Sunday, June 28, 2020

Physical Activity May be Used to Treat or Delay Parkinson's Disease

Parkinson’s disease [PD] is a degenerative neurological disorder affecting approximately one million Americans. According to the Mayo Clinic, “Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.” Further, according to the Clinic, "some research has shown that regular aerobic exercise might reduce the risk of Parkinson's disease.” Indeed, one study demonstrated that  physical activity may be used to treat or prevent Parkinson’s disease.

The study's purpose was to examine the effects of physical activity on PD, and to provide "theoretical guidance for the prevention and treatment of PD." For the analysis, the investigators interrogated four databases. The databases were PubMed, Springer, Elsevier, and Wiley database.

After categorizing risk factors and protective factors for PD, the investigators concluded that physical activities were among the protective factors. Those physical activities were "running, dancing, traditional Chinese martial arts, yoga, and weight training." Further, the investigators concluded that " Physical activity has a positive impact on the prevention and treatment of PD."

And according to WebMD, engaging in physical activity can be beneficial when it comes to PD. Physical activity can improve flexibility, balance, walking and hand strength. And physical activity can help with the control of tremors and uncontrolled movements.

Finally, one analysis concluded "that people living with Parkinson's disease can benefit from being physically active, especially when it comes to improving gait and balance, and reducing risks of falls."
And the investigators suggested that health providers should advise their patients with PD to engage in physical activity.

Indeed, physical activity should be a part of everyone's lifestyle. We know that physical activity, along with a healthy diet, and other healthy lifestyle activities, can improve the length and quality of all our lives. And improvement in PD is just another one of the specific ailments that physical activity might bring about.

Friday, June 26, 2020

Liraglutide as a Treatment for Overweight Individuals with and without Diabetes

Liraglutide was approved for type 2 diabetes treatment in 2010. And In 2014, liraglutide was approved for weight loss. Since most people with type 2 diabetes are also overweight or obese, it would seem that liraglutide would be a good candidate medication for treating those overweight or obese persons who don't have type 2 diabetes, and those overweight or obese persons who do have type 2 diabetes. One study has shown the efficacy of treating non-diabetic patients who are obese with liraglutide. And another study has shown the efficacy of treating type 2 diabetes patients who are overweight or obese with liraglutide.

To determine if liraglutide is a good medication for weight loss for persons who are obese, the investigators performed a meta-analysis to determine the efficacy and the safety of the drug for obese patients. In the analysis, five publications from such databases as EMBASE and Medline were studied. The investigators analyzed 4754 non-diabetic  obese patients by comparing the weight loss in a liraglutide group (2,996 participants) with the weight loss in a placebo group (1,758 particip0ants). The liraglutide group lost 5% more weight than the placebo group.

Therefore, the investigators concluded that "liraglutide [is] an effective and safe treatment for weight loss in...  obese, non-diabetic  individuals.”

Many individuals with type 2 diabetes are overweight. And some medications for treating diabetes, including insulin, can cause weight gain. So a study was done to determine if liraglutide can enable a patient to lose weight and also treat type 2 diabetes. The primary objective of the study was to determine if liraglutide (3.0 mg dose) was more effective in treating obese patients with type 2 diabetes than a placebo group.

The study was a randomized controlled study where the liraglutide 3.0 mg group consisted of 198 participants. The placebo group also consisted of 198 participants. All participants in the liraglutide group were subjected to intensive behavioral therapy (IBT).  And all study participants were being treated with basal insulin.

After 56 weeks, the investigators concluded that the liraglutide 3.0 mg group achieved a 5.8% average weight loss compared to 1.5% for the placebo group. The liraglutide 3.0 mg group also had “significantly greater reductions in mean HbA1c, mean daytime glucose values, and less need for insulin versus placebo…”

Based on the two studies above, it can be concluded that liraglutide is an effective medication for obese patients who are either diabetic or non-diabetic.

Monday, May 25, 2020

Weight Loss Through Diet and Exercise for Osteoarthritis

Weight loss through diet and exercise may be an effective treatment for osteoarthritis. Osteoarthritis can result from wear and tear on your joints. The wear and tear can be a consequence of a number of  conditions, including injuries, age or obesity. And weight loss, resulting from diet, exercise, and lifestyle changes, may improve osteoarthritis symptoms.

A past study concluded that "obese individuals have significantly more severe joint degeneration in the knees compared with normal weight or underweight individuals." Furthermore, the investigators indicated that "Weight loss can prevent onset of osteoarthritis, relieve symptoms, improve function and increase quality of life."

In another study, the importance of weight loss was further confirmed. In the study, where 380 overweight men and women were investigated in the ninety-six month analysis, the researchers determined that "cartilage degeneration was significantly lower among people who lost weight through diet and exercise or diet alone." It should be noted, however, that "weight loss through exercise alone showed no significant difference in cartilage degeneration..."

There is evidence that  obesity is a risk factor for  total knee replacement (TKR) caused by osteoarthritis. And in one study, investigators looked at the effects of intentional weight loss on total knee replacement caused by osteoarthritis. Using intensive lifestyle intervention (ILI) methods, the investigators concluded that engaging in "physical activity, dietary restrictions and behavior to lose weight may be "effective in preventing TKR prior to the development of knee pain."

So, weight loss and maintaining a healthy weight can be beneficial in the treatment of osteoarthritis. Healthcare providers should use this evidence based information in counseling sessions. The providers can advise patients that weight loss through diet, exercise and lifestyle changes can improve the symptoms of osteoarthritis. Knowing that there is action that patients, suffering from osteoarthritis, can take to relieve the symptoms of osteoarthritis can be very helpful to the patients. 

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Friday, May 15, 2020

Under Some Conditions, Prediabetes Can Predict Cognitive Decline

Prediabetes is a serious condition, affecting more than 84 million Americans. And many Americans are not even aware that they have the condition. Prediabetes puts one at high risk for type 2 diabetes, and the condition raises the risk for heart and kidney problems. And one study shows that prediabetes combined with other disorders, such as obesity, may predict cognitive decline.

Prediabetes or hyperglycemia may generally be defined as abnormally high blood glucose, but blood glucose not high enough to be called type 2 diabetes. The clinical tests for prediabetes are typically an A1c test, a fasting glucose test or an impaired glucose test. The investigators in the study mentioned above showed that prediabetes combined with central obesity may predict cognitive decline in those who are less than 87 years of age.

In the study, the investigators looked at 478 individuals who were 65 years of age and older. The investigators looked at markers for glycemia, such as glucose, A1c and insulin resistance. And the investigators looked at markers for obesity such as resistin , adiponectin, glucagon-like peptide-1, and inflammation. They then modeled the markers, while adjusting for age education, sex waist-hip ratio and other parameters. The investigators then used machine learning techniques to perform the analysis.

The investigators concluded that “in individuals younger than 88 years with central obesity, even modest degrees of hyperglycemia might independently predispose faster cognitive decline.”

So, while prediabetes puts one at high risk for type 2 diabetes, and can raise the risk for heart and kidney problems, the abnormally high glucose may also be a risk factor for increased cognitive decline in individuals who are younger than 88 years of age.

This is useful information. Providers, counseling patients between the ages of 65 and 88 years old, should work with patients who have prediabetes and central obesity to help the patients lower their glycemic numbers. The action may impede cognitive decline.

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Monday, April 27, 2020

Medicare's Diabetes Prevention Program Implementation Can be a Model

Some of the difficulties associated with implementing new practices in a healthcare organization are the problems related to meshing the practices with the existing organization's operations. In taking steps to minimize difficulties associated with implementing the CDC's evidence-based Diabetes Prevention Program services, Medicare has provided some guidance on how to overcome obstacles associated with integrating new healthcare services into existing healthcare services.

The CDC’s Diabetes Prevention Program (DPP) study was an evidence-based study. The results of the study were published in 2002. After additional research, following the DPP study, including Medicare’s own Medicare Diabetes Prevention Program test study, Medicare started reimbursing suppliers for diabetes prevention services. The Medicare DPP or MDPP is an adaptation of the original DPP study. The Medicare services can be delivered in healthcare, faith-based, community and other settings. 

To integrate evidence-based services into a healthcare organization, the organization must often look for ways to deliver the services without negatively affecting the desired outcomes. And that’s what Medicare did before deciding to reimburse for the DPP services offered to Medicare beneficiaries.

Medicare worked with YMCAs in eleven states to test the delivery of the DPP services in YMCA settings. The test program was  the CMS DPP Model test. The DPP services were delivered by non-licensed YMCA workers to Medicare beneficiaries in a group format. Delivery by non-licensed workers in a group format can be a cost saving way to deliver the program.

At the conclusion of the model test, Medicare determined that $278.00 could be saved per Medicare beneficiary per quarter with the implementation of the MDPP for Medicare beneficiaries in healthcare and community settings. Medicare expanded the test program, and started reimbursing for MDPP services in April of 2018.

The Medicare approach to the implementation of the MDPP is, perhaps, a model for how other healthcare services might be delivered using out-of-the-box methods. For example, Medicare is reimbursing for services delivered by non-licensed workers. This delivery approach can save money while providing desired outcomes. Maybe, other reimbursable healthcare services can be delivered using methods similar to those used in the MDPP.

Saturday, April 25, 2020

Obesity Impacts Productivity in the Workplace

Obesity is a pressing problem in the United States. Obesity is associated with a great number of comorbidities which negatively affect the health of many Americans. And obesity has a cost associated with it— both healthcare costs and workplace costs. The obesity-related healthcare costs result from the associated comorbidities that are diagnosed and treated. The obesity-related workplace costs result from low productivity in the workplace.

One review study, reported on in 2017, looked at 50 studies pertaining to the costs associated with obesity. The investigators indicated that absenteeism and presenteeism (where a worker is at work, but his or her productivity is low), contributed to increased costs.

And the investigators concluded that “the evidence [from the review] predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customized prevention programs and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.”

Another more recent study shows that absenteeism and disability associated with obesity lead to increased costs due to productivity loss. Indeed, the researchers concluded that for "men, BMI and waist circumference accounted for approximately 60% and approximately 30% of retirement [respectively,] due to disability." And for women, BMI and waist circumference accounted for "approximately 19% and approximately 8%," respectively, due to disability.

The researchers went on to conclude that “total and abdominal obesity were responsible for increased costs from productivity loss due to early retirement among adults 50 years old or older.”

So, many healthcare providers and those in the workplace may be aware of the productivity loss associated with obesity and overweight. And some employers are taking action to curb obesity within the organization by offering wellness programs. Let’s hope that healthcare providers and employers can work together to halt the obesity epidemic. Healthcare providers, employers and employees will benefit.

Saturday, March 28, 2020

Using Teleconferencing to Deliver the Diabetes Prevention Program

For health related programs that require intensive intervention, the intervention can be costly because there are many barriers to delivering the programs. One of these health-related programs is the CDC's National Diabetes Prevention Program or NDPP. It can be difficult for program participants to attend enough in-person sessions to meet their weight loss and other goals. Teleconferencing, which can be used for telehealth, can eliminate many of the barriers hindering attendance at in-person sessions. One study, called SHINE for “Support, Health Information, Nutrition and Exercise,” has shown that teleconferencing can be effective in delivering a version of the CDC’s NDPP for weight loss. It should be noted that in this article, teleconferencing is performed via the telephone.

The NDPP program is a year-long program, consisting of a set of 16 weekly core sessions during the first six months, and a set of core maintenance sessions during the last six months. The NDPP is based on the Diabetes Prevention Program (DPP) study carried out between 1996 and 2001.  In the above mentioned SHINE study, the sessions lasted two years rather than one year. The 16 session curriculum, taken from the original CDC DPP study, was used during the first year of the SHINE study, and a modified version of the curriculum was used for the second year of the SHINE sessions.

Unlike the original DPP study, where the primary outcome was type 2 diabetes, the primary outcome of the SHINE study was weight loss.  For the study, the participants were randomized to two groups – an individual call (IC) group, and a conference call (CC) group. Individuals in the IC-groups received individual telephone calls from a counselor, and individuals in the CC-group received calls from the counselor in a teleconference.

After randomization of subjects to one of the two groups, the IC-group consisted of 129 participants and the CC-group consisted of 128 participants. Measurements, including weight, were taken at baseline, six months, 12 months and 24 months. And the average weight loss for CC-group  was more at the 6, 12 and 24 month assessments than  the average weight loss for the IC-group.  At 6 months, the CC-group average weight loss was 4.0 %  compared to 3.9% for the IC group. At 12 months, the CC-group average weight loss was 4.5% compared to 4.2% for the IC-group. And at the two year period, the CC-group average weight loss was 5.6% compared to 1.8% for the IC-group.

So using teleconferencing is a viable option for weight loss. And a version of the CDC's DPP program curriculum, including the NDPP, can be used to deliver the weight loss program. Those wanting to deliver a version of the DPP should consider using teleconferencing to deliver the program to improve attendance and weight loss.

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