Primary Prevention Of Type Research Articles

Importance of inflammatory markers and IL-6 for diagnosis and follow up of patients with type 2 diabetes mellitus.

Aim To analyse the long-term impact of altered metabolism on the level of mediators of inflammatory response in female patients with type 2 diabetes. Methods This study included 97 female patients with type 2 diabetes and 107 female, nondiabetic control subjects, who were recruited at the Clinical Centre University of Sarajevo and the General Hospital Tešanj. The effects of glycaemic control on markers of inflammatory response represented by C-reactive protein (CRP), fibrinogen, leukocytes, sedimentation rate, and cytokine IL-6 were tested. All subjects were free of evidence of infections, surgery, thyroid disease, polycystic ovarian syndrome, active liver and kidney damage. All biochemical analyses were performed according to standard International Federation of Clinical Chemistry (IFCC) protocols. Results A significant increase of fibrinogen (p<0.001), CRP (p=0.001), interleukin-6 (p=0.013), leukocytes (p<0.001) and sedimentation rate (p=0.008) in diabetic female population compared to control subjects was found. A significant correlation between CRP and haemoglobin A1c (p=0.035), interleukin-6 and glucose (p=0.032), IL-6 and body mass index (p=0.007) was found. Conclusion Our data suggest that inflammation plays an important role in the pathogenesis of diabetes in female diabetic population. A more detailed study on a far larger number of subjects is needed if they were to be used effectively as biomarkers in the primary prevention of type 2 diabetes in this population.

Abstract 41: Omega-6 Fatty Acid Biomarkers and Incident Type 2 Diabetes: A Pooled Analysis of 20 Cohort Studies

Background: Emerging evidence suggests that dietary omega-6 polyunsaturated fatty acids (n-6 PUFA) plays a role in the primary prevention of type 2 diabetes (T2D). Aims: To evaluate the relation between blood and adipose tissue levels of n-6 PUFA and incident T2D, including n-6 linoleic acid (LA), the major dietary PUFA abundant in vegetable oils, and n-6 arachidonic acid (AA), a key precursor of endogenous metabolites that modulate glucose metabolism and inflammation. Methods: A global consortium of 20 prospective cohort studies identified by February 2016. Each study measured LA and AA at study baseline among adults&gt;18y without prevalent T2D, and assessed the association of n-6 PUFA biomarkers and T2D risk prospectively using individual-level data, using a pre-specified analytic plan and harmonized exposures, covariates, and effect modifiers. Findings were centrally pooled using fixed-effects meta-analysis. Results: 39,740 men and women from 10 countries were included (range of cohort means, age, 49-76y, and BMI, 25.0-28.1kg/m 2 ), with 4,347 incident cases of T2D observed during follow-up. In continuous multivariate-adjusted analyses, higher LA was associated with 36% lower risk of T2D (RR,0.64, 95% CI,0.59-0.71, P&lt;0.001, I 2 =49%, Figure 1A ) per interquintile range. Similar inverse associations were observed for LA measured in different fractions, and in sensitivity analysis using random effects model. Levels of AA were not associated with T2D risk overall and in studies grouped by different biomarker fractions except total plasma (per interquintile RR=0.74, 95% CI=0.62-0.88, P&lt;0.001, Figure 1B ). The relations of LA and AA with T2D were not significantly modified by age, BMI, sex, race, aspirin use, n-3 PUFA biomarker, or FADS genetic variants ( P ≥ 0.13 for each). Conclusion: Higher blood and adipose tissue LA levels, biomarkers of the major dietary PUFA, were associated with lower risk of T2D among free-living populations worldwide. There was little evidence that AA levels were appreciably associated with risk of T2D.

Contrasting Efforts: The Microbiome and Type 1 Diabetes

In the search for environmental triggers of type 1 diabetes (T1D), disease associations with the human gut microbiome are of great interest. Three studies of children at high genetic risk for T1D have examined associations between microbial taxa and the development of T1D autoimmunity: DIPP (Diabetes Prediction and Prevention), BABYDIET (Primary Prevention of Type 1 Diabetes in Relatives at Increased Genetic Risk), and DIABIMMUNE (Pathogenesis of Type 1 Diabetes– Testing the Hygiene Hypothesis). These studies are herein examined for their findings, including areas for improvement and means to go beyond preliminary taxonomic associations for predicting functional influences by microbes. These studies serve as useful tools for guiding future research and deserve careful consideration.

Association between anorexia nervosa and type 2 diabetes in Sweden: Etiological clue for the primary prevention of type 2 diabetes

ABSTRACTAim: Caloric restriction has been found to be protective against the development of type 2 diabetes mellitus (T2D) in experimental animal studies. However, studies examining this association in humans are limited. In the present study, we examined whether individuals with anorexia nervosa, one marker of severe caloric restriction in humans, have a low incidence of T2D by using several Swedish registries. Methods: Individuals with anorexia nervosa were identified from the Swedish Hospital Discharge Register and Outpatient Register between 1964 and 2010. Standardized incidence ratios (SIRs) for T2D were studied among individuals with anorexia nervosa compared to those without the disorder. Results: A total of 17,135 individuals were identified with anorexia nervosa in Sweden. From this tally, 34 of them developed T2D, demonstrating a reduced risk of T2D with a SIR of 0.70, compared to individuals without anorexia nervosa. Patients with severe anorexia, indicated by more frequent hospitalizations, had a statistically non-significant lower incidence of T2D than those with fewer hospitalizations. A sibling study, controlled for familial confounding, found a statistically non-significant association between anorexia nervosa and T2D. Conclusion: Our study found that severe caloric restriction by using individuals with anorexia nervosa as a proxy was negatively associated with T2D, which might provide a biological basis for the primary prevention of T2D. Further studies are needed to explore whether moderate caloric restriction can effectively prevent the development of T2D in general population.

Impact of lifestyle intervention in primary prevention of Type 2 diabetes did not differ by baseline age and BMI among Asian-Indian people with impaired glucose tolerance.

To investigate whether the effectiveness of lifestyle interventions on the incidence of diabetes was influenced by the baseline age and BMI of the Asian-Indian participants with prediabetes. Pooled data, obtained from two of our Indian Diabetes Prevention Programmes (2006, n=236 and 2013, n=473; total N=709) which had similar baseline characteristics and intervention principles, were analysed. For the present secondary analysis we dichotomously categorized the participants' baseline age (<45 and ≥45 years) and BMI (<25.0 and ≥ 25.0 kg/m2 ). Glycaemic status was ascertained at 6-monthly intervals by oral glucose tolerance tests. The incidence rates of diabetes and relative risk reduction in both the intervention and the control group were calculated for categories of baseline age and BMI. Interactions between the intervention and baseline age and BMI on diabetes risk were also analysed. Incident diabetes was diagnosed in 227 of the total 709 participants (32.0%) [control group 139 participants (38.8%) vs intervention group 88 participants (24.2%)] during the median follow-up period of 2 years. The overall relative risk reduction was 35.4% (95% CI 19.3-48.3). Lifestyle intervention was equally effective in both age groups [relative risk reduction in those aged <45 years: 43.7% (95% CI 19.8-60.5) and in those aged ≥ 45 years: 28.9% (95% CI 5.3-46.6) P for interaction = 0.52] and in categories of BMI [BMI <25 kg/m2 : 36.1% (95% CI 9.5-54.9); and BMI ≥ 25 kg/m2 : 34.8% (95% CI 12.9-51.2); P for interaction = 0.95]. In Asian-Indian individuals with prediabetes, the effectiveness of lifestyle intervention was not modified by baseline age and BMI.

Lifestyle modification for the primary prevention of type 2 diabetes mellitus in the Canadian Aboriginal population

Canada’s Aboriginal populations have significantly higher rates of type 2 diabetes compared to non-Aboriginal Canadians. In First Nations populations living on reserve, the rates are more than double. Large randomized controlled trials (RCTs) have shown that intensive lifestyle modification in individuals with impaired glucose tolerance can decrease the overall incidence of diabetes by up to 22%.&#x0D; Implementing lifestyle interventions into clinical practice remains a significant challenge because of both limited resources and uncertainly about optimal program design. Most studies have focused on translation into the primary care setting, and have shown moderate benefits. However, there have been no trials examining the feasibility and effectiveness of RCT-based lifestyle modification in Canadian Aboriginal communities. Canadian initiatives have so far focused on school-based healthy lifestyle curriculum and community awareness, but have had little success in reducing weight.&#x0D; Factors such as community remoteness, cultural diversity, poor retention of health care workers, and lack of access to healthy food are significant barriers to implementing lifestyle modification programs in Canadian Aboriginal communities. More importantly, these communities face systemic inequalities that must be addressed in order to achieve meaningful and sustained lifestyle changes.

Remission of type 2 diabetes: is bariatric surgery ready for prime time?

There is mounting evidence that bariatric surgery leads to higher remission rates of type 2 diabetes than any conventional medical treatment, lifestyle intervention, or medically supervised weight loss program. Although remission rates of type 2 diabetes may be as high as 66.7 % after gastric bypass and 28.6 % after gastric band, very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Hence, trials that directly compare bariatric surgery procedures with medical and lifestyle intervention for patients with type 2 diabetes are the best candidate for assessing the role of bariatric surgery in diabetes remission. Three randomized controlled trials and one prospective study have so far been published comparing the effect of Roux-en-Y gastric bypass (RYGB) procedure against optimal medical therapy, with a follow-up ranging from 1 to 6 years: the percentage of diabetic patients in remission (hemoglobin A1C < 6-6.5 % without medications) ranged from 38 to 75 % at the end of follow-up. Intensive lifestyle intervention is also superior to conventional treatment for inducing remission of type 2 diabetes, with remission rates of type 2 diabetes between 10 and 15 % at 1 year of follow-up. Bariatric surgical procedures, especially RYGB, are more effective at inducing initial type 2 diabetes remission in obese patients, but more information is needed about the long-term durability of comorbidity control and complications after bariatric procedures. In the meantime, all efforts should be directed toward primary prevention of type 2 diabetes, given the encouraging results of lifestyle intervention studies.

A dysglycaemic effect of statins in diabetes: relevance to clinical practice?

In this issue of the journal, Erqou and colleagues (DOI 10.1007/s00125-014-3374-x) report, in a systematic review and meta-analysis of randomised trials, a very modest (1.3 mmol/mol or 0.12%) albeit significant increase in HbA1c in patients with diabetes treated with statins, compared with control. Here, we discuss the clinical relevance of the findings. Given the overwhelming benefit of statins on cardiovascular outcomes in diabetes, current guidelines recommending statins for primary prevention in type 2 diabetes should not change, and any effect on microvascular risk is likely to be minimal. Of course, all patients recommended for statin treatment, whether they have diabetes or not, should now be warned of a slight potential for dysglycaemia on starting statins, but at the same time they should be told that very modest lifestyle improvement will help offset this dysglycaemia risk. Finally, we remind colleagues that nearly all drugs have side effects and we should not be surprised by this statin–dysglycaemia effect, which can be easily managed.

Socioeconomic factors and effect of evidence-based patient information about primary prevention of type 2 diabetes mellitus--are there interactions?

BackgroundHaving shown in a recent randomized controlled trial that evidence-based patient information (EBPI) significantly increased knowledge on primary prevention of diabetes compared to standard patient information, we now investigated interaction between socioeconomic status (SES) and the effect of an EBPI.Findings1,120 visitors (aged 40–70 years, without known diabetes) to the “Techniker Krankenkasse” and the “German Diabetes Center” websites were randomized. The intervention group received a newly developed on-line EBPI, the control group standard on-line information. The primary outcome measure was knowledge, classified as “good/average/poor”. We analyzed associations of knowledge with socioeconomic variables (education, vocational training, employment, subjective social status) combined with intervention effect including interactions, adjusted for possible confounding by knowledge before intervention, self–reported blood glucose measurements, blood pressure, blood lipid levels, age and gender. Logistic regression models were fitted to the subpopulation (n = 647) with complete values in these variables.Education (high vs. low) was significantly associated with knowledge (good vs. average/poor); however, there was no significant interaction between education and intervention. After adjustment, the other socioeconomic variables were not significantly associated with knowledge.ConclusionsSocioeconomic variables did not significantly change the effect of the intervention. There was a tendency towards a lower effect where lower educated individuals were concerned. Possibly the power was too low to detect interaction effects. Larger studies using SES-specific designs are needed to clarify the effect of SES. We suggest considering the socioeconomic status when evaluating a decision aid, e.g. an EBPI, to ensure its effectiveness not only in higher socioeconomic groups.Trial registrationCurrent Controlled Trials ISRCTN22060616 (Date assigned: 12 September 2008).

Significance of the results of genome-wide association studies for primary prevention of type 2 diabetes mellitus and its complications. Personalised approach

The method of Genome-Wide Association Studies (GWAS) steadily becomes the basis for searching for candidate genes of monogenic and multifactorial diseases, including type 1 and 2 diabetes mellitus, coronary heart disease, obesity, vascular diseases, and others. To date, approximately 40 loci associated with type 2 diabetes mellitus (T2DM) have been identified and genetic predisposition factors for cardiovascular diseases have been determined. In some cases, the GWAS results not only enable understanding of the pathophysiologic basis for diseases, but also may give rise to new drugs. However, the question naturally arises about the possibility of implementing the accumulated knowledge to predict the development of diseases, including T2DM and its vascular complications. This review summarises the literature data on the possibilities to use the GWAS results to calculate the risk of developing diabetes and cardiovascular diseases. Determination of the individual genetic risk will allow for the primary prevention of diseases and will apparently be the basis of personalised predictive medicine in the near future.

EARLY DISTURBANCES OF CARBOHYDRATE METABOLISM — A TARGET FOR PRIMARY CARDIOVASCULAR PREVENTION

The paper discusses the social and economic costs associated with diabetes mellitus (DM) and its complications. Cardiovascular disease (CVD) is the leading cause of disability and complications in DM patients. The diagnostics and correction of the early disturbances of carbohydrate metabolism are important components of the primary prevention of Type 2 DM (DM-2). The DM-2 development is preceded by the abnormalities typically overlooked by the busy practitioners, such as impaired fasting glucose and impaired glucose tolerance. The authors present the evidence from international clinical trials confirming that the early disturbances of carbohydrate metabolism are an independent risk factor of CVD. Therefore, recently, the importance of the combined primary prevention of DM-2 and diabetes-associated CVD has been extensively discussed.

The rs1142345 in TPMT Affects the Therapeutic Effect of Traditional Hypoglycemic Herbs in Prediabetes.

Therapeutic interventions in prediabetes are important in the primary prevention of type 2 diabetes (T2D) and its chronic complications. However, little is known about the pharmacogenetic effect of traditional herbs on prediabetes treatment. A total of 194 impaired glucose tolerance (IGT) subjects were treated with traditional hypoglycemic herbs (Tianqi Jiangtang) for 12 months in this study. DNA samples were genotyped for 184 mutations in 34 genes involved in drug metabolism or transportation. Multinomial logistic regression analysis indicated that rs1142345 (A > G) in the thiopurine S-methyltransferase (TPMT) gene was significantly associated with the hypoglycemic effect of the drug (P = 0.001, FDR P = 0.043). The “G” allele frequencies of rs1142345 in the healthy (subjects reverted from IGT to normal glucose tolerance), maintenance (subjects still had IGT), and deterioration (subjects progressed from IGT to T2D) groups were 0.094, 0.214, and 0.542, respectively. Binary logistic regression analysis indicated that rs1142345 was also significantly associated with the hypoglycemic effect of the drug between the healthy and maintenance groups (P = 0.027, OR = 4.828) and between the healthy and deterioration groups (P = 0.001, OR = 7.811). Therefore, rs1142345 was associated with the clinical effect of traditional hypoglycemic herbs. Results also suggested that TPMT was probably involved in the pharmacological mechanisms of T2D.

Statins as a Primary Prevention: Which One is Most Effective? A Systematic Review and Meta-Analysis

Background: Type 2 diabetics are at high risk of atherosclerosis and Cardiovascular (CV) events due to their associated dyslipidemic profile. Adverse levels of the lipid triad: Low-Density Lipoprotein Cholesterol (LDL-C), High- Density Lipoprotein Cholesterol (HDL-C) and Triglycerides (TGs), have been shown to be major contributing factors. Statins (HMG-CoA reductase inhibitors) are recommended as first-line lipid therapy as evidence has shown their effectiveness in primary and secondary prevention of CV events. However, there is limited evidence specifically focused on primary prevention in Type 2 Diabetes Mellitus (T2DM) and dyslipidemia. The main purpose of this review was to assess the efficacy of statins in type 2 diabetics with dyslipidemia for the primary prevention of CV events. Methods: A systematic review was carried out to determine the effectiveness of statins in T2DM and dyslipidemia. A comprehensive literature search identified Randomised Control Trials (RCTs) specific to participants with T2DM and dyslipidemia without prior CV events, which investigated the effects of statins on the lipid triad. Bias and quality of the studies were assessed and data extracted was critically analysed. Meta-analyses were carried out to determine the significance of statin effects. PRISMA guidelines were adhered to throughout. Results: 10 RCTs were included investigating the effects of six statins. Statins were shown to improve the lipid triad by lowering LDL-C and TGs and increasing HDL-C, in agreement with previous research. Atorvastatin and rosuvastatin were shown to be most potent in reducing LDL-C and TGs and simvastatin showed the greatest increases in HDL-C. Meta-analyses demonstrated significance favouring statins for LDL-C and TG reductions but less evidence of significant effect of HDL-C improvement with all statins. Statins were well tolerated and adverse effects were minimal. Conclusion: Primary prevention in this high risk population is very important. Statins are effective at reducing CV event risk, and clinicians should have knowledge of most appropriate statin treatments for patients based on individual lipid levels.

Primary prevention of Type 2 diabetes in South Asians — challenges and the way forward

Preventing diabetes is of enormous value, particularly for the South Asian countries, which have a huge healthcare burden from the onslaught of the disease. Type 2 diabetes has been proved to be preventable using lifestyle changes, even in South Asians despite their heightened risk profile. Strategies to improve awareness about diabetes and translation of preventive measures by innovative, culturally specific programmes have to be implemented at national levels. Integrated involvement of the government, community, media, healthcare and education services, and financial support from national and international organizations, are required. South Asian countries have initiated national programmes for diabetes prevention and management. It is also encouraging to note that joint ventures between developed countries such as the USA, UK and other European countries and centres of excellence in South Asia have been initiated to develop large-scale, community-oriented, pragmatic intervention strategies.

A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men

BACKGROUND The role of weight training in the primary prevention of type 2 diabetes mellitus (T2DM) is largely unknown. METHODS To examine the association of weight training with risk of T2DM in US men and to assess the influence of combining weight training and aerobic exercise, we performed a prospective cohort study of 32002 men from the Health Professionals Follow-up Study observed from 1990 to 2008. Weekly time spent on weight training and aerobic exercise (including brisk walking, jogging, running, bicycling, swimming, tennis, squash, and calisthenics/rowing) was obtained from questionnaires at baseline and biennially during follow-up. RESULTS During 508332 person-years of follow-up (18 years), we documented 2278 new cases of T2DM. In multivariable-adjusted models, we observed a dose-response relationship between an increasing amount of time spent on weight training or aerobic exercise and lower risk of T2DM (P&lt;.001 for trend). Engaging in weight training or aerobic exercise for at least 150 minutes per week was independently associated with a lower risk of T2DM of 34% (95% CI, 7%-54%) and 52% (95% CI, 45%-58%), respectively. Men who engaged in aerobic exercise and weight training for at least 150 minutes per week had the greatest reduction in T2DM risk (59%; 95% CI, 39%-73%). CONCLUSIONS Weight training was associated with a significantly lower risk of T2DM, independent of aerobic exercise. Combined weight training and aerobic exercise conferred a greater benefit.

Blood glucose testing and primary prevention of Type 2 diabetes—evaluation of the effect of evidence‐based patient information: a randomized controlled trial

To compare the effect of our newly developed online evidence-based patient information vs. standard patient information about sub-threshold elevated blood glucose levels and primary prevention of diabetes on informed patient decision making. We invited visitors to the cooperating health insurance company, Techniker Krankenkasse, and the German Diabetes Center websites to take part in a web-based randomized controlled trial. The population after randomization comprised 1120 individuals aged between 40 and 70 years without known diabetes, of whom 558 individuals were randomly assigned to the intervention group receiving evidence-based patient information, and 562 individuals were randomly assigned to the control group receiving standard information from the Internet. The primary endpoint was acquired knowledge of elevated blood glucose level issues and the secondary outcomes were attitude to metabolic testing, intention to undergo metabolic testing, decisional conflict and satisfaction with the information. Overall, knowledge of elevated glucose level issues and the intention to undergo metabolic testing were high in both groups. Participants who had received evidence-based patient information, however, had significantly higher knowledge scores. The secondary outcomes in the evidence-based patient information subgroup that completed the 2-week follow-up period yielded significantly lower intention to undergo metabolic testing, significantly more critical attitude towards metabolic testing and significantly higher decisional conflict than the control subgroup (n=466). Satisfaction with the information was not significantly different between both groups. Evidence-based patient information significantly increased knowledge about elevated glucose levels, but also increased decisional conflict and critical attitude to screening and treatment options. The intention to undergo metabolic screening decreased. Future studies are warranted to assess uptake of metabolic testing and satisfaction with this decision in a broader population of patients with unknown diabetes.

Pré-diabetes: diagnóstico, avaliação de complicações crônicas e tratamento

Type 2 diabetes mellitus accounts for 90% of diabetes cases and is associated with macro- and microvascular complications of high morbidity and mortality. Individuals with increased risk for type 2 diabetes include those with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and especially those with combined IFG and IGT. These individuals are part of a group known as prediabetes patients. Approximately 25% of individuals with prediabetes will develop type 2 diabetes in three to five years. Hyperglycemia, in the absence of diabetes, is also associated with increased risk of cardiovascular disease. Studies have shown that changes in lifestyle and drug interventions are effective in delaying or preventing type 2 diabetes in patients with prediabetes. Metformin is the drug of choice when medical treatment is warranted. IGT and IFG are associated with type 2 diabetes and, despite controversy, most studies reinforce the importance of these conditions in the development of micro- and macrovascular disease. Thus, therapeutic interventions in patients with prediabetes are important in primary prevention of type 2 diabetes and its chronic complications.

Primary prevention of type 2 diabetes: integrative public health and primary care opportunities, challenges and strategies.

Type 2 diabetes imposes a large and growing burden on the public's health. This burden, combined with the growing evidence for primary prevention from randomized controlled trials of structured lifestyle programs leads to recommendations to include caloric reduction, increased physical activity and specific assistance to patients in problem solving to achieve modest weight loss as well as pharmacotherapy. These recommendations demand exploration of new ways to implement such primary prevention strategies through more integrated community organization, medical practice and policy. The US experience with control of tobacco use and high blood pressure offers valuable lessons for policy, such as taxation on products, and for practice in a variety of settings, such as coordination of referrals for lifestyle supports. We acknowledge also some notable exceptions to their generalizability. This paper presents possible actions proposed by an expert panel, summarized in Table 1 as recommendations for immediate action, strategic action and research. The collaboration of primary care and public health systems will be required to make many of these recommendations a reality. This paper also provides information on the progress made in recent years by the Division of Diabetes Translation at the US Centers for Disease Control and Prevention (CDC) to implement or facilitate such integration of primary care and public health for primary prevention.

Primary Prevention of Type 2 Diabetes

Primary Prevention of Type 2 Diabetes

Diabetes Prevention Programs

Primary prevention of type 2 diabetes is effective for curbing its epidemic. Lifestyle intervention has been found to be a highly effective, safe, and cost-effective method for the prevention of diabetes in high-risk persons, the benefit of which can extend for many years. Among the pharmacologic agents studied for prevention of diabetes, metformin has been found to be the safest. Interventions using drugs are less preferred because the drugs' effects tend to dissipate after their use is stopped and adverse effects may also result. The major challenge is to translate current knowledge into prevention programs at the national level.