risk Factors for Diabetes Compared to Fasting Glucose and Glycosylated Hemoglobin (HbA1c) Levels in Elderly Prediabetics: Beneficial Effects of Polyherbal Supplements-A Randomized, Double-Blind, Placebo Controlled Trial.

Backgrounds Prediabetes is a condition in which a person's blood glucose levels are higher than normal physiological levels but lower compared to patients with diabetes. Up to 70% of individuals with prediabetes will eventually develop diabetes. To date, there have been no pharmaceutical drugs to treat diabetes. It is believed that early diagnosis and nonpharmacological intervention for prediabetes are critical for effective prevention of diabetes. Most individuals with prediabetes remain undiagnosed even after being evaluated using the standard tests for fasting glucose (FG) and HbA1c. We investigated if postprandial glucose levels (2h-PG) were associated with pre/diabetes and if polyherbal supplements could be beneficial for individuals with prediabetes. Materials and Methods 100 elderly individuals with impaired 2h-PG or fasting glucose levels were recruited to receive either a 12-week supplement of GlucoVita (an antioxidative polyherbal formulation) (n=50) or placebo (n=50). Results No baseline differences were observed for FG, HbA1c, or 2h-PG. Individuals who received a twelve-week administration of GlucoVita supplements had significantly reduced 2h-PG (8.15±1.67 versus 7.35±2.06 mmol/l, P<0.05) levels compared to individuals in the placebo group. In addition, HbA1c levels were lower in individuals who received GlucoVita (5.81±0.49 %) compared to the individuals in the placebo group (6.00±0.51%) (P=0.08) after 12-weeks. Stratified analysis, based on impaired fasting glucose (IFG), 2h-PG, metabolic symptom, and age, demonstrated that, after the 12-week intervention, HbA1c levels were significantly lower in the GlucoVita administered group compared to the placebo group (IFG subgroup; 5.85±0.46%, n= 27 versus 6.14±0.50, n=33, P<0.05) and the metabolic symptom-free subgroup (5.73±0.45%, n=23 versus 6.04±0.52%, n=24, P<0.05). GlucoVita also reduced FG in individuals with normal 2h-PG (6.37±0.27 versus 6.08±0.38 mmol/l, P<0.05). Baseline 2h-PG levels, but not HbA1c or FG levels, were significantly correlated with body weight, waist circumference, and BMI (r=0.25, P<0.05; r=0.31, P<0.01; r=0.22, P<0.05, respectively). Conclusion 2h-PG levels were better associated with body weight, waist circumference, and BMI risk factors compared to FG and HbA1c levels in elderly individuals with prediabetes. Polyherbal formulation GlucoVita supplements improved 2h-PG and HbA1c levels only in elderly individuals who were overweight but were symptom-free and under 65 years of age. Due to the small cohort size of this pilot study, future studies are required to validate our findings.

Effects of unaltered and bioconverted mulberry leaf extracts on cellular glucose uptake and antidiabetic action in animals

BackgroundMulberry is a Korean medicinal herb that shows effective prevention and treatment of obesity and diabetes. Bioconversion is the process of producing active ingredients from natural products using microorganisms or enzymes.MethodsIn this study, we prepared bioconverted mulberry leaf extract (BMLE) with Viscozyme L, which we tested in insulin-sensitive cells (i.e., skeletal muscle cells and adipocytes) and insulin-secreting pancreatic β-cells, as well as obese diabetic mice induced by co-administration of streptozotocin (100 mg/kg, IP) and nicotinamide (240 mg/kg, IP) and feeding high-fat diet, as compared to unaltered mulberry leaf extract (MLE).ResultsBMLE increased the glucose uptake in C2C12 myotubes and 3 T3-L1 adipocytes and increased glucose-stimulated insulin secretion in HIT-T15 pancreatic β-cells. The fasting blood glucose levels in diabetic mice treated with BMLE or MLE (300 and 600 mg/kg, PO, 7 weeks) were significantly lower than those of the vehicle-treated group. At the same concentration, BMLE-treated mice showed better glucose tolerance than MLE-treated mice. Moreover, the blood concentration of glycated hemoglobin (HbA1C) in mice treated with BMLE was lower than that in the MLE group at the same concentration. Plasma insulin levels in mice treated with BMLE or MLE tended to increase compared to the vehicle-treated group. Treatment with BMLE yielded significant improvements in insulin resistance and insulin sensitivity.ConclusionThese results indicate that in the management of diabetic condition, BMLE is superior to unaltered MLE due to at least, in part, high concentrations of maker compounds (trans-caffeic acid and syringaldehyde) in BMLE.

Preliminary efficacy and feasibility of referral to exercise specialists, psychologists and provision of a technology-based behavior change support package to promote physical activity in school teachers ‘at risk' of, or diagnosed with, type 2 diabetes: The ‘SMART Health’ Pilot Study Protocol

IntroductionType 2 diabetes mellitus (T2DM) is a global public health concern. Aerobic physical activity (PA) and resistance training (RT) play significant roles in the prevention and management of T2DM. The aim of this pilot trial is to determine the preliminary efficacy and confirm feasibility of referral to exercise physiologists, psychologists, and provision of a technology-based behavior change support package to promote aerobic PA and RT in school teachers ‘at risk' of or diagnosed with T2DM. Research design and methodsThe SMART (Support, Motivation and Physical Activity Research for Teachers’) Health pilot study will be evaluated using a three-arm randomized controlled trial. The intervention will be guided by Social Cognitive Theory, Health Action Process Approach Model and Cognitive Behavioral Therapy strategies. The participants will be randomly allocated to one of three study groups: Group 1: wait-list control group; Group 2: 5 face-to-face visits with a psychologist and exercise specialist over 3 months; and Group 3: same as Group 2 plus technology-based behavior change support package for an additional 6 months. Assessments will be conducted at baseline, 3-, 9- (primary time-point) and 18-months post-baseline. The primary outcome will be PA measured with pedometers. DiscussionSMART Health is an innovative, multi-component intervention, that integrates referral to exercise specialists, psychologists and provision of a technology-based behavior support package to promote PA and RT in adults diagnosed with T2DM or ‘at risk' of T2DM. The findings will be used to guide future PA interventions and to develop effective community-based diabetes prevention and treatment programs. Trial RegistrationAustralian New Zealand Clinical Trials Registry No: ACTRN12616001309471

Ten clinical studies in China contributing to the global research on prevention and control of diabetes mellitus

Prevalence of diabetes mellitus is rapidly increasing in China. Effective prevention of diabetes has become an important medical issue worldwide, including in China. Treatment of diabetic patients primarily includes effectively controlling blood glucose and reducing the risk of diabetes-related complications, particularly cardiovascular diseases. In recent years, Chinese researchers performed a series of studies in the pre-diabetic and diabetic population. These clinical studies provided abundant medical evidences for the prevention and control of diabetes and its complications. In this study, we present the positive contribution of these studies to the prevention and control of diabetes in China and worldwide.

Diabetes Prevalence in North America and Caribbean Region in 2017 and 2045

Aims and Objectives: Diabetes is a serious and increasing global epidemic, and accurate estimates are essential for more efficient allocation of resources. The International Diabetes Federation (IDF) North America and Caribbean Region (NAC) consist of the U.S.A, Mexico and Canada, as well as 25 Caribbean countries and territories. The new edition of the International Diabetes Federation (IDF) Atlas (IDF, 2017) provides estimates of the numbers of people (18-99 years) living with diabetes in the IDF North America and Caribbean (NAC) Region. Methodology: Estimates for diabetes in adults were taken from 24 data sources in the IDF NAC region, representing 14 out of 28 countries. Selected characteristics of these data sources are as follows: Barbados, Mexico, Suriname, Trinidad and Tobago and the U.S. had studies conducted within the last five years; Belize, Haiti, Mexico and the U.S. Virgin Islands had studies that performed oral glucose tolerance tests. Prevalence rates for other countries may be underestimated due to limited data sources on oral glucose tolerance test. The details of the methodology were described in IDF Diabetes Atlas 8th Ed. Results and Conclusion: Approximately 50.1 (41.8-56.1) million people or 13.1% (10.9-14.6%) of adults aged 18-99, are living with diabetes in the IDF NAC region in 2017. The age-adjusted prevalence is 10.8%, which is highest among all seven IDF regions. If the trend continues, the number of people with diabetes is projected to reach 73.4 (58.8-83.4) million in 2045. About 37.6% of those people living with diabetes in this region are estimated to be undiagnosed in 2017. The number of deaths attributed to diabetes from age 20 to 99 years is 378,720 in 2017. The total healthcare expenditure related to diabetes in NAC region is USD 439,858 million in 2017 and will reach USD 508,315 million by 2045. Diabetes exerts a heavy burden in this region. Therefore effective diabetes prevention and management programs should be implemented in order to control diabetes prevalence. Disclosure Y. Huang: None. S. Karuranga: None. E.J. Boyko: None. B. Malanda: None.

Excess Medical Expenditures Associated with Diabetes-Related Complications among Adult Medicaid Enrollees in Eight U.S. States

The financial burden imposed by diabetes on Medicaid is substantial. While most of this burden is due to treating diabetes-related complications, little information is available on how much Medicaid paid for those complications and variability by state. Using 2008-2012 Medicaid claims data, we estimated per-capita annual medical expenditures for treating selected diabetes-related acute and chronic complications among Medicaid enrollees. Our study population included adults aged 19-64 enrolled in fee-for-service plan from eight states with adequate sample size, stratified by eligibility criteria: disability vs. non-disability enrollees. Complication conditions were identified using ICD-9 codes and selected based on sufficient sample size to derive reliable estimates. We compared expenditures between those with and without selected complications to derive excess expenditures. Diabetes-related complications consumed a substantial amount of excess Medicaid health care resources across the eight states (Table). Excess expenditure levels varied by state, condition, and eligibility criteria, with ischemic heart disease and renal disease having the largest variation. Implementing effective diabetes prevention and control measures could reduce expenditures on complications. Table: Estimated per capita excess annual medical expenditures among adult Medicaid enrollees associated with diabetes-related complications aged 19-64 years by eligibility-based disability status, (At US $ 2012 )ALCACTFLIAILNYOKDisability basedNeuropathy*2,2414,4426,3265,4377,7476,90610,5325,891Non-ESRD renal disease*7,92322,22615,25514,39615,25424,87534,00218,010Ischemic Heart Disease*4,82010,6197,9388,45412,38214,57921,28311,286Hypoglycemia5,94012,72616,98811,88312,47414,11718,10513,768One or more selected complications5,80115,59612,88111,69614,16517,88125,36214,260Non-disability basedNeuropathy*3,6814,7886,7524,4455,2266,7617,4546,799Non-ESRD renal disease*5,17817,48810,1717,4779,61417,05424,66313,553Ischemic Heart Disease*4,17614,90810,8677,26015,03114,38930,88612,200Hypoglycemia3,9648,47211,0877,2799,8319,76520,22911,102One or more selected complications4,75810,7429,7846,3659,17810,36919,64910,015Notes: All excess expenditures are statistically significant (P &amp;lt; 0.01)AL: Alabama; CA: California; CT: Connecticut; FL: Florida; IA: Iowa; IL: Illinois; NY: New York; OK: Oklahoma*Non-ESRD renal disease identified based on ICD-9 codes for proteinuria/albuminuria, nephritis, anemia in chronic kidney disease, acute kidney failure, and other renal diseases without including ESRD, dialysis and transplant.; Ischemic heart disease was based on Chronic Conditions Data Warehouse algorithm. All complications were identified based on ICD-9 codes from the past studies; Medical expenditures were estimated using a generalized linear model with log link and gamma distribution, adjusted for age, sex, race/ethnicity, claims year and comorbidities; The excess medical expenditures associated with a diabetes-related complication were calculated as the difference in predicted expenditures for enrollees with and without the complication. Disclosure B. Ng: None. S. Shrestha: None. R. Soler: None. B. Smith: None. P. Zhang: None.

Alpha-Glucosidase Inhibitory Activity in Different Pepper Cultivars (Capsicum annuum L.)

The number of cases of type II diabetes has increased dramatically worldwide. Plant-based foods offer some options for treating this disease. Effective diabetes prevention is achieved by controlling postprandial hyperglycemia by α-glucosidase inhibition. This study investigated the α-glucosidase inhibitory activity of extracts of 14 cultivars of pepper fruits (Capsicum annuum L.), which are widely consumed in Korea. Pepper fruit extracts were prepared with 70% ethanol and water, and diluted to 50% and 25% strengths before performing an α-glucosidase inhibition assay. No significant differences in α-glucosidase inhibitory activity were found between the two different aqueous extracts. Mee-In and Dda-Go-Ddo-Dda-Go cultivars had the highest and most sustained inhibitory activity (almost 100%) against α-glucosidase. In contrast, while extracts from Soon- Han-Gil-Sang, Gil-Sang, Sweety, Hyul-Jo K, Shin-Hong, and Ai-Mat inhibited α-glucosidase activity, the level of inhibition sharply decreased with decreasing extract concentrations between 100% and 50%. The results of this study suggest the possible existence of unknown inhibitors that are present at different concentrations in different pepper cultivars. Further studies are required to identify the unknown enzymes that are key to α-glucosidase inhibition in pepper fruits.

The Relationship of 5-Aminolevulinic Acid on Mood and Coping Ability in Prediabetic Middle Aged and Older Adults.

In 2010, approximately 79 million Americans had prediabetes and about 50 percent of those individuals were 65 years and older. The most effective diabetes prevention method in prediabetic adults is lifestyle modification. However, despite the benefits of lifestyle change, diabetes prevalence continues to increase. Maintaining a regular exercise routine and a healthy eating plan may be difficult because of the negative emotional barriers (i.e., stress, mood) that a prediabetic individual faces. This is particularly evident in older individuals when you combine that with decreases in mobility and geriatric syndromes. A potential treatment for these emotional barriers is a natural supplement called 5-aminolevulinic acid (5-ALA). In the current study, the group included 154 participants, both men and women, ranging between the ages of 41 to 71 years old. The study design was a double-blind, randomized parallel-group study. The Psychosocial Depressive Symptoms Questionnaire (PDS) and the Perceived Stress Scale (PSS) were used to examine the effect of two doses of 5-ALA (15 mg and 50 mg) on various components of mood (i.e., hopefulness, loneliness, and motivation) and coping ability. Using SAS software, an ordered logistic regression model was used to analyze the association between the dose groups (control, 15 mg, and 50 mg) and the responses to the two questionnaires, the PDS and PSS, used in this study. An integrative literature review, using the PubMed database, searched for studies on the relationship between 5-ALA administration and mood and coping ability. Our literature review resulted in zero published articles. Next, we found that the intake of 5-ALA was significantly associated with improved coping ability (p = 0.004) and improved self-perception of effort spent (p = 0.002). Finally, we found a significant dose-dependent relationship for the association of 5-ALA intake on measures of effort (p = 0.003), loneliness (p = 0.006), and coping ability (p = 0.003). The 50 mg dose was more effective than the 15 mg dose in improving these measures. In conclusion, after 12 weeks of taking 5-ALA, we found significant improvements in self-perception of effort spent, loneliness, and coping ability in prediabetic middle age and older adults. Improved mood and coping ability may allow prediabetic individuals to overcome the emotional obstacles preventing them from maintaining a healthy lifestyle and ultimately, help them to avoid the development of diabetes.

HOMBRE: A randomized controlled trial to compare two approaches to weight loss for overweight and obese Latino men (Hombres con Opciones para Mejorar el Bienestar y bajar el Riesgo de Enfermedades crónicas; men with choices to improve well-being and decrease chronic disease risk)

Latino men bear a disproportionate burden of obesity, diabetes, and cardiovascular disease.However, limited behavioral lifestyle intervention research has focused on Latino men. This trial compares two approaches to weight loss for overweight and obese Latino men: 1) HOMBRE is a culturally adapted intervention that provides individual choice of either self-directed online videos, coach-facilitated in-person groups, and coach-facilitated online groups; and 2) a minimal intensity intervention that uses online videos with a coach available, if solicited by the participant.Latino men with a Body Mass Index (BMI) of ≥27 kg/m2 and one or more cardiometabolic risk factors (n = 424) will be randomly assigned to receive one of the two approaches.The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guides the planned evaluations.The primary aim is to determine the effectiveness of the HOMBRE intervention (the “E” in RE-AIM) on clinically significant weight loss (≥5% of baseline weight) at 18 months. We hypothesize that a significantly higher proportion of HOMBRE participants will maintain ≥5% of weight loss compared with those in the minimal intensity intervention.Secondary aims are to determine the effectiveness of HOMBRE on cardiometabolic risk factors (e.g., blood pressure, waist circumference), health behaviors (e.g., diet and physical activity), and psychosocial well-being (e.g., quality of life and depressive symptoms) and to evaluate the other attributes of RE-AIM. These findings have real word applicability with value to clinicians, patients, and other decision makers considering effective diabetes prevention programs for Latino men in primary care.

Epidemiology of diabetes and diabetic complications in China.

The People's Republic of China (herein referred to as China) has witnessed one of the most dramatic rises in diabetes prevalence anywhere in the world. The latest epidemiological study suggests that approximately 11% of the population has diabetes, with a significant proportion remaining undiagnosed. Risk factors for diabetes in the Chinese population are similar to those in other populations, though gestational diabetes and young-onset diabetes is becoming increasingly common. Data on the prevalence of diabetic complications remain limited, though cardio-renal complications account for significant morbidity and mortality. Other diabetes-related comorbidities are becoming increasingly common, with cancer emerging as a major cause of mortality among individuals with diabetes. There are many challenges and obstacles that impede effective diabetes prevention and the delivery of care, though much progress has occurred over recent years. Lessons learnt from how China has responded to the challenges posed by the diabetes epidemic will be invaluable for other countries facing the many threats of diabetes and its complications.

Molecular Mechanisms of Antipsychotic Drug-Induced Diabetes.

Antipsychotic drugs (APDs) are widely prescribed to control various mental disorders. As mental disorders are chronic diseases, these drugs are often used over a life-time. However, APDs can cause serious glucometabolic side-effects including type 2 diabetes and hyperglycaemic emergency, leading to medication non-compliance. At present, there is no effective approach to overcome these side-effects. Understanding the mechanisms for APD-induced diabetes should be helpful in prevention and treatment of these side-effects of APDs and thus improve the clinical outcomes of APDs. In this review, the potential mechanisms for APD-induced diabetes are summarized so that novel approaches can be considered to relieve APD-induced diabetes. APD-induced diabetes could be mediated by multiple mechanisms: (1) APDs can inhibit the insulin signaling pathway in the target cells such as muscle cells, hepatocytes and adipocytes to cause insulin resistance; (2) APD-induced obesity can result in high levels of free fatty acids (FFA) and inflammation, which can also cause insulin resistance. (3) APDs can cause direct damage to β-cells, leading to dysfunction and apoptosis of β-cells. A recent theory considers that both β-cell damage and insulin resistance are necessary factors for the development of diabetes. In high-fat diet-induced diabetes, the compensatory ability of β-cells is gradually damaged, while APDs cause direct β-cell damage, accounting for the severe form of APD-induced diabetes. Based on these mechanisms, effective prevention of APD-induced diabetes may need an integrated approach to combat various effects of APDs on multiple pathways.

Adult Arabs have higher risk for diabetes mellitus than Jews in Israel.

ObjectiveDiabetes mellitus is an emerging epidemic in the Arab world. Although high diabetes prevalence is documented in Israeli Arabs, information from cohort studies is scant.MethodsThis is a population study, based on information derived between 2007–2011, from the electronic database of the largest health fund in Israel, among Arabs and Jews. Prevalence, 4-year-incidence and diabetes hazard ratios [HRs], adjusted for sex and the metabolic-syndrome [MetS]-components, were determined in 3 age groups (<50 years, 50–59 years, and ≥60 years).ResultsThe study cohort included 17,044 Arabs (males: 49%, age: 39.4±17.3) and 16,012 Jews (males: 50%, age: 40.5 ±17.6). The overall age and sex-adjusted diabetes prevalence rates were much higher among Arabs 18.4% (95%CI: 17.6–19.1); and 10.3% (95%CI: 9.7–10.9) among Jews. Arab females had higher prevalence rates 20.0% (95%CI: 19–21) than Arab males 16.7% (95%CI: 15.7–17.8). Annual incidence rates were also significantly higher among Arabs 2.9% (95%CI: 2.7–3.1) than among Jews 1.7% (95%CI: 1.6–1.8). This held true across all age and sex subgroups. Adjustment for body mass index [BMI] attenuated HR estimates associated with Arab ethnicity across all age subgroups, mainly in the <50yrs age group from HR 2.04 (95%CI: 1.74–2.40) to 1.64 (95%CI: 1.40–1.92). BMI at incident diabetes among females was higher in Arabs than Jews. Males, however, did not differ by ethnicity.ConclusionArabs, mainly female, have high incidence and prevalence of diabetes. This excess risk is only partially explained by the high prevalence of obesity. Effective culturally-congruent diabetes prevention and treatment and an effective engagement partnership with the Arab community are of paramount need.