scholarly journals Long-term follow-up of a randomized clinical trial comparing glycemic excursion minimization (GEM) to weight loss (WL) in the management of type 2 diabetes

2021 ◽  
Vol 9 (2) ◽  
pp. e002403
Author(s):  
Daniel J Cox ◽  
Tamara Oser ◽  
Matthew Moncrief ◽  
Mark Conaway ◽  
Anthony McCall
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Blood Glucose ◽  
Group Treatment ◽  
Primary Care Physicians ◽  
Diabetes Distress ◽  
Carbohydrate Ingestion ◽  
Sustained Improvement

IntroductionWe previously reported the physical, psychological and behavioral 3-month post-treatment results of a randomized controlled trial comparing glycemic excursion minimization (GEM) versus conventional weight loss (WL) therapy in the management of type 2 diabetes (T2D). GEM is a paradigm shift in the lifestyle management of T2D that focuses on reducing postnutrient glucose excursions, rather than reducing weight. We now present the 13-month follow-up results.Research design and methodsThe initial study sample of 172 were 30–80 years old, had T2D for ≤10 years, an HbA1c ≥6.8% (51 mmol/mol), and were not using insulin. Participants were randomized to 6 hours of group treatment, either to WL or one of three versions of GEM. GEM groups differed in degree of blood glucose (BG) feedback provided during treatment: no recommended feedback, systematic capillary BG feedback before and after nutrient intake and physical activity, or continuous glucose monitoring. Since these GEM groups did not differ in pre-post improvement they were combined for initial and current analyses. Of those who completed the 3-month postassessment, 100% and 96% of the WL and GEM participants completed the 13-month follow-up assessment.ResultsPre to follow-up within-group comparisons indicated WL participants sustained improvement in body mass index (BMI) (−0.9±1.4, p=0.001). GEM participants continued to benefit in their HbA1c (−0.5±1.4, p<0.001), BMI (−1±1, p<0.001), high-density lipoprotein (p<0.001), reduction of carbohydrate ingestion (p<0.001), self-monitoring of blood glucose satisfaction (p<0.001) and frequency (p<0.001), diabetes knowledge (p<0.001), diabetes empowerment (p<0.001), and both diabetes distress emotional (p=0.009) and regimen (p=0.001) subscales. Forty-two percent and 52% of WL and GEM participants, respectively, were classified as responders (individuals whose A1c dropped by at least −0.5%), with a mean HbA1c reduction of −1.2% and −1.5%. Neither WL nor GEM responders differed from non-responders in baseline demographics, psychological or disease severity variables. While WL responders could not be predicted, 73% of GEM responders were predicted by post minus pretreatment reductions of HbA1c, diabetes medication and BMI.ConclusionsWhile WL sustained improvement in BMI, GEM sustained benefits across a broad range of physical, behavioral and psychological parameters, beneficial for clinicians and adults with T2D. This may be especially relevant for primary care physicians who manage about 90% of patients with T2D.Trial registration numberNCT03196895.

564-P: Long-Term Follow-up of Glycemic Excursion Minimization (GEM) Compared with Weight Loss in Management of Type 2 Diabetes (T2D)

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 564-P
Author(s):  
DANIEL COX ◽  
MATTHEW A. MONCRIEF ◽  
ANTHONY L. MCCALL
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Long Term Follow Up

scholarly journals Oxidative stress in patients with type 2 diabetes mellitus treated with metformin

2017 ◽  
Vol 27 (2) ◽  
pp. 25857
Author(s):  
Samuel Selbach Dries ◽  
Bárbara Da Silveira Soares ◽  
Ana Luiza Ziulkoski ◽  
Simone Gasparin Verza ◽  
Rafael Linden ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Superoxide Dismutase ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Side Effects ◽  
Diabetic Complications

*** Oxidative stress in patients with type 2 diabetes mellitus treated with metformin ***AIMS: To evaluate oxidative stress parameters in patients with type 2 diabetes mellitus treated with metformin, relating these values to its side effects, plasma levels, glycemic control, diabetic complications, lipid profile, and the influence of pharmacotherapeutic follow-up.METHODS: Patients with type 2 diabetes mellitus, on metformin and in pharmacotherapeutic follow-up for four months, were evaluated. The pharmacotherapeutic follow-up consisted in providing information and answering patients’ questions about medication and disease. In addition, administration times, dosages, and presence or absence of side effects related to the use of metformin were verified. Glycemic and lipid profile, oxidative stress (superoxide dismutase and malondialdehyde) and plasma metformin were evaluated. Pearson’s correlation and Spearman’s correlation were performed to evaluate the relationship between the variables at the beginning of the study. The independent t-test and Mann-Whitney U test were used to assess the difference between the groups with and without diabetic complications. The range of values between the beginning and  end of the study was evaluated using Student’s t-test or Wilcoxon U test. The significance level was set at 5%.RESULTS: The initial sample consisted of 49 patients aged 59±9 years with a body mass index of 29.8±5.1 kg/m2, who have had diabetes for a median time of 36 months (interquartile range of 1-240) and have been on metformin for a median time of 36 months (interquartile range of 1-180). Twenty-five patients left the study between the second and fourth meetings. Malondialdehyde levels differed between before and after pharmacotherapeutic follow-up, being positively correlated with blood glucose, glycohemoglobin, and triglyceride level, and negatively correlated with metformin and superoxide dismutase. Blood glucose, glycohemoglobin, and malondialdehyde levels increased, whereas metformin levels decreased in the group with diabetic complications, and there was a correlation between malondialdehyde and the number of diabetic complications per patient.CONCLUSIONS: In this sample of patients with type 2 diabetes mellitus treated with metformin, oxidative stress was more pronounced in those with poor glycemic control and diabetic complications.

The Impact of Self-monitoring of Blood Glucose on a Behavioral Weight Loss Intervention for Patients With Type 2 Diabetes

2012 ◽  
Vol 39 (3) ◽  
pp. 397-405 ◽  
Author(s):  
Lisa M. McAndrew ◽  
Melissa A. Napolitano ◽  
Leonard M. Pogach ◽  
Karen S. Quigley ◽  
Kerri Leh Shantz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Blood Glucose ◽  
Weight Loss Intervention ◽  
Behavioral Weight Loss ◽  
Self Monitoring ◽  
Behavioral Weight Loss Intervention ◽  
The Impact

scholarly journals Frequency of self-monitoring of blood glucose in relation to weight loss and A1C during intensive multidisciplinary weight management in patients with type 2 diabetes and obesity

2019 ◽  
Vol 7 (1) ◽  
pp. e000659 ◽  
Author(s):  
Shaheen Tomah ◽  
Noor Mahmoud ◽  
Adham Mottalib ◽  
David M Pober ◽  
Mhd Wael Tasabehji ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Body Weight ◽  
Blood Glucose ◽  
Weight Management ◽  
Average Frequency ◽  
Baseline Body Mass Index ◽  
Self Monitoring ◽  
Median Change

ObjectiveWe evaluated the relationship between frequency of self-monitoring of blood glucose (SMBG) and body weight, A1C, and cardiovascular risk factors in patients with type 2 diabetes (T2D) and obesity enrolled in a 12-week intensive multidisciplinary weight management (IMWM) program.Research design and methodsWe conducted a retrospective analysis of 42 patients who electronically uploaded their SMBG data over 12 weeks of an IMWM program and divided them into tertiles based on their average frequency of SMBG per day. Mean (range) SMBG frequencies were 2.3 (1.1–2.9) times/day, 3.4 (3–3.9) times/day, and 5 (4–7.7) times/day in the lowest, middle, and highest tertiles, respectively. Anthropometric and metabolic parameters were measured at baseline and after 12 weeks of intervention.ResultsParticipants in the highest tertile achieved a median change (IQR) in body weight of −10.4 kg (−7.6 to −14.4 kg) compared with −8.3 kg (−5.2 to −12.2 kg), and −6.9 kg (−4.2 to −8.9 kg) in the middle and lowest tertiles, respectively (p=0.018 for trend). Participants in the highest tertile had a median change (IQR) in A1C of −1.25% (−0.6 to −3.1%) compared with −0.8% (−0.3% to −2%) and −0.5% (−0.2% to −1.2%) in the middle and lowest tertiles, respectively (p=0.048 for trend). The association between change in body weight and SMBG frequency remained significant after adjusting for age, sex, baseline body mass index, diabetes duration, and use of insulin therapy.ConclusionsIncreased frequency of SMBG during IMWM is associated with significantly better weight loss and improvement of A1C in patients with T2D and obesity. These findings may suggest future clinical recommendations aimed at increasing SMBG frequency to achieve the most favorable outcomes.

scholarly journals Clinical appraisal of Lodhradi Kashaya on type 2 diabetes mellitus patients

2017 ◽  
Vol 4 (1) ◽  
pp. 58
Author(s):  
Varun K. Singh ◽  
K. R. C. Reddy
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Dosage Form ◽  
Dose Group ◽  
Group A ◽  
Group B

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Lodhradi Kashaya (LKSD) is basically ayurvedic kwath dosage form, described as Madhumehajeet (winner of diabetes mellitus) in ayurvedic classics Basavarajeeyam and the same formulation in Vaidya Chintamani and Charaka Samhita too. The aim of this study was to assess prospectively the drug’s ability in management of type 2 diabetes. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Total 31 patients were taken following the guideline mention in CCRAS protocol for diabetes mellitus research. They are divided into two groups, group A and B, given LKSD 4 g &amp; 2 g TDS respectively for three-month follow up. They are investigated against their blood glucose, HbA1C and liver profile tests. Patients were also investigated for subjective parameters viz polyurea, polyphagia, exhaustion and constipation and their response has also been noted regarding palatability acceptance and ease of administration.</span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Patients has responded positively for formulation. Decrease in FBS and PPBS were found highly significant (P ˂ 0.001) in both groups but more in higher dose (group A). Decrease in HbA1C is also found highly significant in both groups. In LFT, SGOT level were also decreased more in group B in comparison to group A, and it is significant (P = 0.017 and 0.002). SGPT level were also decreased more in group B in comparison to group A, and it is significant in group B (P= 0.085 and 0.002).  </span></p><p class="abstract"><strong>Conclusions:</strong> LKSD is having astringent taste due to tannins and phenols in it. It was found significant not only in controlling blood sugar but also in management of other factors related to diabetes mellitus.</p>

scholarly journals Effectiveness of Solution-based Therapy on Self-Compassion and Reducing Blood Glucose in Elderly Patients with Type 2 Diabetes

2020 ◽  
pp. 158-164
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Elderly Patients ◽  
Control Group ◽  
Old Patients ◽  
Statistical Population ◽  
Self Compassion ◽  
Effect Of Treatment

Introduction and Objectives: One of the problems of diabetes in the elderly is the likelihood of another condition that makes it more difficult to control blood sugar. This study aimed to investigate the effectiveness of solution-based therapy on self-compassion and blood glucose reduction in elderly patients with type 2 diabetes. Materials and Methods: This quasi-experimental study was conducted based on a pretest-posttest design with a control group and follow-up. The statistical population of the study consisted of 60-75-year-old patients with type 2 diabetes referring to Iranian Diabetes Association treatment centers in Tehran, Iran. A total of 36 patients were selected and randomly assigned into two groups of experimental and control. The data were collected using a self-compassion questionnaire and glycated hemoglobin test (HbA1c). The HbA1c test was also administered two months after the end of the training to follow-up and evaluate the sustainability of the treatment effects. The data were analyzed in SPSS software (version 26) through repeated measure ANOVA. Results: The results showed that the solution-based therapy increased self-compassion in the posttest phase (P<0.01), and the effect of treatment was maintained after two months (P<0.01). Moreover, solution-based therapy reduced blood glucose levels in the posttest phase (P<0.01) and retained the effect of treatment after two months (P<0.01). Conclusion: It can be concluded that solution-based therapy has effects on self-compassion and hyperglycemia in elderly patients with type 2 diabetes; moreover, it can be used in treatment centers to improve the status of patients with diabetes.

scholarly journals Perkembangan Diabetes Melitus Tipe 2 dari Prediabetes di Bogor, Jawa Barat

2018 ◽  
pp. 59-69 ◽  
Author(s):  
Eva Sulistiowati ◽  
Marice Sihombing
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Plasma Glucose ◽  
Central Obesity ◽  
Fasting Glucose ◽  
Diabetes Melitus

Abstrak Prediabetes merupakan kondisi gula darah puasa 100-125mg/dL (Impaired Fasting Glucose/IFG) atau kadar gula darah 2 jam setelah pembebanan 75 g glukosa 140-199 mg/dL (Impaired Glucose Tolerance/IGT). Prediabetes meningkatkan risiko terjadinya Diabetes Mellitus tipe 2 (DM tipe 2). Tujuan analisis ini untuk mengetahui terjadinya DM Tipe 2 pada responden dengan prediabetes dalam follow-up 2 tahun. Prospektif studi dalam 2 tahun pada 3344 responden Studi Kohor Faktor Risiko PTM non-DM tipe 2. Data yang dikumpulkan meliputi wawancara, pemeriksaan fisik (BB, TB, lingkar perut, tekanan darah), dan laboratorium (GDP, GDPP, Kolesterol total, HDL, LDL, Trigliserida). Kadar glukosa darah untuk DM Tipe 2 dan prediabetes mengacu pada kriteria ADA 2011. Analisis deskriptif tentang karakteristik, life tabel perkembangan DM Tipe 2 dari prediabetes. Prediabetes yang terjadi sebesar 24,6% (IFG 2,3%; IGT 19,2% dan mix IFG/IGT 2,8%) dan 13,4% mengalami DM tipe 2 dalam kurun waktu 2 tahun. Progresivitas terjadinya DM dari IFG, IGT dan mix TGTmasing-masing 6,21; 6,12 dan 14,6 per 100 orang per tahun. Faktor risiko yang mempengaruhi terjadinya DM tipe 2 antara lain: umur (40-54 tahun RR=1,97; CI 95%:1,02-3,82), 55-65 tahun (RR=2,74; CI 95%: 1,34-5,58), obesitas sentral (RR=4,42; CI 95%: 2,36-8,29), hipertensi (RR= 1,99; CI 95%: 1,29-3,06) dan hipertrigliserida (RR=1,83; CI 95%: 1,18-2,83). Proporsi prediabetes dan terjadinya DM tipe 2 di Bogor Tengah dalam pengamatan 2 tahun, meningkat dengan bertambahnya umur dan dipengaruhi oleh obesitas sentral, hipertensi, hipertrigliserida. Pengendalian faktor risiko dan pemeriksaan gula darah secara rutin dapat mencegah terjadinya DM tipe 2. Perlu ditunjang dengan posbindu PTM aktif di masyarakat, lingkungan kerja maupun sekolah. Kata kunci: Prediabetes, Diabetes Melitus tipe 2 (DM tipe 2), Bogor Tengah Abstract Prediabetes is a condition that fasting plasma glucose 100-125 mg/dL (Impaired Fasting Glucose/IFG) or blood glucose 2 hours after loading 75 g glucose 140-199 mg/dL (Impaired Glucose Tolerance/IGT). Prediabetes increases the risk of type 2 Diabetes Mellitus (T2DM). This analysis is to determine the progression rate to T2DM in prediabetes respondents during 2 years follow up. This is an two years prospective study in 3344 respondents Cohort Study of Risk Factors NCD without T2DM. The data collected included interviews, physical examination (body weight, height, abdominal circumference, blood pressure), and laboratory (fasting plasma glucose/FPG, plasma glucose 2 hours after loading 75 g glucose, total cholesterol, HDL, LDL, triglycerides). Blood glucose levels for DM and prediabetes refers to ADA criteria 2011. Data analisized by descriptive about characteristics, life table of T2DM development from prediabetes. Prediabetes occurred at 24.6% (IFG 2.3%, IGT 19.2% and mix IFG / IGT 2.8%) and 13.4% experienced type 2 diabetes within 2 years. The progression of DM from IFG, IGT and mix TGT is 6.21; 6.12 and 14,6 per 100 person per year respectively. The risk factors of T2DM are age (40-54 years old (RR=1,97; CI 95%:1,02-3,82), 55-65 years old (RR=2,74; CI 95%:1,34-5,58), central obesity (RR=4,42; CI 95%:2,36-8,29), hypertension (RR=1,99; CI 95%:1,29-3,06) and hypertriglyceride (RR=1,83; CI 95%:1,18-2,83). The proportion of prediabetes and progression T2DM in Central Bogor at 2 years follow up is quite high, increasing with age and influenced by central obesity, hypertension and hypertriglyceride. Controlling risk factors and checking blood glucose regularly can prevent T2DM. Need to be supported by posbindu PTM active in the community, work environment and school. Keywords: Prediabetes, type 2 Diabetes Mellitus (T2DM), Central Bogor

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