Therapeutic Lifestyle Modification Research Articles

Prevalence of Systemic Hypertension and Hypertensive Crises among Adult Outpatients in a Cardiac Hospital in Central Nepal

Background: The prevalence of systemic hypertension is a significant global health concern, affecting a large population worldwide. The objective of the study was to determine the prevalence of systemic hypertension and hypertensive crises among adult outpatients in a cardiac hospital in central Nepal. Methods: This is a hospital based cross-sectional observational study conducted at outpatient department of Cardiology in central Nepal. Consecutive 487 patients were included in the study. All the patients had undergone proper blood pressure measurements as per the standard protocol with Aneroid Sphygmomanometer. Results: Out of 487 participants in the study, 199 were diagnosed as hypertensives. The prevalence of hypertension was 40.86%, out of whom 56.28% were males and 43.72% were females with male: female ratio of 1:1.28. Mean age of the patients was 54.97 years with SD(±14.18 years). The highest number of patients with hypertension was in 51 to 60 years (25.6%) followed by 41-50 years (21.60%), 31(15.60%) of the patients presented with Hypertensive crises. Conclusion: The prevalence of systemic hypertension was considerably high in our study. Newer and multifaceted approaches along with other effective preventive strategies have to be implemented to raise awareness among the publics regarding risk factors for systemic hypertension and its control. Early detection and proper management of Hypertension including therapeutic lifestyle modifications is the key to success.

Prevalence and distributions of severely elevated low-density lipoprotein cholesterol (LDL-c) according to age, gender and clinic location among patients in the Malaysian primary care

BackgroundAdults with severely elevated low-density lipoprotein cholesterol (LDL-c) may have familial hypercholesterolaemia (FH) and are at high risk of atherosclerotic cardiovascular disease (ASCVD). The prevalence of elevated LDL-c in primary care clinics in Malaysia is not known. Therefore, this study aimed to determine the prevalence and distributions of severely elevated LDL-c among adult patients attending public primary care clinics in Malaysia. MethodsA cross-sectional study was conducted at 11 public primary care clinics in the central states of Malaysia, among adults ≥18 years old with LDL-c recorded in the electronic medical record. Sociodemographic and LDL-c data from 2018 to 2020 were extracted. Severely elevated LDL-c was defined as ≥4 mmol/L, which were further classified into: 4.0–4.9, 5.0–5.9, 6.0–6.9 and ≥ 7 mmol/L. ResultsOut of 139,702 patients, 44,374 (31.8 %) had severely elevated LDL-c of ≥4 mmol/L of which the majority were females (56.7 %). The mean (±SD) age of patients with severely elevated LDL-c was younger at 56.3 (±13.2) years compared to those with LDL-c of <4.0 mmol/L at 59.3 (±14.5) years. In terms of LDL-c levels, 30,751 (69.3 %), 10,412 (23.5 %), 2,499 (5.6 %) and 712 (1.6 %) were in the 4.0–4.9, 5.0–5.9, 6.0–6.9 and ≥ 7 mmol/L categories, respectively. ConclusionThe prevalence of severely elevated LDL-c of ≥4.0 mmol/L among adult patients in public primary care clinics was high. These patients need to be further investigated for secondary and inherited causes such as FH. Therapeutic lifestyle modification and pharmacological management are pivotal to prevent ASCVD in these patients.

Effects of a therapeutic lifestyle modification intervention on cardiometabolic health, sexual functioning and health-related quality of life in perimenopausal Chinese women: protocol for a randomised controlled trial

IntroductionPerimenopause is a critical transitional period in reproductive ageing. A set of physiological and psychological changes can affect perimenopausal women’s quality of life and further threaten their older adult health...

Hypoglycemic episodes among type 1 diabetic patients in Unaizah, Saudi Arabia: causes, management, and associated factors

BACKGROUND: Diabetes mellitus is a prevalent condition in Saudi Arabia, with approximately 20% of the adult population affected, ranking sixth highest in the world. This disease is associated with both acute and chronic complications. Among these complications, hypoglycemia is particularly dangerous and can occur during diabetes treatment. Individuals diagnosed with type 1 diabetes may experience multiple episodes of asymptomatic or symptomatic hypoglycemia per week.AIM: To assess the frequency of hypoglycemic episodes and identify associated factors among individuals with type 1 diabetes in Unaizah City, Saudi Arabia.MATERIALS AND METHODS: A quantitative, cross-sectional, descriptive research design was employed in April and May of 2023. A convenience sample of 280 type 1 diabetic clients living in the Qassim region of Unaizah City was selected. Participants completed an electronic structured questionnaire that collected information on sociodemographic factors and hypoglycemia-related data. Descriptive statistics and a Chi-square test were used for data analysis, utilizing SPSS version 23. Ethical considerations were strictly adhered to throughout the study.RESULTS: The findings revealed that over two-thirds of the participants (72.1%) reported experiencing hypoglycemic episodes within the past week. Furthermore, more than one-fifth of these individuals attributed the cause of the episodes to high insulin doses (21%). Seeking medical assistance to change medications for hypoglycemia was reported by more than half of the participants (55.4%), while less than half received help from others during hypoglycemic episodes (42.9%). It was observed that adherence to diabetic medication was higher than adherence to diabetic diet and exercise regimens. Males, as well as single or divorced participants, reported a higher frequency of hypoglycemic episodes. Additionally, patients with higher levels of education and those residing in rural regions reported a higher exposure to hypoglycemic episodes.CONCLUSION: The effective management of hypoglycemia necessitates patient education and awareness regarding its causes and symptoms. Targeted interventions are required to improve adherence to therapeutic regimens and lifestyle modifications. Furthermore, when managing hypoglycemia, it is important to consider the gender, marital status, educational level, and residence of diabetic patients.

Que faut-il retenir des recommandations de bonne pratique de la HAS 2022 : « Obésité de l’adulte : prise en charge de 2e et 3e niveaux – Partie I : prise en charge médicale » ?: What to remember from the HAS 2022 best clinical practice recommendations: Obesity in adults: “2nd and 3rd levels of care management – Part I:

Presently in France, more than 8 million people are affected by obesity (17% of the French population), with an even higher prevalence among people from disadvantaged socio-economic backgrounds. This pathology requires a global, multi-professional, multimodal, adapted, and exhaustive management, taking into account all the associated comorbidities and the potential handicap caused by the severity of obesity. These best practice clinical recommendations, published in 2022, improves the management of patients with obesity through: (i) the development of a new clinical classification that graduates the severity of obesity beyond the sole BMI, allowing patients to be referred to the appropriate level of care; (ii) the exhaustive description of the evaluation content (medical, behavioral, psychological and social); (iii) the precision of the objectives and content of the needed therapeutic lifestyle modifications and (iv) the introduction and description of anti-obesity drug indications. These recommendations were then used by another working group to propose a guide for the care pathway of adults living with overweight and obesity (published in February 2023), and to broaden the indications for drug treatments for obesity (opinion on drugs, December 2022). Finally, these recommendations will be completed by a second part concerning the revision of the bariatric surgery recommendations (expected in 2024) in order to propose uniform and quality management of patients living with obesity.© 2023 Société francophone nutrition clinique et métabolisme (SFNCM).Published by Elsevier Masson SAS. All rights reserved.

Utilization of telepharmacy in the management of hypertension

Background: Deaths due to cardiovascular diseases is on the rise, with hypertension as its most important risk factor. Effective management of hypertension, however, remains a challenge. Globally, only one in five adults with hypertension have it under control. The situation is worse in sub-Saharan Africa where hypertension prevalence is highest. Telepharmacy presents a great opportunity to enhance the way we address hypertension management. Objectives: This study sought to determine the effectiveness of pharmaceutical care interventions implemented through telepharmacy on medication adherence, practice of therapeutic lifestyles and overall blood pressure control among patients with hypertension. Methods: This was a randomized control trial conducted among individuals with hypertension recruited from two Ghanaian hospitals from May 2022 to December 2022. Patients with confirmed diagnosis of hypertension were recruited and assigned into a control or intervention group. Both groups were followed for six months with the intervention group receiving telepharmacy services in addition to standard clinical care. Outcome measures included changes in blood pressure, medication adherence, lifestyle modifications, identification and resolution of pharmaceutical care issues. Results: One hundred and eighteen (118) patients with hypertension were involved in the study. There was a statistically significant reduction in mean blood pressures for the intervention group after six months (Systolic-148.1 + 23.6, to 134.8 + 13.7, Diastolic- 85.8 + 9.8, to 79.5 + 8.7) (p < 0.05). The proportion of patients with adequately controlled blood pressure increased from 39.0% to 66.1%. There was also an increase in the mean adherence score (p < 0.05). The number of participants who adopted lifestyle modifications such as reducing salt consumption (89.5%) and exercising (77.2%) increased. The majority (87%) of all pharmaceutical care issues were identified and resolved over the six-month period. Conclusion: Telepharmacy service provided via phone calls was effective in improving the control of blood pressure. It also promoted the practice of therapeutic lifestyle modifications, medication adherence and identification of pharmaceutical care issues among patients with hypertension.

Therapeutic and preventive measures in adolescent girls with emerging polycystic ovary syndrome

Relevance. The manifestation of polycystic ovarian syndrome (PCOS) in adolescence differs significantly from that in adult women and is often hidden under the mask of physiological changes of puberty, which leads to late diagnosis of this disease. However, there is currently there is no convincing and reliable evidence on the advisability of using a number of medications for the treatment of this syndrome in adolescent girls. From this perspective, the first-line therapy inpuberty, with emerging PCOS, is lifestyle modification.Aim: to evaluate the effectiveness of therapeutic lifestyle modification (LSM) and micronutrient support in adolescent girls with PCOS.Materials and Methods. Forty female patients aged 16 to 18 years with a diagnosis of emerging PCOS were included in a prospective study. The patients were divided into 2 groups of 20 subjects each. The 1st group (the main one) – the patients who were recommended to modify their lifestyle in combination with micronutrients (inositol, folic acid, vitamin D, polyunsaturated fatty acids of the omega‑3 family); the 2nd group (the control group) – the girls who were recommended to modify their lifestyle to correct the symptoms of PCOS. The patients’ state was evaluated at the start of treatment, after 3 and 6 months.Results. The best results were seen in Group 1 (LSM +micronutrients) – a statistically significant effect of combined therapy on the metabolic status was found: a decrease in fasting glucose and insulin levels, lower cholesterol levels, normalization of the body mass index; on the hormonal background: a decrease in androstenedione levels, total testosterone, normalization of the LH/FSH ratio, a decrease in the clinical manifestations of hyperandrogenism; on menstrual cycle recovery with spontaneous ovulation.Conclusion. The use of micronutrient support, along with LSM, is an effective means of correcting the clinical manifestations of developing PCOS in adolescent girls, as well as the prevention of the negative effects of the disease.

Evaluating Statin Knowledge-Perceptions and Receptivity Following a Comprehensive Lifestyle Modification Program

Background Though clinical guidelines for cholesterol-lowering therapies advocate for both a trial of lifestyle modification and the initiation of statin medication when appropriate, the extent to which lifestyle modification may alter a patient’s knowledge-perceptions and receptivity towards statins remains unclear. Methods Following completion of a 6-month comprehensive lifestyle modification program, perceived changes in knowledge and receptivity towards statins were examined across prespecified subgroups of age, sex, and statin eligibility using a mixed-methods questionnaire. Quantitative and qualitative analyses incorporated binomial tests, McNemar’s test, and thematic analyses. Results Among 192 patients who completed the program and exit questionnaire between December 15, 2020 and July 2, 2021, 88.4% of patients indicated a perceived improvement in cholesterol and/or statin knowledge (P &lt; . 0001). 48.2% of patients acknowledged that their receptivity towards taking statins increased (P = . 61). Changes in receptivity were attributed to several identified program themes including improvements in health knowledge and awareness, motivation and empowerment. Patients who noted improvements in their mental health also reported significantly increased receptivity towards statins (P &lt; . 001). Conclusions Patients’ perceived knowledge and receptivity towards statins may improve following participation in a comprehensive therapeutic lifestyle modification program. Future research must evaluate the impact of these programs on statin uptake, compliance and outcomes.

SynthA1c: Towards Clinically Interpretable Patient Representations for Diabetes Risk Stratification.

Early diagnosis of Type 2 Diabetes Mellitus (T2DM) is crucial to enable timely therapeutic interventions and lifestyle modifications. As the time available for clinical office visits shortens and medical imaging data become more widely available, patient image data could be used to opportunistically identify patients for additional T2DM diagnostic workup by physicians. We investigated whether image-derived phenotypic data could be leveraged in tabular learning classifier models to predict T2DM risk in an automated fashion to flag high-risk patients without the need for additional blood laboratory measurements. In contrast to traditional binary classifiers, we leverage neural networks and decision tree models to represent patient data as 'SynthA1c' latent variables, which mimic blood hemoglobin A1c empirical lab measurements, that achieve sensitivities as high as 87.6%. To evaluate how SynthA1c models may generalize to other patient populations, we introduce a novel generalizable metric that uses vanilla data augmentation techniques to predict model performance on input out-of-domain covariates. We show that image-derived phenotypes and physical examination data together can accurately predict diabetes risk as a means of opportunistic risk stratification enabled by artificial intelligence and medical imaging. Our code is available at https://github.com/allisonjchae/DMT2RiskAssessment.

Treatment of hypertension in elderly

Whereas systolic blood pressure (SBP) continuously rises with age, diastolic blood pressure (DBP) gradually decreases after the age of 55 years. Therefore, hypertension in the elderly shows the pattern of isolated systolic hypertension. There is evidence on the benefits of controlling blood pressure (BP) in elderly patients with hypertension. The BP lowering effect has also been demonstrated in patients over 80 years of age with hypertension. The BP threshold for the initiation of antihypertensive drug treatment for older adults with hypertension is gradually decreasing. The antihypertensive treatment is recommended if, despite therapeutic lifestyle modifications, SBP ≥140 mmHg or DBP ≥90 mmHg in those aged 65-79 years old, and SBP ≥140-160 mmHg or DBP ≥90 mmHg in those aged ≥80 years old. Although there is no consensus on the target BP for older adults with hypertension, a target SBP of &lt;130-140 mmHg and DBP of &lt;80-90 mmHg are recommended. In older adults over 80 years of age with hypertension, the target SBP is &lt;140-150 mmHg. When the dose of antihypertensive drugs is increased to reach the target SBP, DBP may decrease to less than 70 mmHg, but it should not be &lt;60 mmHg. Thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers can be selected as the first-line drug for older adults with hypertension. Beta-blockers may be selected in case of compelling indications.

Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis.

Osteoarthritis (OA) is a common and debilitating condition in domestic dogs. Alongside pharmaceutical interventions and weight loss, exercise and physiotherapy (PT) are important measures in maintaining patient mobility and quality of life. Physiotherapy for OA aims to reduce pain, optimize muscular function and maintain joint function. Physiotherapeutic plans typically include PT exercises combined with therapeutic modalities, lifestyle and environmental modifications to improve the patient's overall quality of life and function. Information on therapeutic clinical efficacy of physiotherapeutic measures for canine OA is still very limited. Thus, physiotherapeutic strategies are still primarily based on evidence extrapolated from human protocols tailored to people with OA. The authors propose a simple systematic PT approach for canine OA, prioritizing measures according to simplicity, cost effectiveness and practicality. This guide (the "Physiotherapy Pyramid") aims to provide a clear stratified approach to simplify decision making and planning for owners, veterinarians and veterinary physiotherapists, leading to more straightforward design and implementation of treatment plans. Measures are implemented starting at the base of the pyramid, subsequently progressing to the top, allowing effective and practical interventions to be prioritized. The levels of the pyramid are in ascending order: environmental modification, exercise plan, OA-specific home exercises and treatment by a veterinary physiotherapist.

Effectiveness of the Complete Health Improvement Program in a Geriatric Population.

The Complete Health Improvement Program (CHIP) is an intensive therapeutic lifestyle modification program (ITLMP) with well-documented success in decreasing risk factors for cardiovascular disease (CVD). Plant-based diets and physical activity are components of the program that contribute to these improvements. Yet, there are few studies on how ITLMPs affect risk factors specifically for the geriatric population. The goal of this study was to examine results of CHIP participants with a focus on the older (greater than 65years) population in Athens, Ohio. Retrospective data from 2011 to 2017 were analyzed for 26 CHIP classes. Recorded variables included body mass index (BMI), blood pressure (BP), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), blood glucose (BG), and exercise level. Among geriatric participants, significant changes were found in BMI, BP, TC, LDL, HDL, BG, and exercise level (P < .001). As compared to the younger population, changes in variables were equivalent in the geriatric population in all variables (P > .05). These improvements in CVD risk factors among the elderly support the hypothesis that CHIP should be considered for CVD prevention and treatment in the geriatric population.

Possibilities of COC-DRSP in women with stress-dependent menstrual irregularities

Purpose of the study. Evaluation of the effectiveness and safety of COC-DRSP in the control of psychosomatic symptoms in women with stressdependent menstrual irregularities.Materials and methods. The observational study involved 28 women aged 18 to 39 years with somatoform anxiety disorder and menstrual irregularities resulting from stressful events and did not have a tendency to improve in the process of therapeutic lifestyle modification and the use of means to improve adaptation. In order to prevent pregnancy and control the menstrual cycle, the patients were prescribed a combined oral contraceptive containing drospirenone (DRSP-COC) in the «24 + 4» regimen. Prior to the study, 3 and 6 months after initiation of therapy, psychosomatic symptoms of anxiety disorder were assessed.Results. Reception of DRSP-COC (Dimia) led to a significant decrease in the frequency and severity of psychosomatic symptoms after three cycles of therapy with the preservation of the effect with continued administration.Conclusion. DRSP-COC is effective in relieving psychosomatic symptoms in women with stress-related menstrual irregularities.

Evaluation of circulating levels of Interleukin-10 and Interleukin-16 and dietary inflammatory index in Lebanese knee osteoarthritis patients

ObjectivesTo investigate plasma concentrations of Interleukin-16 (IL-16) and Interleukin-10 (IL-10) in Lebanese knee osteoarthritis (KOA) patients and to examine the association between the diet-associated inflammation and increased risk for KOA. MethodsA total of 208 study participants were assigned to one of the 3 groups: Diagnosed Knee Osteoarthritis group (DKOA) (N = 78); Undiagnosed Knee Osteoarthritis group (UKOA) (N = 60) and controls matched on age, sex and sociodemographic characteristics (N = 70). UKOA represents KOA features before they are altered by therapeutic intervention and lifestyle modifications that follow the diagnosis. Energy-adjusted dietary inflammatory index (E-DII™) scores were calculated using 2-day 24-hour recalls. IL-10 and IL-16 were measured using commercially available sandwich enzyme-linked immunosorbent assay kits. ResultsThe UKOA group and controls did not show any significant difference in plasma IL-16 levels (p = 0.28), whereas significantly higher levels of IL-10 were observed in the UKOA group compared to controls (21 ± 41 vs 7.5 ± 12 pg/mL; p = 0.01). The UKOA group had significantly higher IL-16 levels compared to the DKOA group (177 ± 215 vs 80 ± 57 pg/ml; p = 0.001) and significantly higher IL-10 levels compared to the DKOA group (21 ± 41 vs 8 ± 14 pg/mL; p = 0.02). Significantly higher levels of IL-16 were observed in the control group compared to the DKOA group (140 ± 161 vs 80 ± 57 pg/ml; p = 0.009) whereas the DKOA group and controls did not show any significant difference in plasma IL-10 levels (p = 0.82). Additionally, we found significantly higher E-DII scores in the UKOA group compared to controls (0.53 ± 1.028 vs 0.04 ± 1.580; p = 0.04) and in the UKOA group compared to the DKOA group (0.53 ± 1.028 vs -0.37 ± 1.899; p = 0.001). However, there was significant difference in E-DII scores between the DKOA group and controls (p = 0.16). ConclusionsOur findings indicate an association between circulating levels of IL-10 and KOA in Lebanese population, and a potential role of pro-inflammatory diet in KOA pathology. We did not find an association between circulating levels of IL-16 and KOA.

Efficacy of more intensive lipid-lowering therapy on cardiovascular diseases: a systematic review and meta-analysis

BackgroundCardiovascular disease is the leading cause of morbidity and mortality with incidence rates of 5–10 per 1000 person-years, according to primary prevention studies. To control hyperlipidemia—a major risk factor of cardiovascular disease—initiation of lipid-lowering therapy with therapeutic lifestyle modification or lipid-lowering agent is recommended. Few systematic reviews and meta-analyses are available on lipid-lowering therapy for the primary prevention of cardiovascular diseases. In addition, the operational definitions of intensive lipid-lowering therapies are heterogeneous. The aim of our study was to investigate whether intensive lipid-lowering therapies reduce greater cardiovascular disease risks in primary prevention settings.MethodsMEDLINE, EMBASE, and Cochrane Library databases were searched from inception to March 2019 for randomized controlled trials. We used random effects model for overall pooled risk ratio (RR) estimation with cardiovascular events of interest and all-cause mortality rate for the intensive lipid-lowering group using the standard lipid-lowering group as the reference. The Cochrane Risk of Bias Tool was used for quality assessment.ResultsA total of 18 randomized controlled trials were included. The risk reductions in cardiovascular outcomes and all-cause mortality associated with more intensive vs. standard lipid-lowering therapy across all trials were 24 and 10%, respectively (RR 0.76, 95% confidence interval 0.68–0.85; RR 0.90, 95% confidence interval 0.83–0.97); however, the risk reduction varied by baseline LDL-C level in the trial. A greater risk reduction was noted with higher LDL-C level. Intensive lipid-lowering for coronary heart disease protection was more pronounced in the non-diabetic populations than in the diabetic populations.ConclusionsMore intensive LDL-C lowering was associated with a greater reduction in risk of total and cardiovascular mortality in trials of patients with higher baseline LDL-C levels than less intensive LDL-C lowering. Intensive lipid-lowering was associated with a significant risk reduction of coronary heart disease and must be considered even in the non-diabetic populations.

Applying Health Belief Model among High Risk Hypertensive Clients

Background: Worldwide, recent reports indicate that more than one billion adults (more than a quarter of the world’s population) had hypertension, Aim: evaluation the effect of application (HBM) amongst high risk hypertensive clients. Research design: qausi experimental design was used. Sample: included ten percent of total number 910 of clients who attended on out-patient clinic in the previous year (214-2015). Setting: the study was conducted at out patients' clinic of medicine affiliated to the Ain Shams University Hospital. Tools: three tools were used to collect data; the first tool: was a self-administered questionnaire for assessing socio-demographic characteristics of clients, and their knowledge about hypertension. Second tool: (HBM) related to hypertension. Third tool: physically assessment health status of clients measured (BP, pulse, weight, height). Results: study indicated that more than half of hypertensive clients had unsatisfactory knowledge related to hypertension and near three fifth of them with higher percentage in female. Post health belief model application, there was highly significant improvement in clients knowledge, attitude, and blood pressure. Conclusion: the study proved that used of HBM as framework that guide and help improvement in client's knowledge, attitude, and health status. Recommendations: the study recommended that design and implement different educational programs based on HBM for hypertensive client's and regarding to needs assessment for hypertension (e.g.: definition, classification, causes, signs/symptoms, diagnostic methods, complication, methods of early detection of client's at high risk, management) to improve the rate of compliance by improving client's consequences. Counseling hypertensive client's every time whenever they visit to physician to improve the compliance to antihypertensive drugs, therapeutic lifestyle modification, and other needed self-cares to control hypertension. Design and disseminate related booklets and brochures to raise client's knowledge regarding hypertension (detect, treating, controlling) as well the community social support network. Utilize different media channels such as T.V., to raise population awareness regarding hypertension, prevention and intervention.

Self-management of type 2 diabetes mellitus utilizing technology based mobile medical assisted blood glucose management: Study protocol for a prospective, multi-center, observational study

IntroductionDiabetes mellitus is a major health concern globally as well as in China. Currently, the blood glucose (BG) control and patient outcome of diabetes are less than optimal, due to the poor adherence to established evidence-based treatment guidelines and low utilization of preventive care services by both providers and patients. Evidence suggest the benefit of mobile technology-based applications in improving BG monitoring and management in type 2 diabetes mellitus (T2DM). This study is designed to evaluate the effectiveness, safety and timeliness of the mobile internet technology in improving outpatients blood glucose self-management of Chinese T2DM. Methodsand Analysis: This is a prospective, single-arm, multi-center, observational study involving 250 hospitals across China. Patients aged ≥18 and ≤ 80 years with a diagnosis of T2DM and poor glycemic control, who were willing to receive premixed insulin analogues and could use their own WeChat account independently, were included in the study. The primary outcome of the study is to assess the benefit of programme based on change in hemoglobin A1c (HbA1c) from baseline to 3 months. Secondary outcomes included proportion of patients achieving HbA1c<7% at 3 months, change in fasting and postprandial glucose levels from baseline, incidence of hypoglycemia, frequency of self-monitoring blood glucose (SMBG), the patient behavior of BG monitoring on platform and the association of BG control with health care professionals (HCP)-patient interaction. The mobile based technology intervention can improve the HbA1c and BG levels in the patients receiving premixed insulin analogues and that the adherence of SMBG was increased and the incidence of hypoglycemia was decreased. Additionally, early detection of treatment-related hypoglycemia or other complications will contribute to timely therapeutic adjustments and lifestyle modifications under HCP's recommendations through the seamless HCP-patients interaction based on the mobile application. Ethics and disseminationThe study protocol was approved by the ethics committees from each study site according to the International Conference on Harmonization guidelines for Good Clinical Practice and conformed to Declaration of Helsinki. The results of the analyses will be shared with all the participating hospitals and will be published in peer-reviewed journals. No personal information will be included in the findings. RegistrationThis study was registered at chictr.org.cn (ChiCTR 1900021191).

Body Mass Index Change as a Predictor of Biometric Changes following an Intensive Lifestyle Modification Program.

The initial benefits of lifestyle modification programs such as reduction in chronic and cardiovascular diseases (CVD) risk factors have been well documented. However, such positive effects may deteriorate over time following relapse into inactivity. Timely detection of weight regain leading to the deterioration of the accrued benefits could trigger early resumption of intensive lifestyle intervention. To date, no known cost-effective, noninvasive approach for monitoring long-term outcomes has yet been established. The purpose of this study was to determine if body mass index (BMI) change predicted changes in other CVD biometric markers during an intensive lifestyle modification program. This study was an observational, retrospective review of records of participants from the Complete Health Improvement Program (CHIP). Biomarker changes of participants in this community-based Intensive Therapeutic Lifestyle Modification Program (ITLMP) offered in Athens, Ohio, a rural Appalachian college town, between April 2011 and June 2017 were reviewed retrospectively. BMI, heart rate (Pulse), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and glucose (FBS) were monitored before and after program completion. Data were analyzed using a multivariate general linear model. The sample analyzed consisted of 620 participants (mean age of 52.3±13.0 years, 74.5% female). Controlling for age and gender, BMI change significantly predicted 5 out of the 8 biomarker changes measured [Wilk's λ = 0.939, F(8,526) = 4.29, p <.0001]. Specifically, a 1-point BMI decrease was associated with 4.4 units decrease in TC, 3.2 units in LDL, 5.3 units in TG, 2 units in SBP, and 1 unit in DBP (all p values < .05). These results suggest that change in BMI may be a useful predictor of change in other CVD biomarkers' outcomes during and after an ITLMP participation. Tracking BMI, therefore, could serve as a proxy measure for identifying regressing biomarker changes following participation in an ITLMP leading to a timelier reassessment and intervention. Future studies evaluating the value of BMI as a surrogate for highlighting overall cardiovascular health are warranted.

Effect of Participation with Accompanying Household Member in the Complete Health Improvement Program in Appalachia.

Intensive therapeutic lifestyle modification programs, such as the Complete Health Improvement Program (CHIP), reduce cardiovascular disease (CVD) risk factors. However, there are little data on how participation in CHIP with a household member can affect CVD biomarkers. This study focuses on the benefit of joint participation of household members in CHIP in order to have a better outcome in improving CVD risk factors compared with lone or individual participation. Data from 20 CHIP classes offered from 2011 to 2015 in Athens, Ohio, where each class was conducted over 2-4 months, consisting of 16-18 sessions, were collected. Body mass index (BMI), blood pressure, fasting glucose, and lipid profiles were measured before and near the completion of each class. A statistically significant greater reduction in BMI (p = 0.003) in those who attended with a household member compared to those who attended as individuals was found. CHIP has some effect on various CVD risk factors for those who attend intensive therapeutic lifestyle modification programs with an accompanying household member. Hence, encouragement of participation with a family member or a “buddy” may be prudent, especially if weight reduction is a key program participation goal. Further evaluation of the “buddy effect” involving both of those residing in the same household and those who do not but nevertheless provide mutual support is warranted.

A 2018 clinical practice pattern in the management of diabetes in India and Nepal: a three-city study

Knowledge, awareness, and practices with regard to diabetes management in south Asia are not known. This study aimed to determine current clinical practices with regard to managing diabetes in Nepal and India. Doctors attending conferences in Delhi, Guwahati, and Kathmandu were evaluated regarding their diabetes treatment preferences using a standardized questionnaire having 34 multiple-choice questions. The questionnaire evaluated doctor’s preferences on therapeutic lifestyle modification, pharmacotherapy, and insulin injection practices. From a total of 409 filled questionnaires which were collected, 261, 75, and 73 questionnaires from New Delhi, Guwahati, and Kathmandu, respectively, which fulfilled all criteria, were analyzed. The mean age of doctors was 42.26 ± 11.99 years. Low carbohydrate, high protein was the most frequently recommended diet plan. The use of carbohydrate counting in practice was non-existent. Self-monitoring of blood glucose (SMBG) is commonly used in practice with 1–2 times per day checking. The preferred second, third, and fourth oral agents after metformin were sulfonylureas (53.05%), glucosidase inhibitors (37.16%), and dipeptidyl-peptidase-4 inhibitors (DPP4i) (42.79%) respectively. Glimepiride (73.83%) and gliclazide (28.60%) were the most preferred sulfonylureas. Teneligliptin (31.54%), sitagliptin (23.71%), linagliptin (22.24%), and vildagliptin (16.38%) were the preferred DPP4i. Dapagliflozin (30.56%), empagliflozin (20.29%), and canagliflozin (8.85%) were the preferred sodium-glucose co-transporter-2 inhibitor (SGLT2i). Insulin use was delayed in type-2 diabetes, typically initiated only after glycemic control not adequate with five oral anti-diabetes agents (OADs) (50.36%). The most preferred insulin was basal insulin analogue (47.68%) followed by neutral protamine hagedorn (NPH) insulin (22.24%). Most patients received < 20 U of insulin/day (56.96%). The most commonly used short-acting insulin in pregnancy was lispro (204; 49.88%). The preferred long-acting insulin in pregnancy was NPH insulin (180; 44.01%). Lack of use of digital technology, less use of lifestyle modifications, delayed use of insulin, preference for multiple OADs, popularity of sulfonylureas and alpha-glucosidase inhibitors (AGIs), and late use of SGLT2i were some of the key highlights of diabetes practice in south Asia.