Type 2 Diabetes Interventions Research Articles

A Qualitative evaluation in community settings in England exploring the experiences of coaches delivering the NHS Low Calorie Diet programme pilot to ethnically diverse participants

BackgroundThe management of type 2 diabetes (T2D) within diverse ethnic populations requires a culturally tailored approach. However, little is known about the experiences of coaches delivering interventions for T2D, such...

Beta-Cell Tipe1 Orchestrates Insulin Secretion and Cell Proliferation by Promoting Gαs/cAMP Signaling via USP5.

Inadequate β-cell mass and insulin secretion are essential for the development of type 2 diabetes (T2D). TNF-α-induced protein 8-like 1 (Tipe1) plays a crucial role in multiple diseases, however, a specific role in T2D pathogenesis remains largely unexplored. Herein, Tipe1 as a key regulator in T2D, contributing to the maintenance of β cell homeostasis is identified. The results show that the β-cell-specific knockout of Tipe1 (termed Ins2-Tipe1BKO) aggravated diabetic phenotypes in db/db mice or in mice with high-fat diet-induced diabetes. Notably, Tipe1 improves β cell mass and function, a process that depends on Gαs, the α subunit of the G-stimulating protein. Mechanistically, Tipe1 inhibited the K48-linked ubiquitination degradation of Gαs by recruiting the deubiquitinase USP5. Consequently, Gαs or cAMP agonists almost completely restored the dysfunction of β cells observed in Ins2-Tipe1BKO mice. The findings characterize Tipe1 as a regulator of β cell function through the Gαs/cAMP pathway, suggesting that Tipe1 may emerge as a novel target for T2D intervention.

Female community health volunteers' experience in navigating social context while providing basic diabetes services in western Nepal: Social capital and beyond from systems thinking.

The global burden of non-communicable diseases (NCDs) has led to an increased mobilization of community health workers (CHWs) in the prevention and management of NCDs, particularly in resource-poor settings. However, little is known about the experiences of CHWs as they navigate the complex social context while proving home-based NCD management. This study aims to explore the experiences of female community health volunteers (FCHVs) in a community-based pilot project in western Nepal, specially regarding the social challenges they face while delivering basic type 2 diabetes (T2D) services. Using a qualitative phenomenological approach, the study conducted two focus group discussions and nine in-depth interviews with a total of 14 and 9 FCHVs, respectively. Social Capital theory was employed to understand the sociological aspects. The findings shed light on the challenges encountered by FCHVs in expanding their social networks, building trust, and fostering reciprocity among T2D intervention recepients. Notably, social trust was a significant challenge, compounded by power dynamics related to gender and socioeconomic status. FCHVs managed to overcome these challenges through their perseverance, self-motivation, and leaveraging their strong bonding and linking social capital. The recognition they received from the community played a crucial role in sustaining their motivation. The study highlights the importance of FCHVs' strong social capital, supported by available resources and personal motivation, in overcoming social obstacles. It is imperative for community health interventions to anticipate challenges across various elements of social capital to ensure the long-term retention and motivation of CHWs. Establishing appropriate support systems that address personal motivating factors and the strengthen social capital is essential.

410-P: Two-Year (2y) eGFR Slope in People with Type 2 Diabetes (T2D) Receiving a Very Low Carbohydrate Diet (VLCD) Intervention

A VLCD including nutritional ketosis is an effective T2D intervention, but its use is cautioned in renal disease. We compared eGFR slope among people with T2D with varying renal function who received a VLCD intervention via continuous remote telemedicine care (CCI, n=262) or Usual Care without carbohydrate restriction (UC, n=87) over two years. Four ketosis trajectory classes (KTs) were identified within CCI using latent class trajectory modeling. We compared eGFR slopes for CCI KTs using a linear mixed effect model with UC as the reference. The eGFR slope was positive in all CCI KTs and negative in UC (Table 1). eGFR slope improved in CCI (p=0.045), in sustained nutritional ketosis (SNK) group (p=0.01), and in those with baseline eGFR <90 (p<0.001) compared with UC. KT with higher blood ketones (SNK and MDNK) had greater eGFR rise. These results show that eGFR slopes rose in people with T2D on CCI and declined in UC. Rise of eGFR slope appears to have a dose-dependent relationship with endogenous ketone concentration and duration of maintenance of ketosis, including those with stage 2 chronic kidney disease, suggesting nutritional ketosis VLCD may provide benefit rather than risk in early renal disease. Disclosure S.J.Athinarayanan: Employee; Virta Health Corp. C.G.P.Roberts: Employee; Virta Health Corp. R.N.Adams: Employee; Virta Health Corp. B.M.Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.D.Phinney: Board Member; Virta Health Corp., Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. J.Volek: Stock/Shareholder; Virta Health Corp. A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp.

Exploring engagement with a web-based dietary intervention for adults with type 2 diabetes: A mixed methods evaluation of the T2Diet study.

Improved understanding of participant engagement in web-based dietary interventions is needed. Engagement is a complex construct that may be best explored through mixed methods to gain comprehensive insight. To our knowledge, no web-based dietary intervention in people with type 2 diabetes (T2D) has previously used a mixed methods approach. The aim of this study was to explore factors that may contribute to effective engagement in a web-based dietary program for people with T2D. This study employed a mixed methods intervention design, with a convergent design embedded for post-intervention evaluation. The convergent design collected and analyzed quantitative and qualitative data independent of each other, with the two datasets merged/compared during results/interpretation. Quantitative data collected from intervention group participants (n = 40) were self-administered questionnaires and usage data with average values summarized. Qualitative data were participant semi-structured interviews (n = 15) incorporating a deductive-inductive thematic analysis approach. The results from the quantitative and qualitative data indicated positive overall engagement with the web-based dietary program. Factors that contributed to effective engagement were sustained frequency and intensity of engagement; structured weekly program delivery; participants affective engagement prior to and during the intervention, with positive affective states enhancing cognitive and behavioral engagement; and participants experience of value and reward. In addition, the user-centered development process employed prior to intervention delivery played an important role in facilitating positive engagement outcomes. This study yielded novel findings by integrating qualitative and quantitative data to explore engagement with a web-based dietary program involving people with T2D. Effective engagement occurred in this intervention through a combination of factors related to usage and participants' affective, cognitive and behavioral states. The engagement outcomes that emerged will be useful to current and future researchers using digital technologies to deliver lifestyle interventions for T2D or other chronic health conditions.

Type 2 Diabetes Self-Management Interventions Among Asian Americans in the United States: A Scoping Review.

Introduction:Type 2 diabetes (T2D) is one of the leading causes of death among Asian Americans. Despite being a culturally diverse racial group with differences in history, language, religion, and values, Asian Americans are often viewed as a monolith. With the high prevalence rate of T2D, a careful examination of self-management interventions across Asian Americans is needed to develop effective and culturally sensitive interventions.Objective:To describe existing literature by examining study characteristics, different intervention components, and outcome measures of various T2D interventions among Asian Americans.Methods:Using Arksey and O'Malley's framework to ground this review, six online databases were used to identify studies.Results:A total of 18 publications were included. Thirteen studies were published after 2013, with 44% and 22% of these studies focused on Chinese Americans and Korean Americans. We found a lack of geographic diversity in the location of the studies. Majority of the participants were females. Most of the interventions were implemented in person. Licensed health care providers were the most common interventionists, with a number of studies using community health workers. Outcome measures focused on three key areas: physiological, psychosocial and behavioral, and program-related outcomes. Many of the studies measured changes in HbA1C, self-efficacy, distress, depression, and quality of life. Overall, we saw improvements in physiological measures in most of the studies. For example, majority of the studies showed a decline in the participants' HbA1C. Most studies showed an increase or improvement in healthy behaviors. Studies that measured efficacy, knowledge, attitude, motivation, quality of life, or general health showed improvement from baseline. All the studies that measured distress or depression showed a reduction of symptoms postintervention.Conclusion:Overall, we found that culturally tailored interventions that focus on specific Asian American subpopulations saw an improvement in physiological, psychosocial, or behavioral measures. There were several gaps in the existing T2D self-management programs or interventions among Asian Americans studied in the United States. Based on our analysis, we recommend when designing or implementing self-management interventions among Asian Americans, considerations should be made for targeted recruitment for understudied Asian American subgroups, gender, and location.

Cocoa extract exerts sex-specific anti-diabetic effects in an aggressive type-2 diabetes model: A pilot study

Type 2 diabetes (T2D) is characterized by hyperglycemia and insulin resistance. Cocoa may slow T2D development and progression. This study employed male and female BTBR.Cg-Lepob/ob/WiscJ (ob/ob) and wild type (WT) controls to assess the potential for cocoa to ameliorate progressive T2D and compare responses between sexes. Mice received diet without (WT, ob/ob) or with cocoa extract (ob/ob + c) for 10 weeks. Acute cocoa reduced fasting hyperglycemia in females, but not males, after 2 weeks. Chronic cocoa supplementation (6–10 weeks) ameliorated hyperinsulinemia in males and worsened hyperlipidemia and hyperinsulinemia in females, yet also preserved and enhanced beta cell survival in females. The underlying mechanisms of these differences warrant further study. If sex differences are apparent in subsequent preclinical studies, clinical studies will be warranted to establish whether these differences are relevant in humans. Sex differences may need to be considered when designing human dietary interventions for T2D.

132-LB: Effectiveness of Interventions to Improve Cardiovascular Risk Factors in U.S. Asian Persons with Type 2 Diabetes—A Systematic Review and Meta-analysis

Objective: Asian persons have an increased risk of type 2 diabetes (T2D) compared to non-Hispanic white persons, with approximately two in five individuals being diagnosed. The prevalence of T2D among this population has grown in recent years as Asian persons are the fastest growing racial/ethnic group in the US. We conducted a meta-analysis of US randomized controlled trials (RCTs) to evaluate the effectiveness of T2D interventions at improving systolic blood pressure (SBP) , diastolic blood pressure (DBP) , and HbA1c among this population. Methods: An electronic search of literature in PubMed, Scopus, CINAHL, PsycINFO, and Medline was conducted from 1985 to 2019 for studies evaluating T2D interventions among predominantly minority populations. This analysis was limited to RCTs with an average >6% of total participants identifying as Asian, utilizing the 2020 US Census as standard. Interventions focusing on the efficacy of a drug, device, diet, surgery, or procedure were excluded. A random effects meta-analysis was performed to calculate the pooled effect size of the various outcomes. Results: Of the articles reviewed, 9 met inclusion criteria. All 9 included HbA1c and 5 included SBP/DBP. Participants were 62.8% Asian and 40.3% female with a mean age of 53.4 years. Interventions included diabetes education programs, utilization of community health workers, bilingual counseling, and cognitive therapy. There was a 0.36% decrease in HbA1c in the experimental group when compared to the control group (95% CI -0.48 to -0.25, p=0.80, I2=0%) . Compared to control, these interventions had minimal effects on SBP (-0.08, 95% CI -0.22 to 0.07, p=0.73, I2=0%) and DBP (0.01, 95% CI -0.22 to 0.25, p=0.23, I2=29%) . Conclusion: This meta-analysis found that RCTs for T2D in Asian persons modestly lowered HbA1c, with minimal impact on SBP/DBP. Future analysis should include observational studies to evaluate a larger sample and investigate their impact on other markers of health, as well as characterize these effects by level of intervention to inform health policy. Disclosure J. Xiao: None. J. Yu: None. A. Deckard: None. W. Wan: n/a. E. M. Staab: None. A. W. Rodriguez: None. R. Shetty: None. N. Laiteerapong: None.

910-P: Effectiveness of Randomized Controlled Trials to Improve A1C in Hispanic Populations with Type 2 Diabetes: A Systematic Review and Meta-analysis

Objective: In the US, Hispanic persons have a higher rate of Type 2 diabetes (T2D) than the national average, as well as experience more diabetes-related complications than non-Hispanic whites (NHWs) . This increased prevalence can be attributed to social and biological factors, like access to care and increased predisposition to pre-diabetic conditions. Currently, limited evidence exists for the effectiveness of randomized controlled trials (RCTs) at improving A1C levels in this population with T2D. Methods: A systematic search focused on T2D interventions published from 1985 to 20was conducted using PubMed, Scopus, PsycInfo, and CINAHL. Search terms were structured around five broad concepts: diabetes, study design, language, race/ethnicity, and disparities. We focused on non-pharmacologic interventions, and included RCTs with ≥18.5% Hispanic persons, utilizing the 2020 US Census as standard. A random effects meta-analysis was performed to calculate the pooled effect size to provide summary estimates. Results: Of the 111,289 articles reviewed, 28 trials met inclusion criteria. Participants were 90% Hispanic and 70% female with a mean age of 55.8 years. Most interventions used cultural tailoring, lifestyle and behavioral changes, or telehealth support and included bilingual nurses, Spanish educational materials, or community health workers. Compared to control, these interventions were associated with a 0.19% (95% confidence interval: -0.39% to 0.01%; p<0.01) reduction in A1c. Conclusion: This meta-analysis examined non-pharmacologic interventions in Hispanic persons with T2D and found that they reduced A1c to a small degree. This finding is important for future T2D interventions tailoring to this population, as well as future health policy. Future analyses will examine which type of interventions (i.e. individual, community, societal, or multi-level) are most successful at reducing A1c among Hispanic persons. Disclosure S.Uranga: None. L.Bianco: None. A.Deckard: None. W.Wan: n/a. J.Alexander: None. E.M.Staab: None. A.W.Rodriguez: None. R.Shetty: None. N.Laiteerapong: None.

924-P: Effectiveness of Interventions to Improve Hemoglobin A1c among Black Persons with Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Controlled Trials

Background: The prevalence of Type 2 diabetes (T2D) is high among non-Hispanic Black persons. This population also has a high rate of poorly controlled T2D and a high burden of T2D related complications. To address this, various interventions have been studied to improve glycemic control. We performed a meta-analysis of published interventions on Black persons with T2D and their effects on HbA1c outcomes. Methods: An electronic search of literature in PubMed, Scopus, CINAHL, PsycINFO, and Medline was conducted from 1985 to 20for studies evaluating T2D interventions among predominantly minority populations. This analysis was limited to non-pharmacologic randomized controlled trials (RCTs) and studies that had an average ≥12.5% of total participants identifying as Black, utilizing the 2020 US Census as standard. Interventions were aimed at improving outcomes including blood pressure, weight, and lipids. For this analysis, we focused on the outcome HbA1c and its differences between experimental and control groups. A random effects meta-analysis was performed to calculate the pooled effect size of the various outcomes. Results: For this analysis, 35 RCTs were included (n=6467) . The participants were 61% Black and 65% female with a mean age of 56 years. Interventions included interdisciplinary T2D management, telehealth-based support, lifestyle focused programs, and peer support programs. There was a statistically significant reduction in HbA1c in the experimental group when compared to the control group (-0.17, 95% CI -0.28 to -0.06, p<0.01, I2=70%) . Conclusion: This meta-analysis found non-pharmacologic interventions were effective in reducing HbA1c among Black persons to a small degree. Future research is needed to estimate the effects of the level of intervention (i.e. individual, community, societal, or multi-level) in reducing HbA1c among this population to inform future public health programming and policy. Disclosure F.Osman: None. C.Jiang: None. A.Deckard: None. W.Wan: n/a. J.Alexander: None. E.M.Staab: None. A.W.Rodriguez: None. R.Shetty: None. N.Laiteerapong: None.

1491-PUB: Demographic and Psychosocial Predictors of Diabetes Risk and Glycemic Control in Hispanic/Latino Adults

In the U.S., Hispanic/Latino adults face a disproportionate burden of type 2 diabetes (T2D) , in part due to biological factors, including poor glucose control, and diagnosis delays. Beyond biology, social and environmental factors account for majority of risk for T2D progression. In this study, demographic and psychosocial predictors of T2D diagnosis and glycemic control were evaluated among Hispanic/Latino adults with T2D (Morales et al., in BMC Endocrine Disorders, 2020) . T2D was reported by 83% of participants (N=187; 90% Mexican-origin) . Of those with T2D, 69% were female (vs. 47% without T2D) , average age was 58.8±10.2 years (vs. 52.7±12.1 years without T2D) , and 60% had HbA1c > 7%. Females with T2D had a weight of 165.4±31.9; males 172.3±26.3 lbs. (vs. 164.3±36.4 for females and 180.5±30.5 lbs. for males without T2D) . A categorical classification algorithm (Rokach & Maimon, Data Mining and Knowledge Discovery Handbook, 2010) identified T2D diagnosis as most strongly predicted by older age, lower weight, and greater perceived stress (Figure 1A) . Poor glycemic control was most strongly predicted by faith/spirituality, trust in physician, and depression symptomatology (Figure 1B) . T2D interventions for Hispanic/Latino adults should consider how demographic and psychosocial determinants differentially impact and perhaps even predict T2D risk, diagnosis, and glycemic control outcomes. Disclosure S.A. Fields: None. N.M. Glantz: Research Support; Abbott. D. Kerr: Advisory Panel; Abbott Diabetes, Novo Nordisk A/S, Sanofi. Consultant; Evidation Health. Research Support; Novo Nordisk A/S. Stock/Shareholder; Glooko, Inc., Hi.Health.

171-OR: Effect of Interventions on Blood Pressure for Black Persons with Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Controlled Trials

Background: Uncontrolled blood pressure (BP) is a major cardiovascular disease (CVD) risk factor, and CVD is the leading cause of death among non-Hispanic Black persons with type 2 diabetes (T2D) . While many interventions have been designed to improve BP control in this population, disparities persist. A meta-analysis of randomized controlled trials was conducted to evaluate the effectiveness of T2D interventions at improving BP. Methods: An electronic search of Medline, PubMed, Scopus, CINAHL, and PsychINFO was conducted from 1985 to 2019. Keywords included those related to diabetes, study design and race/ethnicity. We included non-pharmacologic trials with ≥12.5% Black persons (using the 2020 US Census as a standard) . Interventions were aimed at improving outcomes including HbA1c, BP, weight and lipids. For this analysis, we focused on the outcomes mean systolic (SBP) and diastolic blood pressure (DBP) differences between control and experimental groups. A random effects meta-analysis was performed to calculate the pooled effect size to provide summary estimates. Results: Sixteen trials (n=2314) reported SBP and DBP outcomes; two additional trials (total n=2919) reported only SBP outcomes. The participants were 59% Black and 71% female with a mean age of 55.9 years. Average baseline BP was similar for the control and intervention groups (134/78 and 134/77, respectively) . Interventions included self-management education, telehealth support, lifestyle programs, and pharmacist-led support. Compared to control, these interventions demonstrated no difference in SBP (0.01, 95% CI -0.to 0.mmHg, p=0.55, I2=0%) or DBP (-0.05, 95% CI -0.15 to 0.mmHg, p=0.20, I2=22%) . Conclusion: In this meta-analysis of trials aimed to improve outcomes in Black patients with T2D, there was no improvement in BP control. Given the high risk of CVD in this population, more effective interventions are needed to improve BP control in Black persons with T2D. Disclosure C.Jiang: None. F.Osman: None. A.Deckard: None. W.Wan: n/a. J.Alexander: None. R.Shetty: None. E.M.Staab: None. N.Laiteerapong: None.

PDB33 Using the PRIME Type 2 Diabetes Model to Compare Models of Renal Failure

Rates of renal failure are substantially higher in patients with type 2 diabetes (T2D) than the general population. Given the considerable cost and quality of life implications associated with renal replacement therapies, accurate modeling of renal failure is critical in the evaluation of the cost-effectiveness of novel T2D interventions. The aim of the present study was to compare renal failure projections from the widely-used United Kingdom Prospective Diabetes Outcomes Model 2 (UKPDS OM2) and a novel estimated glomerular filtration rate (eGFR) threshold-based model.

A systematic review of adherence to physical activity interventions in individuals with type 2 diabetes.

Lifestyle interventions are pivotal for successful management of type 2 diabetes (T2D), however, the proportion of people with T2D adhering to physical activity advice has not been thoroughly studied. The purpose of this systematic review was to summarise the evidence on adherence to exercise or physical activity components in lifestyle interventions in those with T2D. We searched MEDLINE EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus on 12 November 2019. Eligible studies enrolled adults with T2D and reported the proportion of adherence to lifestyle interventions as a primary or secondary outcome. We included 11 studies (nine randomised controlled trials (RCTs) enrolling 1717 patients and two nonrandomised studies enrolling 62 patients). Only one of the studies had low risk of bias. The proportion of participants adhering to physical activity varied from 32% to 100% with a median of 58%. Adherence was higher in interventions using supervised training and lowest in interventions using remote coaching and the adherence rate in observational studies was higher compared to RCTs (92% vs. 55%; p<0.01). Study duration, risk of bias, or participants' sex, were not associated with adherence to physical activity. The proportion of those with T2D adhering to physical activity interventions for T2D varies widely and most of the included studies had a high risk of bias. These findings have important implications for planning and power analysis of future trials and when counselling patients about lifestyle interventions including physical activity or exercise components.

Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies.

The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients’ self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients’ T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. A systematic search of the literature retrieved 19 articles, including 536 participants. These were reviewed using established CIS procedures. Analysis identified seven constructs, from which an overarching synthesizing argument ‘Cultural Conflict’ was derived. Our findings suggest that patients reconstruct knowledge to manage their psychological, behavioural, and cultural conflicts, impacting decisional conflicts associated with T2D self-management and health professional advice (un)consciously. Those unable to resolve this conflict were more likely to default towards cultural identity, continue to align with cultural preferences rather than health professional guidance, and reduce engagement with self-management. Our synthesis and supporting model promote novel ideas for self-management of T2D care for SA patients. Specifically, health professionals should be trained and supported to explore and mitigate negative health beliefs to enable patients to manage social-cultural influences that impact their self-management behaviours.

Type 2 Diabetes Family History and Engagement in Protective Nutrition Behaviors: A Cross-Sectional Study of College Students

The objective of this study was to determine whether having a Type 2 diabetes (T2D) family history is significantly associated with protective nutrition behaviors. Data were collected via web-based survey from undergraduate students (18 or older, n=905). Fruits and vegetables consumption and use of posted caloric information were outcome variables and demographic and family history statuses were predictor variables. Poisson and linear regression analyses were used to model all results. Participants with a positive T2D family history were (48.8%; n=441) and those without were (51.2%; n=462). After adjusting for demographic characteristics, there was no statistically significant relationship between T2D family history status and fruit consumption behavior (β =0.036, p=0.280) or vegetable consumption (β = 0.047, p=0.157). However, college students who have a family history of T2D were more conscious about calorie information when ordering/buying food (RR = 0.873, p&lt;0.05). Health educators are tasked to include family history status as a component of T2D intervention procedures as this group is at higher risk for developing T2D.

Different β-cell secretory phenotype in non-obese compared to obese early type 2 diabetes.

Type 2 diabetes (T2D) is characterized by impaired tissue sensitivity to insulin action (ie, insulin resistance) and impaired β-cell insulin secretion. Because obesity contributes importantly to the development of insulin resistance, we sought to determine whether insulin secretory defects would predominate in non-obese compared to obese T2D. We measured β-cell function and secretory capacity using the glucose-potentiated arginine test in T2D subjects early in the disease course classified as non-obese (BMI <30; n = 12) or obese (BMI ≥30 kg/m2 ; n = 28) and additionally compared responses from non-obese T2D with a non-diabetic control group (n = 12). The acute insulin response to glucose potentiation of arginine-induced insulin release was less in non-obese T2D than in controls and associated with impaired β-cell sensitivity to glucose (PG50 ). Proinsulin secretory ratios were increased in non-obese T2D when compared to obese T2D. Obese T2D subjects had reduced insulin sensitivity (M/I) while non-obese T2D subjects had insulin sensitivity that was comparable to controls. In non-obese T2D, insulin secretory defects predominate with impaired β-cell sensitivity to glucose and proinsulin processing in the absence of insulin resistance. Future studies should consider whether different β-cell secretory phenotypes and tissue sensitivity to insulin explain the varying responsiveness to T2D interventions.

Epigenetics and Type 2 Diabetes Risk.

The influence of environmental factors on type 2 diabetes (T2D) risk is now well recognized and highlights the contribution of epigenetic mechanisms. This review will focus on the role of epigenetic factors in the risk and pathogenesis of T2D. Epigenetic dysregulation has emerged as a key mechanism underpinning the pathogenesis of T2D and its complications. Environmental variations, including alterations in lifestyle, nutrition, and metabolic demands during prenatal and postnatal life can induce epigenetic changes that may impact glucose homeostasis and the function of different metabolic organs. Accumulating data continues to uncover the specific pathways that are epigenetically dysregulated in T2D, providing an opportunity for therapeutic targeting. Environmental changes can disrupt specific epigenetic mechanisms underlying metabolic homeostasis, thus contributing to T2D pathogenesis. Such epigenetic changes can be transmitted to the next generation, contributing to the inheritance of T2D risk. Recent advances in epigenome-wide association studies and epigenetic editing tools present the attractive possibility of identifying epimutations associated with T2D, correcting specific epigenetic alterations, and designing novel epigenetic biomarkers and interventions for T2D.

Knowledge and perceptions of type 2 diabetes among Ghanaian migrants in three European countries and Ghanaians in rural and urban Ghana: The RODAM qualitative study.

African migrants in Europe and continental Africans are disproportionately affected by type 2 diabetes (T2D). Both groups develop T2D at a younger age, and have higher morbidity and mortality from T2D and complications, compared to European populations. To reduce risk, and avoidable disability and premature deaths, culturally congruent and context specific interventions are required. This study aimed to: (a) assess perceptions and knowledge of T2D among Ghanaian migrants in Europe and their compatriots in Ghana and (b) identify specific perceptions and knowledge gaps that might predispose migrants to higher risk of diabetes. Data was gathered through 26 focus groups with 180 individuals, aged 21 to 70, from Amsterdam, Berlin and London and rural and urban Ashanti Region, Ghana. Thematic analysis of the data was informed by Social Representations Theory, which focuses on the sources, content and functions of social knowledge. Three key insights emerged from analysis. First, there was general awareness, across migrant and non-migrant groups, of T2D as a serious chronic condition with life threatening complications, and some knowledge of biomedical strategies to prevent diabetes (e.g healthy eating) and diabetes complications (e.g medication adherence). However, knowledge of T2D prevention and reduction of diabetes complications was not comprehensive. Secondly, knowledge of biomedical diabetes theories and interventions co-existed with theories about psychosocial and supernatural causes of diabetes and the efficacy of herbal and faith-based treatment of diabetes. Finally, migrants’ knowledge was informed by both Ghanaian and European systems of T2D knowledge suggesting enculturation dynamics. We discuss the development of culturally congruent and context-specific T2D interventions for the research communities.

Feasibility of a family-focused YMCA-based diabetes prevention program in youth: The E.P.I.C. Kids (Encourage, Practice, and Inspire Change) Study.

Efficacious lifestyle modification programs for children at risk of type 2 diabetes (T2D) have not been well established outside of clinical settings. In this study, the feasibility of a family-focused, YMCA-based prevention program for children at risk of T2D was evaluated between September 2015 and July 2016 in Tucson, Arizona. A 12-week YMCA-led lifestyle intervention was adapted for 9–12-year-old children and their families to encourage healthy eating, physical activity, and supportive home environments. Two YMCA locations were randomized to offer either a face-to-face lifestyle coach-led intervention or an alternating face-to-face and digitally-delivered intervention. Program feasibility and preliminary effects on child anthropometric and behavioral outcomes were assessed at baseline and post-intervention. Changes were assessed using linear regression combining delivery formats, with adjustment for clustering of participants within site/format. Forty-eight children (10.9 ± 1.2 years old; 45% female; 40% Hispanic; 43% White; 87% obese) and their parents enrolled, and 36 (75%) completed 12-week measures. Weekly program attendance averaged 61%. Participants and coaches highly rated program content and engagement strategies. Statistically significant changes in child BMI-z score (−0.05, p = 0.03) and family food and physical activity environment (+5.5% family nutrition and physical activity score, p = 0.01) were observed. A YMCA-led family-focused T2D intervention was feasible for the YMCA and participants and effects on child weight, behavior, and the home environment warranted further investigation.