Handgrip Strength as a Predictor for Prediabetes

The commonly accepted definition of prediabetes, in general, is as follows: prediabetes is when an individual has abnormally high blood glucose, but the blood glucose is not high enough to be called diabetes. Prediabetes may affect the body in many ways. For example, according to a recent study done in India, prediabetes is associated with unwanted changes in handgrip strength. And a change in handgrip strength may come before the prediabetes. Indeed, one study, looking at subjects in Japan, indicates that handgrip strength could be an independent predictor of prediabetes.

In the India study, 200 subjects were examined. One hundred of the subjects had prediabetes and 100 had normal blood glucose. The researchers measured the handgrip strength of all subjects.

After crunching the data, the researchers found that the handgrip strength was approximately 12% less for the subjects with prediabetes compared to the subjects who had normal blood glucose.  So, handgrip strength decreased with prediabetes.

In the Japanese study, mentioned above, decreasing handgrip strength was shown to be a possible predictor of prediabetes. In the study, the researchers investigated 1075 subjects who had no prediabetes or diabetes. The researchers measured the handgrip strength of the subjects to obtain baseline measurements.  And the researchers used the handgrip strength measurements to calculate the relative handgrip strength. The relative handgrip strength is defined as "absolute handgrip strength (kg) divided by BMI (reported as kg/BMI)."

After two years of follow-up, the researchers concluded "that lower baseline relative handgrip strength predicted a higher risk of prediabetes incidence among the participants." The researchers stated that "relative handgrip strength predicted a lower and significant risk of prediabetes incidence among individuals with normal weight" as defined by a BMI between 18.4 and 25.

Therefore, handgrip strength measurements could be taken in healthcare settings. Those individuals who have low handgrip strength measurements could be examined for other indicators of prediabetes. And for those with prediabetes or a high risk for diabetes, appropriate interventions could be made.

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HbA1c Plus FPG May be Superior to FPG Alone in Predicting Diabetes

FPG (fasting plasma glucose), HbA1c, and the OGTT (oral glucose tolerance test) are typically used to determine if someone has prediabetes or diabetes. Indeed, all three measures are employed by the National Diabetes Prevention Program (National DPP) to determine eligibility for the National DPP. So, these blood based tests are important. A recent study focused on HbA1c and FPG to see if the combination of HbA1c plus FPG was a better predictor of  diabetes than FPG. And the researchers indicated that the combination of elevated HbA1c plus elevated Impaired FPG was superior to elevated FPG alone in predicting a progression to diabetes.

The OGTT is considered by some to be the gold standard for diagnosing diabetes and prediabetes. However, it is not always practical to perform the test, and results are not always reproducible. Therefore, while the OGTT may be more accurate in predicting prediabetes than the HbA1c test in some cases, the HbA1c test is widely used since it is more practical and it is considered to be a valid test.

In the above mentioned HbA1c-FPG related study, a meta analysis considered 3011 patients with prediabetes or elevated glucose levels. The researchers concluded that patients with a combination of  elevated FPG and elevated HbA1c had the highest risk of diabetes. And that "Using HbA1c in combination with FPG could identify subgroups of people with IFG [impaired fasting glucose] at highest risk of progression to DM."

While more research is always needed to better predict the progression from prediabetes to diabetes, using the available results of recent studies is a way to create better criteria for determining Diabetes Prevention Program eligibility.

Healthcare providers should pay attention to this study and other studies related to predicting the progression from prediabetes to diabetes. If we can improve our predictive capabilities, this will lead to more bang for the buck, since we will be able to pinpoint and treat the patients who are more likely to progress to diabetes and increase healthcare cost.

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Intermittent Fasting Can Lead to Weight Loss, Improvements in Type 2 Diabetes and the Cardiovascular System

Since diet is a key element in weight loss, weight maintenance, and overall health, a lot of research has gone into looking at different types of diets. One diet approach that has received much attention in the past several years is the intermittent fasting (IF) diet. Usually, in the IF diet, an individual follows a very low or zero calorie plan for some period, and a normal eating plan at other times. The diet can lead to weight loss. And IF studies have determined that the IF diets can be effective in glycemic control and cardiovascular improvements.

One study consisted of a control group and two intervention groups. One of the intervention groups followed a protocol using a 600 calorie diet for two days a week, and the other intervention group followed a protocol using a 600 calorie diet for 4 days a week. On the non-calorie-restricted days of the week, the participants in both intervention groups were free to eat anything they wanted.

At the end of the twentieth week, participants in both intervention groups showed a decrease in HbA1c and insulin resistance. Further, a 29% "diabetes remission without ... medication" was seen in both groups.

And another study indicated that the 5:2 IF diet, where a person follows a 500-to-600 calorie diet on two days of the week, and a normal diet on the other days of the week, is a beneficial diet. The diet allows an individual to lose weight and lower the risk of cardiovascular disease. In fact, the study’s investigators “found that following weight loss, participants in the 5:2 group continue to eliminate fats (triglycerides) faster and more effectively than other volunteers. Scientists have also noticed a greater reduction in arterial systolic pressure associated with decreased risk of heart attack and stroke.”

So, healthcare providers might want to add IF to their weight loss tools. Not only could IF enable some patients to lose weight, but the weight loss approach might also lead to improvement in type 2 diabetes and cardiovascular conditions.

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Choose a Healthful Plant-Based Diet

Today, many people are following plant-based diets. These diets appear to be beneficial in combating many chronic diseases, including obesity, high blood pressure, and chronic kidney disease. One study has indicated that a plant-based diet is effective in lowering the risk for coronary heart disease (CHD). However, plant-based diets are most beneficial when the diet is a healthful plant-based diet.

So, first of all, what exactly is a plant-based diet? Depending on who you talk to, a plant-based diet can be anything from a semi-vegetarian diet, consisting of very small portions of animal products, to a vegan diet, consisting of absolutely no animal products. At any rate, compared to diets that include a goodly number of animal products, healthful plant-based diets appear to be significantly helpful in lowering CHD.

So, what is a healthful plant-based diet? Well, a healthful plant-based diet is a diet that is a diet focused on the consumption of foods such as fruits, vegetables, whole grains, nuts legumes and oils. A less healthful plant-based diet, for example, is a diet involving the large consumption of juices, refined grains and french fries.

To determine how a healthful plant-based diet can prevent CHD, in one study, researchers followed over 200,000 participants who had no CHD, stroke or coronary artery surgery. The participants were free of most cancers. The participants were asked to fill out a "questionnaire every 2 years on lifestyle, health behaviors, and mental health ... "

The researchers concluded that individuals that followed a diet, built around healthful plant foods, had a lower risk of CHD than those individuals that followed a diet containing less healthful plant foods.

Indeed, there are indications that the use of a healthful plant-based diet can improve health, in general, and CHD risk factors in particular. The evidence creates an opportunity for cardiologists and other healthcare providers. Therefore, healthcare providers should learn more about healthful plant-based diets and how to counsel patients on the benefits that can be gained from the diets.

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Alpha-Lipoic Acid Plus Probiotics May Improve Weight Loss Maintenance

Alpha-Lipoic acid or ALA is an antioxidant that is made in our bodies. ALA works to protect our cells. Probiotics are bacteria and yeasts that live in our bodies. Although some bacteria that live in our bodies are unhealthy, probiotics improve our health. And one study has shown that the combination of ALA supplements and probiotics supplements may enable individuals to maintain weight loss.

There has not been a lot of research on ALA. But some believe that ALA can treat HIV, diabetes and improve weight loss. Probiotics are thought to “balance your ‘good’ and ‘bad’ bacteria to keep your body working the way it should.”

The above referenced study, which combined ALA with probiotics, consisted of 88 overweight participants. The study was carried out in two phases. The participants were divided into groups, and put on different combinations, using low calorie diets, normal diets, ALA and probiotics.

In the first phase, one group was put on an isocaloric diet plus 500 mg of probiotics, one group was put on an isocaloric diet with ALA plus 600 mg of probiotics, one group was put on an isocaloric diet with ALA, and one group was put on an isocaloric diet with a placebo. And during phase 2, the participants were put on normal diets with ALA and probiotics supplements.

Measurements such as weight, BMI, hip circumference and waist circumference were taken and monitored. At the end of the study, the groups on ALA plus probiotics lost significantly more weight than the other groups. The ALA plus probiotics groups also were able to maintain weight loss better than the groups not on the ALA plus probiotics combination.

Of course, more research is needed to determine how the ALA plus probiotics combination works. Indeed, more research into ALA is also needed. But the ALA plus probiotics combination could, potentially, be another weapon in the weight loss and weight maintenance toolbox. The combination could be especially helpful in weight maintenance, since weight maintenance is considered to be more difficult than weight loss. At any rate, healthcare providers should consider the combination of ALA plus probiotics.

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The DASH Diet Might Lower Breast Cancer Risk

The DASH diet's name stands for “Dietary Approaches to Stop Hypertension.” As the name implies, the diets' objective is to lower high blood pressure. And, in general, the diet is considered to be a healthy pattern of eating that can lower blood pressure. The DASH diet or eating pattern may also lower the risk of breast cancer, according to one study.

The DASH diet puts a special focus on eating fruits, vegetables and whole grains. The diet also emphasizes protein from fish, poultry and nuts. These foods are high in calcium, protein, potassium and fiber. These nutrients are known to help lower blood pressure. Further, after looking at the top diets in use in 2021, the U.S.News rated the DASH diet as the second best overall diet. The U.S.News indicated that the diet puts limitations on saturated fats and salt. And that individuals who follow the DASH diet will eventually lower their salt consumption to about 1500 mg per day.

For the DASH-breast-cancer study mentioned above, researchers established two groups: one group consisted of 477 participants with breast cancer and the other group consisted of 507 healthy participants. The healthy participants were the control group. The study was done at the Cancer Institute of Iran between 2014 and 2016. The researchers indicated that the DASH diet reduced the risk of breast cancer.

Specifically, the researchers concluded that “adherence to the DASH dietary pattern could be associated with an approximately 30% reduction in risk of breast cancer.”

While more studies are necessary to determine if the DASH diet is as effective as the study indicates, with respect to breast cancer risk, the DASH diet has been shown to promote health. The diet is known to be a healthful diet. Therefore, healthcare providers should include the diet in their diet-counseling sessions for appropriate patients. The possibility of lowering breast cancer risk, as well as blood pressure, is a strong incentive to give advice on the DASH diet.

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Prediabetes Raises the Risk of Heart Failure

Prediabetes is associated with cardiovascular disease, kidney problems and, of course, diabetes. Prediabetes is a precursor to type 2 diabetes. And diabetes is highly associated with heart failure (HF). In fact, one report indicated that the risk of heart failure in persons with diabetes is about double the risk compared to those with normoglycaemia. However, there remains doubt as to whether prediabetes raises the risk of heart failure. So, one study was done to determine if there is a relationship between prediabetes and HF, such that those with prediabetes are at a higher risk of HF.

The study was a meta-analysis consisting of 15 studies. The studies included 9,827,430 individuals. The researchers used definitions of prediabetes established by  the American Diabetes Association (ADA), the World Health Organization (WHO), and the International Expert Committee (IEC). For their definitions, the organizations used glucose-measurement ranges for impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and elevated HbA1c.

The researchers determined that when an individual had prediabetes as defined by the above mentioned organizations, there was an increased risk of heart failure when compared with normoglycaemia. The researchers concluded that “Prediabetes is associated with an increased risk of HF. Future studies are needed to evaluate effective treatments for prediabetes to prevent the development and progression of HF.” And since the National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP) can delay or prevent type 2 diabetes, it may be prudent to determine if the program can delay or prevent HF.

A follow-on study based on the original Diabetes Prevention Program study has shown that participation in the study did lower blood pressure. Perhaps, collecting blood pressure measurements and other cardiovascular data in DPP clinical settings could lead to a tweaking of the DPP program that could cause a delay or prevent HF in program participants.

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