Tuesday, December 29, 2020

Prediabetes and Cardiac Autonomic Neuropathy

Prediabetes is a condition where an individual has abnormally high blood glucose, while not high enough to be diagnosed as diabetes. Prediabetes can cause heart and kidney problems. Cardiac autonomic neuropathy (CAN) may be defined as “the impairment of autonomic control of the cardiovascular system.” While the condition is frequently not given much focus, CAN is frequently associated with type 1 and type 2 diabetes. CAN may also be associated with heart problems and mortality. Further, at least one recent study has concluded that CAN is also associated with prediabetes.

The investigators involved in the study did a search, electronically, to find individuals, in other studies, with prediabetes, normal glucose and type 2 diabetes. The researchers searched the following databases: Medline, MBASE, Pubmed, Web of science, Scopus and Cochrane.

As a result of the database search, the researchers found 4431 participants who satisfied the analysis’ inclusion criteria. The participants included 1730 individuals with prediabetes. There were 1999 individuals who had normal glucose. And there were 702 individuals with type 2 diabetes. And there was a higher than normal number of individuals experiencing CAN.

Further, the researcher concluded that “There [was] a higher than expected prevalence of CAN in prediabetes. Early detection of CAN in prediabetes through population screening needs careful consideration in view of the excess morbidity and mortality risk associated with this condition.”

The above study underlines the importance of diagnosing prediabetes. And once prediabetes is diagnosed, screening for other known prediabetes comorbidities should then occur -- including screening for CAN. Providers should make it a point to screen for prediabetes. The providers should counsel patients who do have predicates on how to lower the chances of getting type 2 diabetes. The providers should then advise the patients on other prediabetes-associated conditions. This can benefit a patient by potentially improving the patient’s health.

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Tags: , , , , bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis 

Friday, December 25, 2020

Obesity Plays a Role in COVID-19

Obesity is a disease that affects millions of people worldwide. The disease is known to be associated with certain types of cancer, including breast and colon cancer. And the disease is known to be associated with diabetes and heart disease. With respect to COVID-19, researchers have concluded that obesity plays a role in the virus. Obesity can be associated with mortality in those with COVID-19. Further, overweight/obesity can be a factor in COVID-19 related pneumonia.

One study, in the form of a meta-analysis, indicated that those suffering from COVID-19 have poor outcomes when they are obese. The researchers did a scientific literature search for COVID-19 related studies. Included in the database search were the following databases: Pubmed, EMBASE, Google, Google scholar, Springer, Elsevier, the Lancet, and Oxford journals. The researchers used keywords and phrases such as COVID-19 and "obesity mortality during COVID-19." After excluding studies that didn’t satisfy their inclusion criteria, the researchers chose 14 studies for the analysis. “The primary objective of [the] study was to find out the effect of overweight or obesity on patients suffering from COVID-19.”

The researchers concluded that “patients with obesity are at high risk of mortality from COVID-19 infection.” Further, the results of the study indicated that age and gender are “significantly associated with COVID-19 mortality.”

Another study, performed in Germany, looked at the Association between COVID-19 and pneumonia and overweight/obese subjects. The researcher used survey results for the analysis. The researchers focused on people with a history of COVID-19 who were 18 years or older. All participants in the study had to be diagnosed using PCR (polymerase chain reaction) or a retrospective antibody test. There were 220 participants in the survey, and 204 of the participants had experienced COVID-19.

And the researchers concluded that there is “an association of overweight/obesity with signs of pneumonia in COVID-19.” The researchers went on to say that the possible association between overweight/obesity, COVID-19 and pneumonia “should be investigated further to possibly reduce the proportion of severe cases of COVID-19.”

The above studies show that obesity is negatively associated with COVID-19, just as obesity is negatively associated with cancer, diabetes, heart disease and other conditions. Treating obesity and overweight should be a part of a patient's overall treatment protocol.

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Tags: , , , , bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis

Friday, November 27, 2020

Elements of the Original Diabetes Prevention Program Study are Used in Other Diabetes Prevention Studies

The CDC’s National Diabetes Prevention Program (National DPP) is considered, by some, to be the “gold standard” for behavioral lifestyle intervention. The program is based on the landmark Diabetes Prevention Program study that was led by the NIH during 1996 to 2001. 

The study created an intensive lifestyle intervention (ILI) method that successfully lowered the risk of type 2 diabetes by 58%. The ILI approach consisted of 16 weekly sessions during the first six months of the study, followed by monthly contacts for the remainder of the study. There were in-person contact sessions at least every two months. The study was the basis for the CDC’s National DPP. And elements similar to those used in the original DPP intervention have been employed in other diabetes prevention studies.

One such recent study compared two weight-maintenance diets to determine which diet would cause a decrease in type 2 diabetes cases. The study lasted three years, and the study used an approach similar to the National DPP, consisting of an initial phase and a follow-on phase. The initial phase involved eight weeks of weight reduction, while the follow-on phase was a three year maintenance period. There were 2326 adult participants in the study. All of the participants had a BMI that was greater than or equal to 25. The primary outcome was type 2 diabetes.

The researchers concluded that the diets were not significant in reducing the risk of type 2 diabetes. However, “the overall protocol combining weight loss, healthy eating, and physical activity was successful in markedly reducing the risk of T2D.” The results showed that the type 2 diabetes "incidence in both [diet] groups was less than one third of predicted incidence."

Just as the original DPP study demonstrated, the above study indicated that establishing an initial phase focusing on a weight loss approach that includes diet and physical activity, followed by a maintenance phase, can lower the risk of type 2 diabetes.

Providers should adopt appropriate elements of the DPP program when treating patients who are at high risk for type 2 diabetes. Further, providers should consider including DPP techniques in treatment protocols for other chronic diseases. The DPP intensive lifestyle intervention is patient-centered, evidence-based, and can, in many cases, be less costly than other approaches to chronic disease treatments.

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Tags: , , , , bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis

Sunday, November 22, 2020

Plant Protein vs Animal Protein

We all know that protein is important to our health. We know that protein is helpful in repairing tissue, and protein enables us to build muscle and bones. Protein also helps us to build skin and nails. And eating protein can enable us to lose weight, because protein makes us feel full longer, causing us to eat less food. However, here are some questions often asked about protein: does protein lower the risk of mortality? And which is best, plant protein or animal protein? At least two studies have been done to address these questions.

One of the studies was a meta-analysis where the analysts reviewed 32 papers. After the analysis, the investigators suggested that protein can lower the risk of mortality. Further, plant protein can help us live longer. Specifically, the investigators concluded that “Higher intake of total protein was associated with a lower risk of all cause mortality, and intake of plant protein was associated with a lower risk of all cause and cardiovascular disease mortality.” The investigators went on to say that “replacement of foods high in animal protein with plant protein sources could be associated with longevity.”

And in another study, consisting of 70,696 Japanese adults, the researchers concluded that “higher plant intake was associated with lower total and CVD related mortality. Furthermore, “replacement of red meat protein with plant protein was associated with lower total cancer related and CVD related mortality."

So, in general, protein can lower mortality. Therefore, eating protein is something that should be encouraged. But plant protein may be superior to animal protein, since plant protein may surpass animal protein in health benefits.

Thus, healthcare providers ought to take note. The providers should advise patients on plant protein benefits, and recommend a plant based diet to their patients. Of course this means that providers might want to take the time to gain knowledge of plant diets so that the providers will understand what plants are good protein sources. The knowledge will put providers in the best position to help patients.

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Friday, October 30, 2020

Intensive Lifestyle Intervention May Lower Cancer Risk

Overweight and obesity have been shown to be associated with certain types of cancers. These cancers include breast cancer, colon cancer and other cancers. One may wonder if living a healthier lifestyle can lower the risk of obesity related or overweight related cancers. So some investigators, using results from the Look AHEAD (Action for Health in Diabetes) study, attempted to determine if intentional weight loss could reduce the risk of cancer.  And the researchers concluded that it could.

The Look AHEAD study consisted of 16 U.S. study centers. The study was a randomized controlled trial that used an intensive lifestyle intervention (ILI) method similar to that used in the Diabetes Prevention Program (DPP) study. The Look AHEAD study was done to determine if intentional weight loss could reduce “cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes.” The study consisted of 5,145 participants and it was scheduled to conclude in 2012.

While the prevention of cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes was the primary focus of the study, cancer was one of the outcomes that the investigators wanted to look at. Therefore, cancer incidence was given attention. “Cancer incidence was defined as the first reported occurrence of a malignant tumor other than nonmelanoma skin cancer.” The investigators looked at medical records, death certificates, hospital records and emergency department records to determine cancer incidence in Look AHEAD participants.

The investigators concluded the following: “An ILI aimed at weight loss lowered incidence of obesity‐related cancers by 16% in adults with overweight or obesity and type 2 diabetes. Although the result was not statistically significant, this finding provided evidence that patients with obesity can reduce their cancer risk through weight loss.”

Stressing the importance of weight loss for people with obesity can lower the risk for cancer. And making weight loss recommendation to obese patients is something that healthcare providers should do.

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Tags: , , , , bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis

Thursday, October 15, 2020

White Coat Adherence and Glucose Control

 Upcoming visits to a healthcare provider can cause a person to respond in different ways. The response can be involuntary or on purpose. Many patients’ blood pressure will rise or decline as a result of contact with a healthcare provider. This rise or fall in blood pressure is called the white coat syndrome. The change in blood pressure is involuntary. On the other hand, patients may purposely increase their adherence to their healthcare providers’ instructions just before the healthcare visit. This adherence is called white coat adherence (WCA). And WCA can lead to errors in treatment, including diabetes treatment.

WCA may be defined as “an increased adherence to treatment regimens directly before a visit with a healthcare provider.” And when WCA is present while treating diabetes, the situation can negatively affect the diabetes treatment. So, a study was done to determine how to lessen the possibility of a misinterpretation of Glucose Control  Monitoring data that might be caused by WCA.

It is known that up to 50% of patients who have chronic conditions will increase the adherence to medical guidelines just before and just after a healthcare provider visit. Patients will be more likely to take prescribed medications as directed and to follow treatment guidelines as directed two to three days before the visit and two to three days after the visit.

The above-mentioned study was an observational study, consisting of 276 patients. The investigators looked at patients between January 2013 and July 2018 who were using continuous or intermittent scanning glucose monitoring (rtCGM or iscCGM). And the investigators looked at CGM-data over various periods of time before and after a healthcare visit.

The investigators concluded that the WCA effect was especially present during the three days before a healthcare visit. And that a more accurate assessment of the patient’s diabetic condition can be made by looking at GCM-data two weeks before the scheduled healthcare meeting. Specifically, the investigators indicated that “based on [their] findings, analysis of CGM data, particularly in adult patients non-optimal diabetes control, should encompass a period of adequate length (i.e. a minimum of one-two weeks) before consultation to avoid misinterpretation due to WCA.”

The study just confirms the existence of WCA in diabetes treatment. But more than that, it offers guidance that can be put in place to minimize the associated misinterpretations of the CGM results.

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Tags: , , , , bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis

Thursday, September 24, 2020

Increased Waist Circumference with Weight Loss Can Raise CVD Risks

The Diabetes Prevention Program (DPP) trials is a landmark study that proved that intensive lifestyle intervention (ILI) can delay or prevent type 2 diabetes. Because of the success of the DPP trials, another study called the Look AHEAD  study was carried out. The purpose of the Look AHEAD study was to determine if ILI could reduce "cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes.” A secondary analysis of the study was also done to determine the relationship between cardiovascular disease (CVD), waist circumference (WC) and weight loss.

The Look AHEAD failed to conclusively show that ILI could reduce cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes, however, the study was a useful study. In the secondary analysis, the investigators concluded that even with weight loss, an increase in waist circumstance can cause an increase in CVD risk.

The analysis consisted of 5,490 participants, where four groups were formed. One group consisted of participants that had lost weight and reduced WC, another group that had gained weight and increased WC, a group that had gained weight and reduced WC and a group that had lost weight and increased WC. All changes happened within one year of baseline.

The researchers performing the secondary analysis concluded that "increased WC during the first year of ILI, independent of weight change, was associated with higher risk for subsequent cardiovascular outcomes."

Still, it should be noted that, in general, weight loss via ILI is associated with a lowering of the risk of negative cardiovascular outcomes. Further, in one Look AHEAD follow-on study that used machine-learning methods to analyze the Look AHEAD data, the investigators concluded that 85% of the Look AHEAD subjects did, in fact, experience a significant reduction in cardiovascular events as a result of weight loss.

It is possible to have an increase in CVD risk with weight loss, if there is a rise in WC. And while providers should be aware of the possibility of increased CVD risk with a rise in WC, employing ILI for weight loss is still a prudent approach to possibly lower CVD risks.

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