Obesity management among patients with type 2 diabetes and prediabetes: a focus on lifestyle modifications and evidence of antiobesity medications

BACKGROUND The prevalence of diabetes increasingly rapidly. Previous research has demonstrated the efficacy of a diabetes prevention program (DPP) in lifestyle modifications which can prevent or delay the onset of type 2 diabetes among individuals at-risk. Digital DPPs have the potential to utilize technology, in conjunction with behavior change science, to prevent prediabetes on a national and global scale OBJECTIVE The aim of this study was to investigate the effects of a digital DPP (VP Transform for Prediabetes) on weight loss and physical activity among participants who had completed twelve months of the program. METHODS This study was a secondary analysis of retrospective data of adults with prediabetes who were enrolled in VP Transform for Prediabetes for 12 months of the program. The program incorporates interactive mobile computing, remote monitoring, an evidence-based curriculum, behavior tracking tools, health coaching and online peer support to prevent or delay the onset of type 2 diabetes. Analysis included data that were collected at baseline and after 12 months of the VP Transform for Prediabetes DPP. RESULTS The sample (N=1,095) comprised people with prediabetes who completed 12 months of the VP Transform for Prediabetes program. Participants included 67.7% female, with a mean age of 53.6 (SD 9.75). On average, participants decreased their weight by 10.9 pounds (5.5%) and increased their physical activity by 91.2 minutes per week. CONCLUSIONS These results suggest that VP Transform for Prediabetes is effective at preventing type 2 diabetes through significant reduction in body weight and increase of physical activity. Furthermore, these results suggest that the DPP remains effective 12 months after beginning the program. A prospective, controlled clinical study is warranted to validate these findings.

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Current Perspectives on Management of Type 2 Diabetes in Youth

Children ◽

10.3390/children8010037 ◽

2021 ◽

Vol 8 (1) ◽

pp. 37

Author(s):

Sachi Singhal ◽

Seema Kumar

Keyword(s):

Type 2 Diabetes ◽

Severe Obesity ◽

Rapid Development ◽

Adult Onset ◽

Socioeconomically Disadvantaged ◽

Lifestyle Modifications ◽

First Line ◽

Diabetes In Youth ◽

First Line Treatment

The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is on the rise, and the increase in prevalence of this disorder parallels the modern epidemic of childhood obesity worldwide. T2DM affects primarily post-pubertal adolescents from ethnic/racial minorities and those from socioeconomically disadvantaged backgrounds. Youth with T2DM often have additional cardiovascular risk factors at diagnosis. T2DM in youth is more progressive in comparison to adult onset T2DM and shows lower rates of response to pharmacotherapy and more rapid development of diabetes-related complications. Lifestyle modifications and metformin are recommended as the first-line treatment for youth with T2DM in the absence of significant hyperglycemia. Assessment of pancreatic autoimmunity is recommended in all youth who appear to have T2DM. Pharmacotherapeutic options for youth with T2DM are limited at this time. Liraglutide, a GLP-1 agonist, was recently approved for T2DM in adolescents 10 years of age and older. Several clinical trials are currently underway with youth with T2DM with medications that are approved for T2DM in adults. Bariatric surgery is associated with excellent rates of remission of T2DM in adolescents with severe obesity and should be considered in selected adolescents.

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Comparison of the Effectiveness of Lifestyle Modification with Other Treatments on the Incidence of Type 2 Diabetes in People at High Risk: A Network Meta-Analysis

Nutrients ◽

10.3390/nu11061373 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1373 ◽

Cited By ~ 4

Author(s):

Kazue Yamaoka ◽

Asuka Nemoto ◽

Toshiro Tango

Keyword(s):

Type 2 Diabetes ◽

High Risk ◽

Lifestyle Modification ◽

Meta Analysis ◽

Intervention Group ◽

Control Group ◽

Lifestyle Modifications ◽

Randomized Controlled ◽

Indirect Comparisons

Background: Many clinical trials have been conducted to verify the effects of interventions for prevention of type 2 diabetes (T2D) using different treatments and outcomes. The aim of this study was to compare the effectiveness of lifestyle modifications (LM) with other treatments in persons at high risk of T2D by a network meta-analysis (NMA). Methods: Searches were performed of PUBMED up to January 2018 to identify randomized controlled trials. The odds ratio (OR) with onset of T2D at 1 year in the intervention group (LM, dietary, exercise, or medication) versus a control group (standard treatments or placebo) were the effect sizes. Frequentist and Bayesian NMAs were conducted. Results: Forty-seven interventions and 12 treatments (20,113 participants) were used for the analyses. The OR in the LM was approximately 0.46 (95% CI: 0.33 to 0.61) times lower compared to the standard intervention by the Bayesian approach. The effects of LM compared to other treatments by indirect comparisons were not significant. Conclusions: This meta-analysis further strengthened the evidence that LM reduces the onset of T2D compared to standard and placebo interventions and appears to be at least as effective as nine other treatments in preventing T2D.

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“I Did Not Believe You Could Get Better”—Reversal of Diabetes Risk Through Dietary Changes in Older Persons with Prediabetes in Region Stockholm

Nutrients ◽

10.3390/nu11112658 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2658

Author(s):

Linda Timm ◽

Meena Daivadanam ◽

Anton Lager ◽

Birger Forsberg ◽

Claes-Göran Östenson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Persons ◽

Lifestyle Modification ◽

Qualitative Content Analysis ◽

Diabetes Risk ◽

Main Theme ◽

Lifestyle Modifications ◽

Activity Data ◽

Dietary Changes

Diabetes risk can be controlled and even reversed by making dietary changes. The aim of this study was to improve the understanding of how older persons with a high risk of developing Type 2 diabetes manage and relate to information about diabetes risk over a ten-year period. Fifteen qualitative interviews were conducted among participants from the Stockholm Diabetes Prevention Program (SDPP). The participants were asked to recall the health examinations conducted by the SDPP related to their prediabetes and to describe their experiences and potential changes related to diet and physical activity. Data were analyzed using qualitative content analysis. The main theme found was that T2D (type 2 diabetes) risk is not perceived as concrete enough to motivate lifestyle modifications, such as changing dietary patterns, without other external triggers. Diagnosis was recognized as a reason to modify diet, and social interactions were found to be important for managing behavior change. Diagnosis was also a contributing factor to lifestyle modification, while prognosis of risk was not associated with efforts to change habits. The results from this study suggest that the potential of reversing prediabetes needs to be highlighted and more clearly defined for older persons to serve as motivators for lifestyle modification.

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Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine

American Journal of Lifestyle Medicine ◽

10.1177/1559827620930962 ◽

2020 ◽

Vol 14 (4) ◽

pp. 406-419

Author(s):

John Kelly ◽

Micaela Karlsen ◽

Gregory Steinke

Keyword(s):

Type 2 Diabetes ◽

Remission Rate ◽

Diabetes Remission ◽

Primary Component ◽

Therapeutic Interventions ◽

Lifestyle Interventions ◽

Lifestyle Modifications ◽

Weighted Mean ◽

Lifestyle Medicine

Objectives. The present review represents the position of the American College of Lifestyle Medicine on type 2 diabetes (T2D) and remission treatment. Background. Research now reveals that sufficiently intensive lifestyle interventions can produce remission of T2D with similar success to bariatric surgery, but with substantially fewer untoward side effects. Methods. A literature review was conducted to examine lifestyle modifications targeting T2D remission, with most studies using a combination of blood glucose markers and treatment history. Results. There were notable differences in the dosing intensity of lifestyle interventions between therapeutic interventions and subtherapeutic interventions. Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%, while studies with subtherapeutic dosing typically used more moderate caloric restrictions (reducing energy intake by 500-600 kcal/day) and the weighted mean remission rate was 6.9%. Conclusions. Remission should be the clinical goal in T2D treatment, using properly dosed intensive lifestyle interventions as a primary component of medical care for T2D patients.

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Diet composition and the risk of type 2 diabetes: epidemiological and clinical evidence

British Journal Of Nutrition ◽

10.1079/bjn20041117 ◽

2004 ◽

Vol 92 (1) ◽

pp. 7-19 ◽

Cited By ~ 111

Author(s):

M. Parillo ◽

G. Riccardi

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Diet Composition ◽

Intervention Studies ◽

Epidemiological Studies ◽

Lifestyle Changes ◽

Lifestyle Modifications ◽

Body Weight Reduction ◽

Increased Risk

In the last 10 years nutritional research on diabetes has improved dramatically in terms of both number of studies produced and quality of methodologies employed. Therefore, it is now possible to attempt to provide the evidence on which nutritional recommendations for the prevention of type 2 diabetes could be based. We therefore performed a literature search and, among the papers published in indexed journals, we selected relevant epidemiological (mostly prospective) and controlled intervention studies. Lifestyle factors that have, so far, been consistently associated with increased risk of type 2 diabetes are overweight and physical inactivity. However, recent evidence from epidemiological studies has shown that the risk of type 2 diabetes is also associated with diet composition, particularly with: (1) low fibre intake; (2) a high trans fatty acid intake and a low unsaturated:saturated fat intake ratio; (3) absence of or excess alcohol consumption. All these factors are extremely common in Western populations and therefore the potential impact of any intervention on them is large: indeed, >90% of the general population has one or more of these risk factors. The ability to correct these behaviours in the population is estimated to reduce the incidence of diabetes by as much as 87%. Recent intervention studies have shown that type 2 diabetes can be prevented by lifestyle changes aimed at body-weight reduction, increased physical activity and multiple changes in the composition of the diet. Within this context, the average amount of weight loss needed is not large, about 5% initial weight, which is much less than the weight loss traditionally considered to be clinically significant for prevention of type 2 diabetes. In conclusion, new emphasis on prevention by multiple lifestyle modifications, including moderate changes in the composition of the habitual diet, might limit the dramatic increase in incidence of type 2 diabetes envisaged worldwide.

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Strawberry pink blood: hypertriglyceridaemia and diabetic ketoacidosis secondary to poorly controlled type 2 diabetes mellitus

BMJ Case Reports ◽

10.1136/bcr-2021-243696 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243696

Author(s):

Timothy Xin Zhong Tan ◽

Steven Hoon Chin Lim ◽

Joan Khoo

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Good Effect ◽

Lifestyle Modifications ◽

Diagnostic Challenge ◽

Intravenous Insulin ◽

One Year

A 54-year-old woman with insulin-requiring type 2 diabetes mellitus presented with acute shortness of breath and drowsiness on a background of polydipsia, weakness and significant weight loss. One year ago, she had decided to stop her insulin and other medications and adopt lifestyle modifications instead. Initial emergency department (ED) blood samples were highly lipaemic and appeared strawberry pink. She was eventually diagnosed with diabetic ketoacidosis (DKA) with severe hypertriglyceridaemia, intubated for airway protection, and managed with fluid resuscitation and intravenous insulin to good effect. We share an uncommon DKA presentation at the ED. History was limited as the patient was drowsy and minimally communicative. Physical examination was unremarkable. Blood investigations were also delayed in view of the need for additional centrifugation. These contributed to a paucity of information in the acute setting and resulted in a diagnostic challenge.

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SUN-691 Type 2 Diabetes Management in the Context of Smith-Magenis Syndrome: Case Report

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.098 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Kylie Tamm Mulvaney ◽

Airani Sathananthan

Keyword(s):

Type 2 Diabetes ◽

Peripheral Neuropathy ◽

Diabetes Management ◽

Psychosocial Health ◽

Exercise Intolerance ◽

Hormone Deficiency ◽

Lifestyle Modifications ◽

Truncal Obesity ◽

Wake Patterns

Abstract Background: Smith-Magenis syndrome (SMS) is a rare condition caused by microdeletion chromosome 17p11.2 via RAI1 gene mutations, causing disrupted circadian sleep-wake patterns. Characteristic behaviors include: sleep disturbance, anxiety, maladaptive habits with self-injury (biting, picking, self-hugging, page-flipping) and outbursts. Characteristic features include: craniofacial abnormalities, short stature, 2/3 toe syndactyly, scoliosis, cardiac and genitourinary defects, hypotonia, peripheral neuropathy, epilepsy, childhood-onset truncal obesity, toileting difficulties. Management of adults with SMS span multiple disciplines: otolaryngology, audiology, ophthalmology, assessments of scoliosis, seizures, familial psychosocial health, sleep and behavioral changes with each medication. Annual assessments include: fasting lipids, thyroid panel, screening urinalysis. Patients should receive standard treatment for comorbid endocrine conditions, classically: hypercholesterolemia, hypothyroidism, growth hormone deficiency. Clinical Case: 49-year-old Hispanic female with history of SMS who presented to endocrinology for type 2 diabetes mellitus (T2DM) management. Past medical history includes T2DM with peripheral neuropathy, hypertension, hypercholesterolemia, intellectual disability, anxiety, recurrent genitourinary infections, sleep apnea. Physical exam is remarkable for macroglossia, truncal obesity, scoliosis, extremity excoriations evident of skin picking and xerosis, syndactyly of 2nd-3rd toes. Patient exhibited maladaptive behaviors like page-flipping, self-hugging, tantrums. Over the past 3 years, BMI remained in the obese range (>30 kg/m2) and A1c fluctuated from 7.0 to 10.6% averaging 8.8% (<5.7%). Patient is currently managed on insulin glargine, pioglitazone and liraglutide. She did not tolerate metformin due to dose-dependent diarrhea. Patient’s mother chose against SGLT2 inhibitors due to diminished genitourinary hygiene. T2DM management was complicated by patient behaviors, including nocturnal consumption of fructose-containing food and beverages, exercise intolerance, and associated caregiver fatigue. Conclusion: This case describes a patient managed for metabolic dysfunction in conjunction with a rare microdeletion disorder causing neurobehavioral disturbance with disrupted circadian sleep-wake patterns. The most difficult aspects of diabetes management included difficulty implementing lifestyle modifications to control the patient’s hyperglycemia.

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