Intensive Lifestyle Modification Research Articles

Liraglutide for overweight and obesity

Liraglutide for overweight and obesity

Lifestyle modifications alone or combined with hormonal contraceptives improve sexual dysfunction in women with polycystic ovary syndrome

To describe the prevalence of female sexual dysfunction in a well-defined polycystic ovary syndrome (PCOS) population, and to assess the impact of common PCOS treatments on sexual function. Secondary analysis of a randomized controlled trial, oral contraceptive pills and weight loss in PCOS. Two academic medical centers. Women with PCOS (N = 114) defined by the Rotterdam criteria. Continuous oral contraceptive pill (OCP) or intensive lifestyle modification (Lifestyle) or the combination (Combined) for 16 weeks. Change in Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores after 16 weeks. There was no change in total FSFI or FSDS-R score in any treatment group; however, an increase in the FSFI desire domain subscore was observed in the Lifestyle and Combined treatments, indicating improved sexual desire over the 16-week period. Overall, 33 participants (28.9%) met criteria for sexual dysfunction by FSFI criteria (baseline score ≤26.55). Among this group, FSFI score improved after 16 weeks of Lifestyle and Combined treatments. There was no change in prevalence of sexual dysfunction in treatment groups at 16 weeks. Use of OCPs did not alter FSFI scores. Female sexual dysfunction is highly prevalent among women with PCOS. Our findings suggest that common treatments for PCOS, including intensive lifestyle modification and the combination of intensive lifestyle modification and OCPs, have the potential to improve sexual function in these women; the mechanism for these improvements is likely multifactorial. NCT00704912.

Effects of Oral Contraception and Lifestyle Modification on Incretins and TGF-ß Superfamily Hormones in PCOS.

To examine the effects of common treatments for polycystic ovary syndrome (PCOS) on a panel of hormones (reproductive/metabolic). Secondary analysis of blood from a randomized controlled trial of three 16-week preconception interventions designed to improve PCOS-related abnormalities: continuous oral contraceptive pills (OCPs, N = 34 subjects), intensive lifestyle modification (Lifestyle, N = 31), or a combination of both (Combined, N = 29). Post-treatment levels of activin A and B, inhibin B, and follistatin (FST), as well as Insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 2 (IGFBP-2), glucagon, glucagon-like peptide 1 (GLP-1) and 2, and oxyntomodulin were compared to baseline, and the change from baseline in these parameters were correlated with outcomes. Oral contraceptive pill use was associated with a significant suppression in activin A, inhibin A, and anti-mullerian hormone (AMH), but a significant increase in FST. IGF-1, IGFBP-2, glucagon, and GLP-2 levels were significantly decreased. Oxyntomodulin was profoundly suppressed by OCPs (ratio of geometric means: 0.09, 95% confidence interval [CI]: 0.05, 0.18, P < 0.001). None of the analytes were significantly affected by Lifestyle, whereas the effects of Combined were similar to OCPs alone, although attenuated. Oxyntomodulin was significantly positively associated with the change in total ovarian volume (rs = 0.27; 95% CI: 0.03, 0.48; P = 0.03) and insulin sensitivity index (rs = 0.48; 95% CI: 0.27, 0.64; P < 0.001), and it was inversely correlated with change in area under the curve (AUC) glucose [rs = -0.38; 95% CI: -0.57, -0.16; P = 0.001]. None of the hormonal changes were associated with live birth, only Activin A was associated with ovulation (risk ratio per 1 ng/mL increase in change in Activin A: 6.0 [2.2, 16.2]; P < 0.001). In women with PCOS, OCPs (and not Lifestyle) affect a wide variety of reproductive/metabolic hormones, but their treatment response does not correlate with live birth.

Non-alcoholic fatty liver disease: a review of epidemiology, risk factors, diagnosis and management.

Due to the rising prevalence of obesity and type II diabetes mellitus, non-alcoholic fatty liver disease is becoming the leading cause of chronic liver disease in the Western world. In some patients, simple steatosis can result in non-alcoholic steatohepatitis which over time can lead to liver cirrhosis and its associated sequelae, including hepatocellular carcinoma. Early identification and management of patients at risk with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications. In this review, we will discuss the epidemiology of non-alcoholic fatty liver disease, pathogenesis, diagnosis, management and surveillance strategies to offset the morbidity and mortality of this disease, as well as liver and non-liver-related complications.

Lifestyle Modification Improves Insulin Resistance and Carotid Intima-Media Thickness in a Metabolically Healthy Obese Prepubescent Population.

The aim of this study was to analyze effects of a 12-month lifestyle modification that involved a Mediterranean diet (MedDiet) and physical activity (PA) program in a population of metabolically healthy obese children (MHOCh). We included a population of MHOCh with ≤1 of the following criteria: waist circumference and blood pressure ≥90 percentile, triglycerides >150 mg/dL, high-density lipoprotein-cholesterol (HDL-c) <40 mg/dL, or impaired fasting glucose. After 12 months of intensive lifestyle modification, anthropometric measurements, glycemic and lipid profiles, adherence to the MedDiet, energy intake, PA, body composition, and carotid intima-media thickness (cIMT) were analyzed. One hundred thirty-one MHOCh (70 boys and 61 girls; P = 0.65, age: 7.9 ± 1.3 years, body mass index [BMI]: 24.7 ± 3.5 kg/m2) were included. After 12 months of intervention, a significant decrease in standard deviation (SD) units of body weight (-0.5 ± 0.1; P < 0.001) and BMI (-0.5 ± 0.1; P < 0.001) were observed in the total population. A significant improvement in adherence to the MedDiet (+2 points) and a significant reduction in protein, fatty acids, total fat, and cholesterol intake in the entire population were observed. All participants did more moderate-vigorous PA, which led to a significant increase in lean and total mass and decrease in total fat. Significant improvements in the glycemic profile (insulin levels [-6.6 μIU/mL, P < 0.001] and HOMA index [-1.2, P < 0.001]) were observed. Participants with pathological cIMT values reduced this cardiovascular predictor to normal values. A 12-month lifestyle modification intervention involving weight loss with MedDiet and PA in MHOCh yielded improvements in MedDiet adherence, lipid intake, moderate-vigorous PA, body composition, insulin resistance, and cIMT.

Les Canadiens partiellement Français sont susceptibles à une augmentation des facteurs de risque cardiovasculaire : une étude de cohorte rétrospective basée sur la population

BackgroundThrough various research lead in the past, it has been made evident that Quebec is home to higher rates of acute myocardial infarction (AMI) and higher prevalence of cardiovascular risk factors than other Canadian provinces. This proposed study will perform a retrospective analysis on Caucasian populations in order to analyze the cardiovascular risk factors in partially francophone populations in comparison to French and Non-French Canadians. Furthermore, we will closely analyze both genders of aforementioned populations. MethodsThis population-based retrospective cohort study was achieved using the University of Ottawa Heart Institute CCTA registry. Included are Caucasian patients of all ages who came to UOHI for a CCTA between 2006 and 2018 and provided written informed consent. SPSS was used to compare the different populations (French Canadian, partially French Canadian and non-French Canadian) and sex. ResultsThe PFC population more closely resembles FC, having higher incidence of cardiovascular risk factors such as smoking, dyslipidemia and type 2 diabetes. InterpretationOur results suggest that PFC, like FC, may benefit from more intensive education and lifestyle modification techniques.

A Single Injection of a Liver-Directed A20 Gene Therapy Yields Long-Term Glycemic Control in Diabetic Mice to Reduce Vascular Complications

Diabetic patients suffer a two- to four-fold higher incidence of coronary artery disease and stroke and >10-fold higher incidence of peripheral vascular disease. Poor glycemic control is the most significant risk factor for heightened vascular complications in diabetes. At the molecular level, we showed increased vascular complications in patients with poor diabetes control relate to inadequate expression of the anti-inflammatory and atheroprotective molecule, A20. Hyperglycemia causes post-translational O-glycosylation of A20, targeting it for ubiquitination and degradation. Strict and sustained control of blood glucose by intensive insulin therapy and lifestyle modifications decrease vascular risk in diabetic patients. Unfortunately, few patients successfully comply with these stringent guidelines. Our objective was to explore a novel, safer and easier-to-implement means of controlling blood glucose. Our data indicate that liver-directed gene therapy of the A20 gene can achieve this goal. Seven-week-old C57BL/6 mice were rendered diabetic via five consecutive injections of streptozotocin. Six weeks after diabetes was established, we intravenously injected rAd.A20 or control α-galactosidase (rAd.αgal), measured glycemia weekly and performed a glucose tolerance test (GTT). Tissue/plasma was harvested on 10, 30, and 100 days after the mice achieved euglycemia. Remarkably, 80% of the A20-treated, but none of the α-gal-treated mice became euglycemic or significantly improved their glycemia within the first week after treatment. This result was sustained with >70% of these mice remaining euglycemic at 100 days. GTT curves either normalized (10 days) or significantly improved (30 and 100 days) in euglycemic A20-treated mice. Normalization of glycemia and GTT in A20-treated mice did not associate with increased insulin levels, but with higher intrahepatic and circulating levels of lipocalin 13 (LCN13). LCN13, a transporter protein, regulates glucose metabolism through insulin-dependent and -independent mechanisms. Increased LCN13 mRNA levels in A20-treated livers had decreased levels of gluconeogenic enzymes, PEPCK and G6Pase, and increased expression of the glucose transporters GLUT1 and two in the liver, along with GLUT1 and four in skeletal muscles. The latter correlated with higher glycogen storage in livers and skeletal muscles. Liver-directed A20 gene therapy Results in sustained glycemic control in diabetic mice. This remarkable effect is insulin-independent and can be attributed to A20-mediated upregulation of LCN13, a glucose metabolism regulator, predicting efficacy in both type 1 and type 2 diabetes. Recent development of clinically safe gene therapy vectors predict clinical translatability of this novel therapy to reduce the debilitating vascular complications of diabetes.

Study within a trial protocol: Same-day consent vs. delayed consent in a randomized trial.

Randomized trials are designed to evaluate the effects of health care interventions. The recruitment process in a randomized trial can be challenging. Poor recruitment can have a negative impact on the allocated budget and estimated completion date of the study and may result in an underpowered research that will not adequately answer the original research question. We aim to perform a Study Within A Trial (SWAT) to evaluate the impact of same-day consent or delayed consent on recruitment and retention in the host trial. This SWAT is designed as an observational study. However, the host trial is a randomized controlled trial evaluating the effectiveness of an intensive lifestyle modification program in patients with peripheral arterial disease. For this trial and SWAT, same-day consent is defined as the patient giving consent on the same day, after the investigator has fully explained the predesigned information leaflet for the host trial. Delayed consent is defined as the patient feeling they still need further time to consider their decision to participate or not. The SWAT was registered on the Northern Ireland Network for Trials Methodology Research.

836-P: The Effect of Intensive Lifestyle Modification Compared with Metformin Interventions on Fasting Blood Glucose: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Type 2 diabetes mellitus (T2DM) is a prevalent disease and remains a substantial economic burden on society. Intensive lifestyle modification (ILM) and metformin are common interventions aimed at individuals with prediabetes to prevent the progression to T2DM. Objective: To assess the effect of ILM and metformin interventions by evaluating fasting blood glucose (FBG). Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Databases including MEDLINE, CINHAL, Nutrition and Food Sciences, and ProQuest were searched. Inclusion criteria were individuals with prediabetes, had separate ILM and metformin interventions, and assessed baseline and post-intervention FBG. Exclusion criteria were individuals outside the age of 13-65 years, had unrelated medical conditions, taking other diabetic medications, and &amp;lt;12 weeks in duration. Statistical analysis was completed using the Comprehensive Meta-Analysis software (CMA). Results: Of 257 studies, 5 RCTs with a total of 4,045 participants were included for analysis. ILM was significantly associated with a lower FBG level post-intervention compared to metformin (MD±SEM=-0.15±0.068; p=0.026) and placebo (MD±SEM= -0.37±0.12; p=0.003). Metformin was significantly associated with a lower FBG post-intervention compared to placebo (MD±SEM= -0.25±0.059; p=0.00). Conclusion: ILM and metformin interventions are associated with an improvement in FBG compared to placebo. Although our analysis showed a statistical benefit of ILM compared to metformin, we conclude that the clinical significance in FBG is comparable for supporting both interventions. In addition, appropriate cost-effective interventions should be considered to reduce the economic burden on society. Prioritizing multidisciplinary teams is important for successful implementation and preventing T2DM in this population. Disclosure M. Kucab: None. T. Boateng: None. I. Young: None. E. Gucciardi: None.

942-P: Treatment of Weight Regain after Bariatric Surgery: Real-World Comparative Outcomes

After bariatric surgery, people frequently do not achieve a healthy weight and/or regain weight. There is limited outcomes data on anti-obesity medications in patients with prior bariatric surgery. GLP-1RAs promote weight loss by decreasing gastric motility and appetite, yet post-prandial levels of GLP-1 are elevated after bariatric surgery. We evaluated weight outcomes in patients with prior bariatric surgery seen in an academic medical center’s weight management program. We compared the following groups: intensive lifestyle modification (ILM) vs. any GLP-1 RA (GLP-1) vs. any non-GLP-1 RA weight loss agents (non-GLP-1) vs. combination of weight loss agents including GLP-1 RA (GLP-1 combination). We included patients with a history of bariatric surgery, at least two clinic visits, and no anti-obesity medications at the initial visit. Data was extracted from the Electronic Medical Record and confirmed by manual chart review. All patients were counseled on lifestyle modification for weight loss. The two GLP-1-based treatment groups had significantly greater % weight loss at 3- and 6-months compared to the ILM group (Figure). In multivariable regression model, adjusting for baseline age and sex, surgery type did not (p=0.2 and p=0.97 for 3- and 6-mo analyses) influence outcome. GLP-1 RA therapies (alone or in combination) are effective for weight loss in patients with prior bariatric surgery, regardless of surgery type. Disclosure C. Gazda: None. J. Almandoz: None. I. Lingvay: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk A/S, Sanofi, TARGET PharmaSolutions, Valeritas, Inc. Other Relationship; Self; Novo Nordisk A/S. J. Clark: None.

4125 Plan for a Retrospective Evaluation of a Multi-Modal Weight-centric Prediabetes Intervention.

OBJECTIVES/GOALS: To determine if a multi-modal, interdisciplinary intervention delivered to a group of prediabetic patients will result in reduced rates of diabetes progression. This project is a retrospective evaluation that will exam the feasibility and possibly efficacy of this intervention. METHODS/STUDY POPULATION: We will evaluate outcomes of 50 participants for the clinic, aged 21-60 inclusive. Patients will have a Body Mass Index &gt;25kg/m2 with a diagnosis of prediabetes. Patients must be non-pregnant, using approved contraception, and agree to not become pregnant for 1 year after enrollment. After enrollment, the initial treatment period is for 1 year and includes a 12 week low calorie diet plan, a 6-month intensive behavioral and lifestyle modification plan followed by a 6 month behavior reinforcement extension. Weight management medications may be used if appropriate for the patient from a clinical perspective during the 6-month intensive behavioral/lifestyle modification. RESULTS/ANTICIPATED RESULTS: It is anticipated that there will be decreased weight with a mean weight loss goal of approximately &gt;10%. Furthermore, it is expect that there will be improvement of other markers of metabolic disease. These include improvement of lipid values (LDL-C, HDL-C, Triglycerides, Total Cholesterol) as well as blood pressure with expected blood pressures of below 130/80 in greater than 50% of participants. Finally, It is expected that 50% or greater participants will have improvement of glycemic control. It is anticipated that greater than 50% of participants will have improvement of glycemic control and achieve normoglycemia. These values will be determined based upon fasting glucose or A1c. DISCUSSION/SIGNIFICANCE OF IMPACT: The significance of this intervention is enormous. By demonstrating feasibility in this trial, we can work toward both assessing efficacy and possibly dissemination of this model program. If these interventions provide durable changes at scale, this could help slow the epidemic of obesity and obesity related comorbid conditions.

Mindful Eating and Active Living: Development and Implementation of a Multidisciplinary Pediatric Weight Management Intervention.

Pediatric overweight and obesity are significant individual and public health issues that require an innovative approach. While evidence suggests that intensive family-based behavioral lifestyle modification can improve weight status, practical and logistical realities limit the ability of primary healthcare providers to intervene effectively. MEALs (Multidisciplinary Engagement and Learning/Mindful Eating and Active Living) is a family-based mindfulness intervention developed to address pediatric overweight and obesity, while improving healthy lifestyle behaviors through cooking classes. The incorporation of mindfulness, a psychological strategy associated with increased awareness of internal experiences, allows for a focus on the importance of healthy eating along with safe and efficacious kitchen practices. The Template for Intervention Description and Replication (TIDieR) checklist and guide is used to describe the intervention with the intention of providing necessary details to implement the intervention in clinical practice or replicate the intervention for further study. Lessons learned from pilot iterations of the intervention are provided.

Current Long-Term Pharmacotherapies for the Management of Obesity.

Obesity is a serious and growing worldwide health challenge associated with type 2 diabetes mellitus, cardiovascular disease, osteoarthritis, some cancers, sleep apnea, asthma, and nonalcoholic fatty liver. The Korean Society for the Study of Obesity recommends that pharmacotherapy should be considered when intensive lifestyle modifications fail to achieve a weight reduction in obese patients with a body mass index ≥25 kg/m2. Long-term medications for obesity have traditionally fallen into two major categories: centrally acting anorexiant medications and peripherally acting medications, such as orlistat. In this paper, we provide an overview of the anti-obesity medications currently available for the long-term and individualized treatment of obesity.

Effect of Weight Loss on Upper Airway Anatomy and the Apnea-Hypopnea Index. The Importance of Tongue Fat.

Rationale: Obesity is the primary risk factor for obstructive sleep apnea (OSA). Tongue fat is increased in obese persons with OSA, and may explain the relationship between obesity and OSA. Weight loss improves OSA, but the mechanism is unknown.Objectives: To determine the effect of weight loss on upper airway anatomy in subjects with obesity and OSA. We hypothesized that weight loss would decrease soft tissue volumes and tongue fat, and that these changes would correlate with reductions in apnea-hypopnea index (AHI).Methods: A total of 67 individuals with obesity and OSA (AHI ≥ 10 events/h) underwent a sleep study and upper airway and abdominal magnetic resonance imaging before and after a weight loss intervention (intensive lifestyle modification or bariatric surgery). Airway sizes and soft tissue, tongue fat, and abdominal fat volumes were quantified. Associations between weight loss and changes in these structures, and relationships to AHI changes, were examined.Measurements and Main Results: Weight loss was significantly associated with reductions in tongue fat and pterygoid and total lateral wall volumes. Reductions in tongue fat were strongly correlated with reductions in AHI (Pearson's rho = 0.62, P < 0.0001); results remained after controlling for weight loss (Pearson's rho = 0.36, P = 0.014). Reduction in tongue fat volume was the primary upper airway mediator of the relationship between weight loss and AHI improvement.Conclusions: Weight loss reduced volumes of several upper airway soft tissues in subjects with obesity and OSA. Improved AHI with weight loss was mediated by reductions in tongue fat. New treatments that reduce tongue fat should be considered for patients with OSA.

Abstract TP132: Intensive Medical Management and Life-Style Modifications Can Be Successfully Applied in Combination With Indirect Surgical Revascularization for Symptomatic Intracranial Atherosclerotic Disease

Introduction: We present the results of using the strict model of intensive medical management (IMM) and life-style modification of SAMMPRIS in a phase 2 study of EDAS revascularization in patients with symptomatic intracranial atherosclerosis (ERSIAS). Methods: ERSIAS was a mid-development, single surgical arm trial that enrolled patients closely matched to those recruited in SAMMPRIS with the exception of including also individuals with occlusions of the intracranial arteries. In addition to surgery, primary and secondary risk factors were strictly managed and a life-style modification program with monthly phone calls to encourage adherence to medication, diet, physical activity, and smoking cessation was applied. Every 3 months, patients were clinically evaluated and data of adherence to medical regimen was collected. Results: As previously reported, the rate of recurrent stroke in ERSIAS at one year was 7.7%. ERSIAS required patients to have ceased smoking for at least 6 months before enrollment. Of the 52 patients enrolled only 5 had a relapse in their smoking habit (9.6%). At the end of the study four stopped smoking, representing a failure on smoking control of only 2%. Patient’s engagement in vigorous physical activity increased from 43% at baseline to 84% at follow-up (p=0.03). Median LDL values at baseline, 6 months, and 12 months were 83.9 (IQR 65.2), 70.9 (IQR 38.8), and 77 (IQR 78.25), respectively. At an individual level 75.6% of patients had improvement in LDL control. The SBP goal (&lt;160mmHg) was achieved in 91% of patients, and a reduction of SBP was observed in 65.9% at either 6 or 12 months. Median HbA1c values in diabetic (DM2) patients were 6.3% (QR 2.5) at baseline, 5.1% (IQR 2.5) at 6 months, and 5.9% (IQR 2.8) at 12 months, accounting for an improvement in 60% of patients at either 6 or 12 months. Conclusion: A dedicated follow-up program optimized medical adherence and results in ERSIAS. The surgery did not affect the ability of patients to engage in exercise or adhere to medical management. The IMM model of SAMMPRIS was successfully applied in this surgical trial. Strict observance of the improvements in medical management should be integrated in future interventional studies for ICAD.

Arterial Stiffness Accelerates Within 1 Year of the Final Menstrual Period: The SWAN Heart Study.

Menopause may augment age-dependent increases in arterial stiffness, with black women having greater progression in midlife compared with white women. We sought to determine whether and when women experience changes in arterial stiffness relative to the final menstrual period (FMP) and whether these changes differ between black and white midlife women. Approach and Results: We evaluated 339 participants from the SWAN (Study of Women's Health Across the Nation) Heart Ancillary study (Study of Women's Health Across the Nation). Women had ≤2 carotid-femoral pulse-wave velocity (cfPWV) exams over a mean±SD of 2.3±0.5 years of follow-up. Annual percentage changes in cfPWV were estimated in 3 time segments relative to FMP and compared using piecewise linear mixed-effects models. At baseline, women were 51.1±2.8 years of age and 36% black. Annual percentage change (95% CI) in cfPWV varied by time segments: 0.9% (-0.6% to 2.3%) for >1 year before FMP, 7.5% (4.1% to 11.1%) within 1 year of FMP, and -1.0% (-2.8% to 0.8%) for >1 year after FMP. Annual percentage change in cfPWV within 1 year of FMP was significantly greater than the other 2 time segments; P<0.05 for both comparisons. Adjusting for concurrent cardiovascular disease risk factors explained part of the change estimates but did not eliminate the difference. Black women had greater increase in cfPWV compared with white women in the first segment; P for interaction, 0.04. The interval within 1 year of FMP is a critical period for women when vascular functional alterations occur. These findings underscore the importance of more intensive lifestyle modifications in women transitioning through menopause.

Efficacy of different prediabetes program models in improving clinical outcomes in people with prediabetes

AbstractBackground:Educational programs in general seem to have a clinically significant beneficial effect among the T2DM population in terms of improved glycaemic control. However, few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken.Objective:The present study evaluates for the first time, the differences in the effectiveness of the different educational programs [intensive lifestyle modification (Group Education Program, GEP), supervised education through social media (WhatsApp Education Group, WEP) and standard care via PHCCs (Control Group, CG)], among Saudi females with pre-diabetes.Methods:This was a 6-month, multi-center, 3-arm cluster, randomised, controlled (1:1:1), multi-intervention study conducted from July 2018 until March of 2019 in Riyadh, SA. A total of 1140 females from SA were cluster randomised equally to three groups, out of which only 253 [N = 100 GEP, N = 84 WEP and N = 69 CG] received intervention. Participants completed questionnaires including demographic, dietary and physical activity data. Anthropometrics, blood samples and dietary intake were collected at baseline and 6 months. A total of 120 [37 CG (age 50.9 ± 7.1 years; body mass index (BMI) 31.6 ± 5.8kg/m2), 40 GEP (age 42.9 ± 12.2 years; BMI 34.8 ± 9.0kg/m2) and 43 WEP (age 43.7 ± 8.1 years; BMI 30 ± 5.1kg/m2)] participants completed the study.Results:Haemoglobin A1c (HbA1c; primary endpoint) significantly improved in all groups over time, with no difference in between-group comparisons. Between group comparisons adjusted for age revealed a clinically significant reduction in BMI in favour of GEP (p = 0.02) post-intervention. A clinically significant reduction was also observed in favour of GEP in terms of weight (p = 0.003), waist circumference (p = 0.017), systolic and diastolic blood pressure (p-values &lt; 0.01), triglycerides (p &lt; 0.001) and caloric intake (p &lt; 0.005) over time.Conclusion:Prediabetes education programs of 6-month duration, whether delivered through an intensive lifestyle modification, social media or standard care, are equally efficacious in improving HbA1c levels among Saudi women with prediabetes, but intensive lifestyle is superior in terms of weight reduction and over-all cardiometabolic improvement.

Prediabetes in sub-saharan Africa: Pathophysiology, predictors, and prevalence

Prediabetes – comprising impaired fasting glycaemia (IFG) and/or impaired glucose tolerance (IGT) – is a transitory median interphase between normal blood glucose levels and diagnostic levels of diabetes. The raised blood glucose levels surreptitiously damage the body's organ systems and are often an augury of type 2 diabetes mellitus (T2DM), the two having been found to share similar pathogenesis. Current concepts in the pathogenesis of prediabetes support a pentad of mechanisms responsible for its development. Majority of the countries in Sub-Saharan Africa belong to the low and middle income category, whose population accounts for more than 70% of the 352 million adults (20–79 years) worldwide with IGT (one component of prediabetes), as at 2017. The presence of prediabetes increases health care related expenditure in individuals and takes a toll on the workforce. Nigeria (West Africa) is currently among the top ten countries with the highest number of individuals with IGT as at 2017, and Ethiopia (East Africa) has been projected to join Nigeria in this category by 2045. A PubMed and MEDLINE search was conducted using the keywords prediabetes, Sub-Saharan Africa, prevalence, and pathophysiology. Major studies were identified and reviewed. Numerous large scale studies have revealed that progression from prediabetes to T2DM is not relentless. Structured and intensive lifestyle modifications aimed at modest weight loss, increased physical activity, and healthy dietary habits have shown to halt or slow the progression to T2DM, and in some cases, even reverse prediabetes, with such individuals regaining normal blood glucose levels.

A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence.

The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.

Expanding Diabetes Prevention: Obstacles and Potential Solutions

Accurately diagnosing prediabetes is critical to refer high-risk individuals for intensive lifestyle modification or pharmacotherapy where appropriate. This perspective briefly reviews the obstacles to detecting prediabetes and broader implementation of diabetes prevention strategies as well as potential solutions (Table 1). Table 1Obstacles to Diabetes Prevention Obstacles Complexity and confusion of defining prediabetes Prediabetes is diagnosed late in the trajectory towards type 2 diabetes with current criteria Lack of awareness of prediabetes, access and referral to intervention programs Lack of long-term sustainability of diabetes prevention interventions Lack of community-wide, population-based strategies Open table in a new tab