scholarly journals 4063 Glycemic control in a weight management-focused group medical visits (WM/GMV) intervention: examining the moderating effects of body mass index (BMI)

2020 ◽  
Vol 4 (s1) ◽  
pp. 31-31
Author(s):  
Elizabeth Kobe ◽  
Cynthia J. Coffman ◽  
Amy S. Jeffreys ◽  
William S. Yancy ◽  
Jennifer Zervakis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Management ◽  
Glycemic Response ◽  
Targeted Interventions ◽  
Group Medical Visits ◽  
Low Carbohydrate Diet ◽  
Medical Visits ◽  
The Impact ◽  
Baseline Bmi

OBJECTIVES/GOALS: The impact of baseline BMI on glycemic response to group medical visits (GMV) and weight management (WM)-based interventions is unclear. Our objective is to determine how baseline BMI class impacts patient responses to GMV and interventions that combine WM/GMV. METHODS/STUDY POPULATION: We will perform a secondary analysis of Jump Start, a randomized, controlled trial that compared the effectiveness of a GMV-based low carbohydrate diet-focused WM program (WM/GMV) to traditional GMV-based medication management (GMV) on diabetes control. The primary and secondary outcomes will be change in hemoglobin A1c (HbA1c) and weight at 48 months, respectively. Study participants will be stratified into BMI categories defined by BMI 27-29.9kg/m2, 30.0-34.9kg/m2, 35.0-39.9kg/m2, and ≥40.0kg/m2. Hierarchical mixed models will be used to examine the differential impact of the WM/GMV intervention compared to GMV on changes in outcomes by BMI class category. RESULTS/ANTICIPATED RESULTS: Jump Start enrolled 263 overweight Veterans (BMI ≥ 27kg/m2) with type 2 diabetes. At baseline, mean BMI was 35.3 and mean HbA1c was 9.1. 14.5% were overweight (BMI 27–29.9) and 84.5% were obese (BMI ≥ 30). The proposed analyses are ongoing. We anticipate that patients in the higher BMI obesity classes will demonstrate greater reductions in HbA1c and weight with the WM/GMV intervention relative to traditional GMV. DISCUSSION/SIGNIFICANCE OF IMPACT: This work will advance the understanding of the relationship between BMI and glycemic response to targeted interventions, and may ultimately provide guidance for interventions for type 2 diabetes.

scholarly journals Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes

2020 ◽  
Vol 180 (1) ◽  
pp. 70 ◽  
Author(s):  
William S. Yancy ◽  
Matthew J. Crowley ◽  
Moahad S. Dar ◽  
Cynthia J. Coffman ◽  
Amy S. Jeffreys ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Management ◽  
Group Medical Visits ◽  
Medical Visits

scholarly journals Impact of a 2-year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Shaminie J. Athinarayanan ◽  
Sarah J. Hallberg ◽  
Amy L. McKenzie ◽  
Katharina Lechner ◽  
Sarah King ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Principal Component ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
Ldl Particles ◽  
Low Carbohydrate ◽  
Lipoprotein Subfraction ◽  
The Impact

Abstract Background We have previously reported that in patients with type 2 diabetes (T2D) consumption of a very low carbohydrate diet capable of inducing nutritional ketosis over 2 years (continuous care intervention, CCI) resulted in improved body weight, glycemic control, and multiple risk factors for cardiovascular disease (CVD) with the exception of an increase in low density lipoprotein cholesterol (LDL-C). In the present study, we report the impact of this intervention on markers of risk for atherosclerotic cardiovascular disease (CVD), with a focus on lipoprotein subfraction particle concentrations as well as carotid-artery intima-media thickness (CIMT). Methods Analyses were performed in patients with T2D who completed 2 years of this study (CCI; n = 194; usual care (UC): n = 68). Lipoprotein subfraction particle concentrations were measured by ion mobility at baseline, 1, and 2 years and CIMT was measured at baseline and 2 years. Principal component analysis (PCA) was used to assess changes in independent clusters of lipoprotein particles. Results At 2 years, CCI resulted in a 23% decrease of small LDL IIIb and a 29% increase of large LDL I with no change in total LDL particle concentration or ApoB. The change in proportion of smaller and larger LDL was reflected by reversal of the small LDL subclass phenotype B in a high proportion of CCI participants (48.1%) and a shift in the principal component (PC) representing the atherogenic lipoprotein phenotype characteristic of T2D from a major to a secondary component of the total variance. The increase in LDL-C in the CCI group was mainly attributed to larger cholesterol-enriched LDL particles. CIMT showed no change in either the CCI or UC group. Conclusion Consumption of a very low carbohydrate diet with nutritional ketosis for 2 years in patients with type 2 diabetes lowered levels of small LDL particles that are commonly increased in diabetic dyslipidemia and are a marker for heightened CVD risk. A corresponding increase in concentrations of larger LDL particles was responsible for higher levels of plasma LDL-C. The lack of increase in total LDL particles, ApoB, and in progression of CIMT, provide supporting evidence that this dietary intervention did not adversely affect risk of CVD.

scholarly journals The impact of weight loss related to risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitor

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yi-Hsin Chan ◽  
Shao-Wei Chen ◽  
Tze-Fan Chao ◽  
Yi-Wei Kao ◽  
Chien-Ying Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Sodium Glucose Cotransporter ◽  
The Impact ◽  
Baseline Bmi ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background Sodium–glucose cotransporter 2 inhibitor (SGLT2i) use reduces body weight (BW) in patients with type 2 diabetes mellitus (T2DM). Obesity and T2DM are strong risk factors of new-onset atrial fibrillation (AF). However, whether BW loss following SGLT2i treatment reduces AF risk in patients with T2DM remains unclear. Methods We used a medical database from a multicenter health care provider in Taiwan, which included 10,237 patients with T2DM, from June 1, 2016 to December 31, 2018, whose BW data at baseline and at 12 weeks of SGLT2i treatment were available. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the SGLT2i, or the end of the study period, whichever occurred first. Results The patients’ baseline body mass index (BMI) was 28.08 $$\pm$$ ± 4.88 kg/m2. SGLT2i treatment was associated with a BW loss of 1.35 $$\pm$$ ± 3.28 kg (1.78%$$\pm$$ ± 4.47%). There were 37.4%, 47.0%, and 15.6% of patients experienced no-BW loss (n = 3832), BW loss 0.0–4.9% (n = 4814), and $$\ge$$ ≥ 5.0% (n = 1591) following SGLT2i treatment, respectively. Compared with patients with baseline BMI < 23 kg/m2, AF risk significantly increased in patients with baseline BMI $$\ge$$ ≥ 27.5 kg/m2 (P for trend = 0.015). Compared with those without BW loss after SGLT2i treatment, AF risk significantly decreased with a BW loss of $$\ge$$ ≥ 5.0% (adjusted hazard ratios [95% confidence intervals]: 0.39[0.22–0.68]). Use of diuretics, old age, high-dose SGLT2i, higher estimated glomerular filtration rate, and baseline BMI were independent factors associated with a BW loss of $$\ge$$ ≥ 5.0% following SGLT2i initiation. By contrast, neither baseline BMI nor BW loss after SGLT2i treatment predicted major cardiovascular adverse events or heart failure hospitalization risk (P for trend > 0.05). Conclusion BW loss of ≥ 5.0% following SGLT2i treatment was associated with a lower risk of new-onset AF in patients with T2DM in real-world practice.

scholarly journals Regression from prediabetes to normal glucose regulation: State of the science

2020 ◽  
Vol 245 (10) ◽  
pp. 889-896 ◽  
Author(s):  
Anthony Sallar ◽  
Samuel Dagogo-Jack
Keyword(s):  
Type 2 Diabetes ◽  
Primary Outcome ◽  
Vascular Complications ◽  
Present Review ◽  
Glucose Regulation ◽  
Targeted Interventions ◽  
Normal Glucose ◽  
Normal Glucose Regulation ◽  
The Impact

Prediabetes, an intermediate stage between normal glucose regulation and type 2 diabetes, is diagnosed based on documentation of impaired fasting glucose, impaired glucose tolerance, or a hemoglobin A1c level of 5.7–6.4%. Individuals with prediabetes have increased risks for the development of type 2 diabetes and multiple vascular complications. Randomized controlled trials have demonstrated the feasibility of preventing progression from prediabetes to type 2 diabetes, using lifestyle or pharmacological interventions. Lifestyle modification has a sustained effect on diabetes prevention, whereas medications lose efficacy when discontinued. Few studies have pre-specified reversal of prediabetes as the primary outcome. There is emerging evidence that reversal of prediabetes (i.e. restoration of normal glucose regulation) confers significant protection from future diabetes and complications, including premature death, during long-term follow-up. Current lifestyle intervention protocols have been more effective in preventing progression from prediabetes to type 2 diabetes than restoring normal glucose regulation; thus, interventions that prevent type 2 diabetes in people with prediabetes do not always reverse prediabetes. Given the compelling benefits of restoration of normal glucose regulation, specific protocols for reversal of prediabetes need to be developed and tested. The design of such protocols requires a deeper understanding of the pathobiology of prediabetes and early glucose dysregulation. The present review focuses on those studies that have assessed the impact of interventions on regression of the prediabetes state and restoration of normal glucose regulation. Furthermore, we discuss alterations in adiposity, glucoregulatory mechanisms, metabolomics, inflammatory markers, and other factors that predict the initial escape from normoglycemia. Such knowledge could inform the future development of novel, refined, and targeted interventions for the reversal prediabetes/early dysglycemia and restoration of normal glucose regulation. Impact statement Prediabetes increases the risks of future type 2 diabetes (T2D) and vascular complications, risks that can be prevented by restoring normal glucose regulation (NGR). Few studies have pre-specified reversal of prediabetes and restoration of NGR as primary outcome, and current approaches that prevent T2D in people with prediabetes do not always reverse the prediabetes. The present review focuses on studies that have assessed reversal of the prediabetes, and discusses known and emerging predictors of prediabetes. We argue that fuller knowledge of such predictors could inform the discovery of novel, targeted interventions for reversing prediabetes.

scholarly journals Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial

PLoS ONE ◽  
2018 ◽  
Vol 13 (4) ◽  
pp. e0195898 ◽  
Author(s):  
Wen-Chih Wu ◽  
Tracey H. Taveira ◽  
Sean Jeffery ◽  
Lan Jiang ◽  
Lisa Tokuda ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Group Medical Visits ◽  
Randomized Controlled ◽  
Medical Visits
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