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.

Thursday, March 19, 2020

A Low-Carbohydrate Diet in Conjunction with Alternate Day Fasting May be Feasible

Intermittent fasting, an eating pattern technique where an individual follows a zero calorie or very low-calorie diet on some days of the week, and follows a regular eating pattern on the other days, is a recognized method for weight loss and glycemic improvement. Low carbohydrate diets are also recognized as a way to lose weight and improve glycemic control. And one study has combined intermittent fasting, in the form of alternate day fasting, with low carbohydrate diets to improve weight and other metabolic processes.

The study combined ADF with a low carbohydrate diet. Ninety-four subjects with obesity (BMIs pf 30 to 49.9) in the Chicago area were selected for the study. Thirty-one subjects completed the study. For the ADF design of the diet, participants ate 600 calories during the fasting days, consisting of 30% carbohydrates, 35% protean, and 35% fat. For the low-calorie design of the diet, participants chose their food ad libitum during the “feast” days, to form a diet, again, consisting of 30% carbohydrates, 35% protean, and 35% fat.

The weight loss study lasted six months, with the first three months being a weight loss period. And the last three months being a weight maintenance period. Meal replacements were used to enable the study participants to take in the desired macronutrient content during the six month study period, while adhering to the 600 calorie limit during the fast days.

At the six month period average weight loss was 6.3%, total cholesterol was reduced by 6% and the LDL was decreased by 8%. There was a decrease in systolic blood pressure by 7 mmHg, and there was a decrease in fasting insulin of 8%.

The investigators concluded that while more research is required, the “findings suggest that ADF combined with the low carbohydrate diet is effective for weight loss, weight maintenance, and improving certain metabolic disease risk factors such as LDL-cholesterol, blood pressure, and fasting insulin.” The study shows that ADF plus low carbohydrate diet is an eating pattern that probably should be given some consideration by healthcare providers.

Wednesday, February 26, 2020

Intentional Weight Loss to Lower Cancer Risks

Studies have shown that there is a high correlation between obesity and cancer. Indeed, according to epidemiologic studies, there are at least 11 cancers that are associated with obesity. However, an important question is the following: Can intentional weight loss lower the risk of cancer? And a recent study appears to indicate that for some demographics, the answer is yes.

Most experts agree that a healthy diet, physical activity and healthy lifestyle changes will likely contribute to lowering the risk of many illnesses, including cancer. Along with the above-mentioned behaviors, to lower cancer risk, an individual should abstain from the use of alcohol, or limit alcohol consumption. And the study, mentioned above, sheds light on the effects of intentional weight loss in cancer risk reduction.

The study looked at postmenopausal women’s weight and waist circumference at baseline, and three years later. There were 50,667 subjects in the study. Since a 5% weight loss has been shown to have health benefits for some disease conditions, a 5% weight loss was used in the study. The following three subject categories were established for the study: Individuals who intentionally lost at least 5% of their weight or waist circumference (WC), individuals who unintentionally lost 5% of their weight, and individuals who lost or gained less than 5% of their weight.

The investigators concluded that for the postmenopausal women who had at least a 5% intentional weight loss, the cancer risk was reduced compared to those women who unintentionally lost at least 5% of their weight or WC, and compared to those women who lost or gained less than 5% of their weight or WC.

So this study does indicate that intentional weight loss can lower cancer risk— at least in postmenopausal women. And since intentional weight loss of at least 5% has been proven to be beneficial in other health areas for most demographic groups, it is quite possible that a 5% intentional weight loss or WC loss may lower cancer risk for demographic groups other than postmenopausal women.

Monday, February 24, 2020

Gut Microbiota, Eating Patterns and Prediabetes

Gut microbiota, which include bacteria, fungi and viruses, have been found to influence obesity and other metabolic diseases. For example, gut bacteria diversity appears to be important for weight management and metabolic health. One study demonstrated that the diversity can influence obesity, because individuals with the least gut bacteria diversity are more prone to be obese. Another study indicated that a low level of gut bacteria diversity can give rise to insulin resistance which can lead to type 2 diabetes. And a more recent study has shown that there is a relationship between gut microbiota abundance, eating patterns, and prediabetes.

The study was done in Sweden. The investigators looked at 1726 subjects ranging in age from 18 to 71 years old. The group was 55% women, and the mean BMI of the group was 25.5. No one in the group had diabetes. Two food patterns were used to determine the relationship between diet, prediabetes prevalence, and gut microbiota composition. One of the food patterns was called the “Health-conscious” pattern, and the other food pattern was called the “Sugar and High-Fat Dairy” pattern. Examining fecal microbiota from the gut was part of the analysis.

The investigators found that for subjects that followed the "Health-conscious" eating pattern, there was a lower level of prediabetes. And there was a higher level of prediabetes for the women who followed the “Sugar and High-Fat Dairy” eating pattern.

For those subjects that followed the “Health-conscious” eating pattern, there was an abundance of gut microbiota that differed in amount from the microbiota found in the subjects that followed the “Sugar and High-Fat Dairy” eating pattern. This was especially true for the type of gut microbiota called Roseburia. For those subjects who followed the “Sugar and High-Fat Dairy” pattern, there was no significant amount of this type of microbiota in the fecal material.

Therefore, the abundance of microbiota -- in this case Roseburia -- is important for good metabolic health, including possibly lowering the risk of prediabetes. So, gut bacteria amount and diversity may be essential for good health.


Tuesday, January 28, 2020

Self Motivation and Weight Loss

The CDC's Diabetes Prevention Program (DPP) has become the gold standard for weight loss programs. The program was put in place by the CDC to delay or prevent type 2 diabetes. It has been shown that weight loss can lead to improvements in prediabetes. And helping the program participants become self-motivated to lose weight is an important element of the program.

The program is a one year program, in which the first six months are the core sessions, where participants learn the basics of healthy eating, physical activity, and lifestyle modification. And the last six months are the core maintenance sessions, where what was learned in the first six months is reinforced. The DPP program sessions are facilitated by coaches who work with program participants to help them learn how to motivate themselves to set goals, eat healthy, exercise, and lose weight.

It appears that many of the people who succeed at weight loss are self-motivated. These individuals can  lose at least 5% of their weight without guidance from weight loss professionals or weight loss programs. And one study has pinpointed characteristics of those individuals who are able to motivate themselves to lose weight.

These individuals are able to add lifestyle change to their daily routine, they are able to learn from past experiences with weight loss attempts, and these individuals don’t need a lot of support from others to achieve their goals.

Specifically, the investigators concluded that “Overweight or obese individuals with strong internal motivation, problem‐solving skills and self‐reliance are more likely to be successful at achieving self‐directed weight loss. The patients identified with these characteristics could be encouraged to self‐manage their weight‐loss process, leaving the places available in more resource‐intensive professional‐led programmes to those individuals unlikely to succeed on their own.”

And one thing is obvious: for patients who are not self-motivated, providers need to learn to collaborate with these patients, and empower these patients to take action. This will enable the patients to learn to hold themselves accountable in their weight loss efforts. So when there ceases to be outside help, the patients will know that they can achieve their weight loss goals. The DPP program can give an individual the skills to do this.

Monday, January 27, 2020

Time Restricted Eating as a Treatment for Metabolic Syndrome

The combination of physical activity, a healthy eating pattern, and lifestyle modification are the most employed treatments for weight loss, weight management, and other metabolic conditions. One important metabolic condition is metabolic syndrome. A modified eating pattern or diet is being looked at for addressing the syndrome. That modified eating pattern is an adaptation of intermittent fasting (IF). The modified eating pattern is called time restricted eating.

Metabolic syndrome is a set of unhealthy conditions. The Mayo Clinic defines metabolic syndrome as a cluster of conditions that "include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels."

Intermittent fasting, typically, is where an individual follows a very low calorie diet on some days of the week, and a normal calorie diet on the other days of the week. An adaptation of the IF idea is time restricted eating. It's where an individual only eats during a specific number of hours per day, while eating nothing during the other hours of the day. An individual would only eat between 7:00 AM and 7:00 PM, for example.

Researchers in a small study of nineteen participants investigated the effects of a time restricted eating pattern on the metabolic syndrome. In the twelve week study, the participants only ate during a period of about ten hours, and fasted for about fourteen hours.

The researchers concluded that for the study participants, there was a lowering of blood pressure, an average three percent weight loss, and improvements in blood glucose and cholesterol. This leads one to believe that time restricted eating could be an effective treatment for metabolic syndrome, since there was improvement in components that are usually included in the cluster that defines the syndrome.

The above mentioned study was a small study. Therefore, more research is needed into the effectiveness of time restricted eating patterns in the treatment of metabolic syndrome. Still,  considering time restricted eating patterns as a possible treatment for metabolic syndrome may not be a bad idea.

Saturday, December 21, 2019

Prediabetes Plus Other Conditions as Risk Factors for Other Chronic Conditions

Because prediabetes is a risk factor for type 2 diabetes, the condition is gaining in importance in healthcare. Prediabetes is an abnormally high blood glucose condition, but not high enough to be called diabetes. And this abnormally high glucose state, along with other disorders, can raise the risk for other diseases. In fact, when a person has prediabetes, plus overweight, obesity, or central obesity, the risk for cardiovascular diseases and other morbidities can be heightened. Therefore, gaining more insight into ailments that can combine with prediabetes to increase the risk for diabetes and other morbidities becomes extremely important.

The CDC offers a program called the National Diabetes Prevention Program or NDPP. And Medicare offers the Medicare DPP, which is built on the NDPP. In both programs, individuals must have a BMI greater than or equal to 25 (greater than or equal to 23 for Asians) as part of the eligibility requirements, again, because excess body fat increases the risk for type 2 diabetes.

One study has shown that for men, having prediabetes plus a high BMI and belly fat can raise the risk of cardiovascular (CV) disease. The investigators concluded that “Among men with prediabetes, both BMI and waist circumference should be included when evaluating the risks of major CV events and mortality. Measurement of adiposity constitutes a simple and cost-effective strategy to identify those at high-risk population in prediabetes.”

Another study has shown that the hormone, cortisol, can be an important marker for a person with prediabetes. Cortisol is called the stress hormone, because the level of cortisol typically rises in our body during stressful situations. And this rise can lead to glucose elevation in our blood stream. While more glucose in our blood stream can be helpful in stressful situations -- giving us focus and energy -- too much glucose in the blood stream, for too long, can be harmful. Since a high level of cortisol can lead to an increase in glucose in the blood stream, being able to evaluate the cortisol in our body could be helpful.
And in the above referenced study, it was found that the cortisol in the saliva for persons who are prediabetic is not as high as the cortisol in the saliva for people with type 2 diabetes. So looking at the cortisol level in saliva for persons with prediabetes, and taking actions to lower the cortisol, like lowering the stress, may one day be helpful in delaying or preventing type 2 diabetes.

At any rate, evaluating a person for prediabetes is beneficial. And healthcare providers should make a point of including prediabetes considerations in patient evaluations. Further, the providers should include, risk-increasing conditions in the  evaluations. These inclusions may help prevent or delay type 2 diabetes and other chronic conditions.
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