Medical Nutrition Therapy Can Improve HbA1c in Children and Adolescents

Prediabetes may be defined as having elevated glucose, but not elevated enough to be called diabetes. Prediabetes is known to sometimes lead to type 2 diabetes. And while for adults,  the progression from prediabetes to type 2 diabetes has received much attention, and is understood to a great extent, the progression of prediabetes to type 2 diabetes in children and adolescents has not received a lot of attention, and the progression is less understood. One study looked at how nutrition, “as a surrogate marker for lifestyle modification,” could affect the progression in children and adolescents over a period of four years. 

The researchers hypothesized that “Adherence to nutrition visits could reduce BMI and lower HbA1c.” The study participants consisted of 108 youths who had prediabetes. There were 46 males with an average age of 12.4, and 62 females with an average age of 13.3. All 108 youths were given medical nutrition therapy every three months after receiving a diagnosis of prediabetes. The study participants were split into two groups – an experimental group and a control group. The experimental group received at least two nutrition visits per year, and the control group received no more than one nutrition visit per year. And while the control group had higher BMI z-scores, both groups had similar HbA1c measurements.

The control group progressed to type 2 diabetes at a faster rate than the experimental group. Eighteen of the control group participants moved on to type2 diabetes by the fourth year, and four of the experimental group participants moved on to type 2 diabetes by the fourth year. The average time it took the participants in the control group to get type 2 diabetes was 25.8 ± 12.6 months. And the average time it took the participants in the experimental group to get type 2 diabetes was 34.9 ± 11.8 months.

The researchers concluded that “Adherence to nutrition visits was associated with a 4-fold reduction in the likelihood to progress from prediabetes to T2D in US youth.” Indeed, nutrition should play a significant role in the treatment of prediabetes in children and adolescents, just as it does in the treatment of prediabetes in adults. And healthcare providers and coaches should take note. 

 

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The Diabetes Prevention Program Services Are Commercially Reimbursed

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored a study to determine if lifestyle changes could prevent or delay type 2 diabetes. The study was called the Diabetes Prevention Program (DPP) trial. The researchers concluded that a relatively small amount of weight loss, along with healthy eating and physical activity, can prevent or delay type 2 diabetes for people with prediabetes. Based on the trial's results, the National Diabetes Prevention Program, or National DPP, was started and led by the CDC. However, there was very little reimbursement by commercial insurers for the program. However, today, there are a number of commercial insurers reimbursing for the program.

The Diabetes Prevention Program or DPP trial was started in 1996. The trial ended in 2001. The trial was a randomized study consisting of three groups. One of the groups, called the Intensive Lifestyle Intervention group, used diet, exercise and lifestyle modification for the prediabetes treatment. One of the groups, called the Metformin group, used metformin for the treatment. And one of the groups was the Placebo group which was treated with usual care approaches. To be included in the trial, a person had to have a BMI of at least 24, except for Asian American, who needed a BMI of at least 22. 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. And 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."

And Medicare did its own study to see if the National DPP services would benefit Medicare beneficiaries. The study did show that Medicare beneficiaries could benefit from the National DPP services, so Medicare started the Medicare DPP or MDPP in 2018, with reimbursement for the DPP services. And today, a number of commercial insurers are reimbursing for the National DPP.

 

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Tags: environmental scanning, balanced scorecard, business planning, strategic management, bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis, prediabetes, diabetes prevention, diabetes

Dietary Patterns Can Predict Metabolic Syndrome and Diabetes

A recent study looked at young adulthood dietary patterns to determine if the patterns can predict the risk of metabolic syndrome (MetS) and diabetes-related biomarkers prior to middle age. And the researchers determined that eating patterns can be predictive. The diabetes-related biomarkers that can be predicted  include high blood pressure, insulin resistance, prediabetes and high β-cell function.

MetS is a collection of comorbid conditions that raise the risk of cardiovascular disease, stroke, and type 2 diabetes. These conditions include hypertension, hyperglycemia, abdominal obesity, and abnormal cholesterol and triglyceride levels.

High blood pressure, also known as hypertension, is a common illness where the blood's long-term push on your artery walls is so great that it may ultimately result in health issues including heart disease.

Insulin resistance is the inability of muscle, fat, and liver cells to use glucose from the blood for energy. Prediabetes is a condition in which the blood glucose is higher than normal, but not high enough to be diagnosed as diabetes.

High beta-cell (β-cell) function refers to β-cells producing more insulin than normal in order to reduce blood sugar levels.  This can make the β-cell overwork. "This overwork can lead to the loss of β-cells or to β-cells being unable to carry out their function effectively."

To do the analysis, the researchers, in the study, used data on young adults from a long running birth cohort in Australia. The researchers assessed persons in two groups who followed two diet patterns. One group followed a typical western dietary pattern which was rich in meats, refined grains, processed and fried foods. And the other group followed a dietary pattern rich in fruits and vegetables, whole grains and legumes. The participants were examined at 21 years and 30 years. Among the cardiometabolic parameter the researchers looked at were blood pressure, MetS, insulin resistance, prediabetes, and  β-cell function.

The researchers concluded that following an unhealthy Western diet was associated with increased chances of MetS and insulin resistance, while following a healthy, sensible diet was associated with decreased risks. Diets must be optimized in early adulthood in order to promote later cardiometabolic health.

Healthcare providers should start advising young adults in their twenties and thirties to follow a healthy eating pattern such as a whole foods, plant-based pattern. Following this type of diet could likely improve long-term health and possibly prevent metabolic syndrome and diabetes. And this will benefit the patient and lower healthcare costs.

 

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Tags: environmental scanning, balanced scorecard, business planning, strategic management, bariatric industry analysis, weight loss industry analysis, weight management industry analysis, prediabetes, diabetes prevention

Intermittent Fasting with a High Quality Eating Pattern

Although the most desired strategy for weight reduction and weight management is a mix of food, exercise, and lifestyle adjustment, this approach typically fails to accomplish long-term weight loss. But other diet options, being explored, are adding to our understanding of potentially successful weight loss procedures. Intermittent fasting is one of those strategies. Intermittent fasting (IF) is a cyclical eating pattern characterized by alternating periods of eating and fasting. However, in most IF diets, the food's quality is not addressed.

So, one study compared the weight lost achieved using a one-day fasting protocol with the weight loss achieved using a two-day fasting protocol, where all participants followed a high-quality, nutrient-dense eating pattern. It was found that while two days of fasting achieved better results than one day of fasting, both the two-day method and the one-day method achieved respectable results.

The randomized, controlled study contrasted a one-day fasting regimen, consisting of 10 individuals, with a two-day fasting regimen, also consisting of 10 individuals. The researchers examined the effect of the two diet regimens on weight reduction, body composition, cardiovascular markers such as blood pressure, and cholesterol. The researchers also looked at body composition.

The researchers examined "hormone and hunger responses" in the "20 overweight men and women" over a four-week period. A licensed dietician provided weekly dietary advice and compliance monitoring to the participants. All outcome indicators were evaluated during the week before the study started and during the week after the five-week study ended.

The participants in the one-day IF protocol followed a high-quality nutrient-dense meal pattern consisting of 400 calories on the fasting day and a high-quality diet on the non-fasting days. The participants in the two-day IF protocol followed the same high-quality nutrient-dense meal pattern as the participants in the one-day protocol. However, the participants in the two-day protocol consumed an additional 100 calories on the fasting days.

Both protocols resulted in good results: The researchers concluded that each IF protocol optimized weight loss and improved body composition, cardiometabolic health, and hunger management. However, the two-day protocol provided “enhanced benefits in overweight women and men.”

As in most cases, more research is needed. However, consuming high-quality food while on an IF diet appears to be beneficial.

 

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Prediabetes and Retinopathy

 Retinopathy is a disease of the retina. There are various forms of the disease. For example, there is hypertensive retinopathy and there is diabetic retinopathy. Treatment and prevention of these diseases involves controlling  high blood pressure and blood glucose levels. And of course, a yearly eye exam is critically important for those persons with retinopathy. Diabetic retinopathy is the most common form of the disease. And this type of retinopathy is one of the principal causes of vision loss worldwide. At least two studies have linked prediabetes to a high level of retinopathy.

Prediabetes is where there is a higher than normal level of glucose in the blood, but the elevated level is not high enough to be deemed diabetes. For some time, it was known that prediabetes was often followed by diabetes. So, a study was designed to look into the progression from prediabetes to diabetes. The Diabetes Prevention Program trial was done between 1996 and 2001. The researchers looked at how prediabetes could lead to diabetes. It was found that prediabetes raises the risk of type 2 diabetes, and treating prediabetes could delay or prevent type 2 diabetes is many cases.

Further investigation into the incidence of retinopatyh among persons with prediabetes was done after the original Diabetes Prevention Program study. The researchers looked at a subset of the participants in the original study. There were 3224 participants in the original Diabetes Prevention Program study. The subset consisted of 302 participants. The researchers "found detectable retinopathy in 7.6% of patients," who had prediabetes. So, retinopathy can be associated with prediabetes.

In another study, to determine a relationship between retinopathy and prediabetes, researchers examined articles in MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Google Scholar and the Cochrane databases. After examining 5994 abstracts and 98 full-text articles, the researchers chose twenty-four studies for their analysis. The twenty-four studies consisted of 8759 participants with prediabetes. The researchers concluded that there was a 6.6% rate of retinopathy among persons with prediabetes compared with 3.2% for populations with normal levels of blood glucose.

The above studies indicate that healthcare providers may want to examine the eyes of patients with prediabetes. The providers may detect early signs of retinopathy. And this would be beneficial to the patient and the provider.

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Using Simulation to Investigate Obesity and Type 2 Diabetes

According to Wikipedia, “A simulation is the imitation of the operation of a real-world process or system over time. Simulations require the use of models; the model represents the key characteristics or behaviors of the selected system or process, whereas the simulation represents the evolution of the model over time. Often, computers are used to execute the simulation.”

Simulation is beneficial for assessing public health concerns.
Indeed, simulation, using modeling, has been employed to forecast future levels of obesity and the relationship between obesity and type 2 diabetes as we age.

In one study, 41,567 children and adults' life paths were examined using simulation. And the researchers concluded that, "Given the current level of childhood obesity, the models predicted that a majority of today’s children, [approximately 57%] will be obese at the age of 35 years, and roughly half of the projected prevalence will occur during childhood.”

Additionally, another study employed simulation to analyze the incidence and trends of obesity, as well as the influence of obesity on the risk of type 2 diabetes in a computer model of Los Angeles-born children.

The researchers created the Virtual Los Angeles cohort-ViLA. This was a model calibrated to the Los Angeles County population. The model incorporated trends, causes, and effects of obesity, with a particular emphasis on diabetes as a significant obesity consequence over the duration of the participants represented in the simulation.

Each person depicted in the model engaged in both beneficial and not so beneficial behaviors that are known to be associated with obesity and diabetes. These behaviors included the intake of sugar-sweetened beverages, engagement or non-engagement in physical activity, fast-food consumption, and consumption of diets rich in fresh fruits and vegetables.

Additionally, the model used probability estimates to predict which modeled person might acquire or lose weight and develop type 2 diabetes, based on the person’s sociodemographic characteristics, historical activities, and previous weight or type 2 diabetes status. The researchers utilized the model to create a simulation of 98,230 residents ranging in age from birth to 65 years and residing in 235 Los Angeles County areas.

The simulation results indicated that obesity prevalence frequently increased from 10% to 30% across the life-course of the modeled individuals. And the prevalence of type 2 diabetes  typically increased from less than 2% in the 18-to-24 age group to 25% in the 40-to-49 age group.

As demonstrated, simulation can be beneficial for examining public health concerns. And obesity is a significant public health problem. Another significant public health problem is type 2 diabetes. The modeling experiments cited above indicate the magnitude of the health issues created by the combination of obesity and type 2 diabetes. Additionally, the research underscores the need for the healthcare sector to step up efforts to address obesity and diabetes.

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Treating Obesity and Other Related Conditions with Telehealth

According to the Health Resources Services Administration, telehealth may be defined as "the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration." Telehealth has the potential to improve the treatment of overweight, obesity and related diseases.

A Finnish study analyzed the outcomes of their healthy weight coaching (HWC) program. This is a "web-based obesity management program integrated into standard Finnish clinical care." The program lasts 12 months. And the participants receive coaching support, remotely, in a one-on-one format. The researchers concluded that the HWC is an effective program for helping participants lose weight. And that the program can be integrated into a clinical setting.  

A 2009 study was done in Ottawa Canada to determine the effectiveness of telehealth for home health care. In the study, literature was analyzed to compare the benefits of treating diabetes using telehealth versus treating diabetes using common diabetes treatment procedures. It was found that patients who received treatment via telehealth had a higher quality of life, and experienced less hospitalization than diabetes patients receiving the normal diabetes treatment.

Although the leaders of the Canadian study indicated that more research needs to be done, as stated above, telehealth improved quality-of life and reduced hospitalizations. The use of telehealth also improved glycemic control and patient satisfaction.

A 2007 study was done in the United States to establish the effectiveness of telehealth in treating obesity.  Three weight loss programs were compared. These programs were telehealth, traditional classes, and no program. The study looked at the amount of weight participants regained in each program. The study also assessed a participants' satisfaction with a given program, and the convenience of a program for the participants. Participants in the telehealth program lost slightly more weight than participants in the other two programs.

However, the difference in weight loss was not enormous. But the telehealth group found the telehealth program to be more convenient. And convenience  is important in trying to modify a lifestyle. If one program is more convenient to follow than another, a person is more likely to follow the more convenient program.

Telehealth may elevate the treatment of obesity by making it easier to modify lifestyle. Healthcare providers are paying close attention to telehealth methodology, not only in the fight again overweight and obesity, but, also, in the treatment of other medical conditions.

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