Friday, November 30, 2018

The Diabetes Prevention Program Services May One Day Be Commercially Reimbursed

The National Institute of Diabetes and Digestive and Kidney Diseases (NIKKD) helped lead a study to determine if lifestyle changes could prevent type 2 diabetes. The study was named the Diabetes Prevention Program (DPP). The researchers concluded that a relatively small amount of weight loss, along with healthy eating and physical activity, can prevent type 2 diabetes for those people with prediabetes. The positive results eventually led Medicare, including Medicare Advantage, to start reimbursing suppliers who offer a modified version of the type 2 diabetes prevention program, called the Medicare Diabetes Prevention Program (MDPP). The MDPP might lead to commercial insurer reimbursement for the DPP services.

The Diabetes Prevention Program or DPP trial was started in 1996 by The NIKKD to determine if weight loss promoted by healthy eating and physical activity could be used to prevent type 2 diabetes in persons with prediabetes. The study was a randomized trial consisting of three groups. One of the groups used diet, exercise and lifestyle modification for the prediabetes treatment, one of the groups used metformin for the treatment, and one of the groups was the placebo group. All three groups contained prediabetic subjects that were overweight but not obese. Results from the study were reported in 2002.
The specific goal of the study was to determine if individuals with prediabetes could avoid type 2 diabetes by losing 7% of their weight through diet, exercise, and lifestyle modification. During the approximately 2.8-year period of the study, it was concluded that the intensive lifestyle group experienced a 58% reduction in the incidence of type 2 diabetes, and that the metformin group experienced a 31% reduction compared to the placebo group. After ten years, the type 2 diabetes incidence "was reduced by 34% ... in the lifestyle group and 18% .. in the metformin group compared with placebo."

Based on positive results from the original DPP study, Medicare carried out its own test to determine if the DPP methods could be cost effective for Medicare beneficiaries. The DPP was fond to be cost effective for Medicare beneficiaries. Therefore, Medicare began offering its diabetes prevention program in April of 2018. The program is called the Medicare Diabetes Prevention Program or MDPP.

And since commercial insurers reimburse for the MDPP under Medicare Advantage programs, these insurers may one day make the DPP services a covered benefit for "commercially insured populations."
 

Wednesday, November 28, 2018

The EndoBarrier, Obesity and Type 2 Diabetes

G.I. Dynamics of Lexington Massachusetts is the producer of the EndoBarrier. The EndoBarrier is an intestinal liner that mimics some of the functions of gastric bypass surgery. The liner is placed in the stomach, endoscopically, through the mouth. By serving as a barrier in the intestine, the device limits the amount of calories absorbed by the body during digestion. The device aids in the management of obesity and type 2 diabetes.

The “EndoBarrier bridges the gap between pharmaceuticals and surgery by providing a safer and more effective way to control glucose and weight loss for individuals who are underserved by drugs and injections but for whom surgery is not an option.”

While the EndoBarrier could bridge the gap between pharmaceuticals and surgery for the treatment of obesity as well as type 2 diabetes, it may be common, one day, to use the device in combination with pharmaceuticals. In fact, in 2013, G.I. Dynamics said that the company's collaboration with other companies might “lead to improvements in the device, as well as potential combinations of drug treatment and EndoBarrier Therapy to optimize patient outcomes.”

A recent study indicates that the EndoBarrier is an “effective treatment for obesity and type 2 diabetes.” Thirty-one patients completed a 12 month study which showed that there was a weight reduction and a reduction in HbA1c. The investigators concluded that “the EndoBarrier appears to be a safe and effective treatment strategy in overweight patients with poor glycemic control despite medical therapy or in those who are eligible but decline bariatric surgery.”

Healthcare providers should monitor the advances in devices used to treat overweight, obesity and type 2 diabetes. These devices, including the EndoBarrier, will no doubt add to the overweight, obesity and type 2 diabetes treatment arsenals. These devices will indeed fill a gap between pharmaceuticals and surgery. And providers who are well informed will be able to counsel patients on the risks and benefits of the EndoBarrier and other similar devices. 
 

Monday, October 29, 2018

Healthy BMIs

Based on a study done a few years back, The Centers for Disease Control and Prevention (CDC) suggested “that people who are modestly overweight actually have a lower risk of death than those of normal weight.” The CDC's suggestion implied that, in general, people with a BMI greater than 25 may generally be healthier than people whose BMI is lower than 25. However, subsequent studies have indicated that BMIs in the range of 20 to 24.9 are usually the healthiest BMIs.

The NIH classifies body weight as follows: A normal weight BMI is between 18.5 and 24.9. Overweight is between 25 and 29.9. A BMI between 29.9 and 39.9 is designated as obesity. And a BMI of 40 or more is considered to be extreme obesity.

A study done in Australia and the Netherlands looked at 246,000 subjects. At first the data indicated that the healthiest BMI range agreed with the CDC’s findings -- something above 25. However, "after adjusting their findings to exclude people with preexisting illnesses and smokers—two groups that tend to have lower body weights despite their poor health—the study authors found BMIs at the high end of 'normal' had lower mortality rates than people in the 'overweight' category."

Indeed, one of the most common chronic illnesses is hypertension. It’s associated with type 2 diabetes and cardiovascular problems. Well, one study concluded that "Being as lean as possible within the normal body mass index range may be the best suggestion in relation to primary prevention of hypertension." So being lean, not overweight, is the healthier state -- at least for hypertension.

Healthcare providers should push back on the idea that BMIs greater than 25, in general, are healthier than BMIs between 20 and 24.9, except in special cases. Very muscular individuals, for example, may have a higher body weight for their height than normal, but still be healthy. Further, these more muscular individuals could be healthier than someone of normal BMI. However, in most instances, a BMI between 20 and 24.9 is desirable for good health.
 

Sunday, October 7, 2018

More Ideas for Fighting Childhood Obesity

Approximately a third of the United States adult population is categorized as obese. Researchers in the U.S. and other places in the world are working to create methods to fight the disease. Obesity is associated with a number of serious chronic illnesses. Therefore, reducing obesity is an important goal. And since childhood obesity often leads to adult obesity, establishing effective, early-life, childhood obesity treatments for the disease is urgent. And a number of ideas that have been put forward to fight adult obesity might be useful in fighting childhood obesity.

For example, according to one investigator, rather than sitting for a long period of time at an office desk, it is healthier to take frequent standing breaks to "decrease your chances of getting diabetes. ..." Further, 'If you can also walk around your office, you get even more benefits. You will lose weight, you lessen your chance of heart disease, and you will improve your brain.' And this idea might apply to children.

For example, as one study concluded, "Interrupting sitting with brief moderate-intensity walking improved glucose metabolism without significantly increasing energy intake in children with overweight or obesity." Further, "interrupting sedentary behavior may be a promising intervention strategy for reducing metabolic risk in such children."

Another example of how a treatment for adult obesity may be useful for childhood obesity is the drug, Metformin. Metformin is often used in adults to fight type 2 diabetes. And it can also be helpful with weight loss in some cases. The drug is now being considered for the treatment of childhood obesity.  Indeed, one study indicates that the drug can lead to weight loss in children. The investigators concluded that "Metformin compared with placebo has beneficial effects on anthropometric and metabolic indicators in the management of childhood obesity."

Based on the above studies, healthcare providers might want to consider advocating more intensive physical activity for children. The providers also might want to investigate the use of Metformin for some of their pediatric patients.

Wednesday, September 26, 2018

A High Protein Diet May Be Advantageous

We would all no doubt agree that macronutrients are important components of any diet. The three macronutrients are protein, fat and carbohydrates. In trying to achieve a healthy diet, one must determine the appropriate quantities of these nutrients. Experts often outline the amount of fats and carbohydrates a person should consume on a daily basis for good health. Experts often weigh the merits of a low fat diet compared to a low carbohydrate diet for example. But while there is some question as to what a high protein diet really is, there is evidence that a diet that many experts would consider a high protein diet can be effective in weight loss.

With respect to daily food intake, some experts believe that a healthy diet should consist of between 10 and 35% protein for a person's daily food intake. We will consider a high protein diet to be at least 35%. In a three month study consisting of seventy-six women with an average BMI of 32, it was concluded that a 35% protein diet will lead to a reduction in triglycerides, which can be beneficial to health.

And in another study, consisting of 105 subjects diagnosed as having metabolic syndrome, 51 participants were assigned to a standard-protein diet (SPD), and 54 were assigned to a high-protein diet (HPD). The investigators concluded that "There were no significant differences in weight loss and biomarkers of [metabolic syndrome] when the overall group was examined, but the participants with more adherence rate in the HPD group lost significantly more weight than adherent participants in the SPD group."

So, the above mentioned studies give some indication that a high protein diet could improve a person's health by helping the person lose weight. Based on the studies, both health care providers and patients should pay close attention to the patients' daily protein intake. Indeed "Going on a high-protein diet may help you tame your hunger, which could help you lose weight." And healthcare providers who appropriately use a high-protein diet may enable some of their patients to lose weight.
 

Friday, September 21, 2018

Childhood Obesity and Physical Activity

Obesity continues to be a serious problem worldwide including the U.S.  Approximately one third of the U.S. adult population is obese. Researchers in the U.S. and in other places in the world are attempting to develop methods to fight the disease. Because obesity is associated with a number of serious illnesses, curbing the disease is an important endeavor.  And establishing effective, early-life, childhood obesity treatments for the disease is imperative, since obesity-related illnesses can start before a person is five years of age. One early-life treatment is physical activity.

Experts agree that obesity during childhood exposes a child to a higher risk for high cholesterol, hypertension, type 2 diabetes, and cardiovascular disease. And one "study has found that obesity can...put children at risk for...attention deficit hyperactivity disorder, allergies and ear infections. So curbing childhood obesity is important for the future."

Fortunately, there has been some success in the development of new knowledge concerning the fight against childhood obesity. One example of the new knowledge is a finding concerning physical activity. The investigators in one study concluded that acute exercise can "reduce food intake in obese youth when intense, without altering the macronutrients composition of the meal." 

And another study indicates that "Time spent on VPA [vigorous-intensity physical activity] was associated with higher [fat-free mass index] and better physical fitness." And that "the results suggest that promoting VPA may be important to improve childhood body composition and physical fitness ... at an early age." 

If healthcare providers take an active role in the childhood obesity fight by applying new methods based on information such as that mentioned above, we may put a dent in childhood obesity. Incorporating new methods could reduce the risk that children will face obesity-related illnesses in adulthood. Therefore, it is incumbent on providers to utilize as many effective methods as possible to curb childhood obesity. Indeed, all healthcare providers, and other healthcare stakeholders, should work to curb childhood obesity.

Wednesday, August 22, 2018

Waist Related Measurements Can Be Useful in Healthcare

Body mass index or BMI is probably the most frequently employed measurement of excess, possibly harmful, body fat. A BMI greater than or equal to 30 is considered to be an indication of obesity. However, other measurements of excess harmful body fat have been put forward. These measurements include waist circumference and waist-to-height ratio. The measurements focusing on waist may provide more useful health information than BMI alone, in many ways, since belly fat can cause many problems, including heart problems.

A study consisting of 1700 subjects done by researchers at the Mayo Clinic indicated that “those with a normal BMI, but high levels of belly fat were about twice as likely to have a heart attack, procedures to open blocked arteries, or to die from heart problems during the follow up than people without belly fat."

An acceptable waist circumference is equal to or less than 35 inches for women and equal to or less than 40 inches for men. Acceptable waist-to-height ratios are generally less than .6. In fact, in one study the "Cut-points for predicting whole body obesity were 0.53 in men and 0.54 in women. The cut-point for predicting abdominal obesity was 0.59 in both sexes."

Healthcare providers need to take waist related measurements, and use the measurements for diagnoses and counseling sessions. If a patient has too much belly fat, the provider should encourage the patient to follow a diet and engage in physical activity that can lead to weight loss.

BMI is a good all-around measurement of overweight and obesity. The measurement is widely used, so comparison studies can be readily performed. But waist related measurements should also be taken so that a more complete assessment of excess, harmful body fat can be made.

Both healthcare providers and patients should recognize the importance of waist related measurements. Healthcare providers should make taking waist related measurements a part of their normal intake process. These measurements are relatively easy to perform. Providers should use every tool available to fight overweight and obesity.

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