Sunday, July 30, 2023

The DPP is Less Effective for Those with Mental Disease

The National Diabetes Prevention Program (DPP), a key component of diabetes preventive efforts over the past ten years, effectively lowers the incidence of diabetes. However, not a lot is known about how well the DPP can treat people with prediabetes and typical mental health issues like depression or anxiety. Weight loss is a primary targeted outcome in the DPP. So, a study was done to determine if a virtually delivered DPP would motivate weight loss in individuals with prediabetes, obesity and mental health issues.

The study was carried out at Kaiser Permanente Northwest (KPNW), a large integrated health care organization that serves around 600,000 members in southwest Washington and Oregon. All information used in the analysis was gathered in the course of administering healthcare as usual. And the information was entered into the electronic health record (EHR) system used by KPNW (Epic®).

Patients who met the following inclusion criteria in the EHR were contacted in 2017 and invited to participate in a digital DPP: they had to be current KPNW health plan members, be between the ages of 65 and 75, have a BMI ≥30 kg/m2, have a HbA1c between 5.7% and 6.4%, have never been diagnosed with diabetes before, and have access to and be actively using the electronic patient portal (roughly 80% of all KPNW health plan members meet this requirement). Through the patient portal, a secure email message was delivered to eligible patients with a special online link that allowed them to sign up for the digital DPP at no cost to themselves.

Utilizing a validated translation of the DPP lifestyle intervention by the Centers for Disease Control and Prevention (CDC), Omada Health offered the digital DPP intervention to KPNW patients. There were 3904 participants in the analysis, 472 enrollees in the DPP, and 3432 study participants who were not enrolled in the DPP. At baseline, about the same percentage of participants and non-enrollees in the digital DPP had a mental health diagnosis: 24.8% of enrollees and 22.8% of non-enrollees. Additionally, there were no changes in patient usage of psychiatric medications based on DPP enrollment status (4.9% for participants and 6.5% for non-enrollees).

The researchers concluded that having a mental health diagnosis substantially lessened the effect of the digital DPP on weight change for persons with obesity, mental health issues and prediabetes. There was no significant weight loss in DPP participants who had mental health issues compared to non-DPP enrollees. These results for digital the DPP are broadly in line with other research that evaluated DPP delivered via telephone and in-person. Lastly, the researchers suggested that the current DPP curriculum might need to be modified for participants with mental health issues.


Monday, July 24, 2023

Controllable Unhealthy Behaviors, Hypertension and Stroke

The most common type of stroke is ischemic stroke, where blood vessels to the brain are blocked or damaged causing the brain not to get an adequate amount of blood. According to the CDC, controllable risk factors for hypertension include an unhealthy diet (containing too much salt for example), not getting enough exercise, being obese, drinking too much alcohol and using tobacco. More than 60% of all strokes are caused by hypertension. And a recent study was done to uncover the relationship between controllable unhealthy lifestyle behaviors and the risk of the first ischemic stroke in middle-aged or elderly persons diagnosed with hypertension.

As part of the study, the researchers in China analyzed health data for 629 individuals with hypertension. For the study, hypertension was declared when the systolic pressure was greater than 130 mmHg, and the diastolic pressure was greater than 80 mmHg (or >130/80). All study participants were at least 45 years of age. The researchers found that once an individual had hypertension, there was a strong relationship between the number of unhealthy lifestyle behaviors a person engaged in and the first ischemic stroke the individual experienced. Statistical analysis showed that engaging in 5 unhealthy lifestyle behaviors raised the risk of a first-ischemic stroke within 5 years after a hypertension diagnosis.

To reduce the risk of stroke, the researchers suggest that an individual should control all unhealthy lifestyle behaviors. But if it is not possible to control all unhealthy lifestyle behaviors, the individual should first increase physical activity. The individual should then control his or her weight. And, next, the individual should quit smoking (if they smoke). The individual should then manage alcohol intake and follow a healthy diet. Following these lifestyle changes can be beneficial to the individual, and assist the individual’s doctor in his or her efforts to help the individual manage hypertension, thus, lowering the risk of a first-ischemic stroke.

Indeed, healthcare providers should work with patients to help them engage in physical activity, follow a healthy diet, control weight and quit smoking. Not only will this lower the risk of hypertension and stroke, it will improve overall health.



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