scholarly journals Implementation of a community-based low-calorie dietary intervention for the induction of type-2 diabetes and pre-diabetes remission: a feasibility study utilising a type 2 hybrid design

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Kim R. Quimby ◽  
Natasha Sobers ◽  
Colette George ◽  
Natalie Greaves ◽  
Francine Browman-Jones ◽  
...  
Keyword(s):  
Weight Loss ◽  
Feasibility Study ◽  
Clinical Skills ◽  
Fasting Blood Glucose ◽  
Diabetes Remission ◽  
Community Based ◽  
Implementation Phase ◽  
Implementation Effectiveness ◽  
Low Calorie

Abstract Objectives The aims of this feasibility study were to (1) examine the implementation of a community-based health advocate (CHA) training programme to develop the clinical skills needed to support a diabetes remission protocol based on a low-calorie diet (LCD) and (2) investigate if participant weight loss can be achieved and diabetes remission induced under these conditions. Methods This tripartite study followed a type 2 implementation-effectiveness design. Three faith-based organisations (FBOs) were purposively selected as study sites. Implementation outcomes were guided by the Consolidated Framework for Implementation Research. During the pre-implementation phase, site ‘readiness’ to facilitate the intervention was determined from a site visit and an interview with the FBOs’ leadership. During the implementation phase, congregants could volunteer for the 10-week CHA training which included practical exercises in weight, glucose and blood pressure (BP) measurement, and a summative practical assessment. Acceptability and implementation effectiveness were assessed via survey. During the intervention phase, other congregants and community members with T2DM or pre-diabetes and overweight were invited to participate in the 12-week LCD. Anti-diabetic medication was discontinued on day 1 of the intervention. Clinical effectiveness was determined from the change in weight, fasting blood glucose (FBG) and BP which were monitored weekly at the FBO by the CHA. HbA1C was performed at weeks 1 and 12. Results The FBOs were found to be ready as determined by their adequate resources and engagement in health-related matters. Twenty-nine CHAs completed the training; all attained a passing grade at ≥1 clinical station, indicating implementation effectiveness. CHA feedback indicated that the programme structure was acceptable and provided sufficient access to intervention-related material. Thirty-one persons participated in the LCD (11 T2DM:20 pre-diabetes). Mean (95%CI) weight loss was 6.0 kg (3.7 to 8.2), 7.9 kg in males vs 5.7 kg in females; A1C (%) decreased from 6.6 to 6.1, with a greater reduction in those with T2DM when compared to pre-diabetes. FBG decreased from 6.4 to 6.0mmol/L. T2DM remission rates were 60% and 90% by A1C<6.5% and FBG<7mmol/L respectively. Pre-diabetes remission was 18% and 40% by A1C<5.7% and FBG<5.6 respectively. Conclusion Implementation of a community-based diabetes remission protocol is both feasible and clinically effective. Its sustainability is to be determined. Adaptability to other disorders or other settings should be investigated. Trial registration NCT03536377 registered on 24 May 2018.

scholarly journals Implementation of a Community-Based Low-Calorie Dietary Intervention for the Induction of Type-2 Diabetes and Pre-Diabetes Remission: A Feasibility Study Utilising a Type-2 Hybrid Design

2021 ◽  
Author(s):  
Kim Quimby ◽  
Natasha Sobers ◽  
Colette George ◽  
Natalie Greaves ◽  
Francine Browman-Jones ◽  
...  
Keyword(s):  
Weight Loss ◽  
Feasibility Study ◽  
Clinical Skills ◽  
Fasting Blood Glucose ◽  
Diabetes Remission ◽  
Community Based ◽  
Implementation Phase ◽  
Implementation Effectiveness ◽  
Low Calorie

Abstract Objectives The aims of this feasibility study were to (1) examine the implementation of a community-based health advocate (CHA) training program to develop the clinical skills needed to support a diabetes remission protocol based on a low-calorie diet (LCD) and (2) investigate if participant weight loss can be achieved and diabetes remission induced under these conditions. Methods This tripartite study followed a type-2 implementation-effectiveness design. Three faith-based organizations (FBOs) were purposively selected as study sites. Implementation outcomes were guided by the Consolidated Framework for Implementation Research. During the pre-implementation phase, site ‘readiness’ to facilitate the intervention was determined from a site visit and an interview with the FBOs’ leadership. During the implementation phase, congregants could volunteer for the 10-week CHA training which included practical exercises in weight, glucose and blood pressure (BP) measurement, and a summative practical assessment. Acceptability and implementation effectiveness were assessed via survey. During the intervention phase, other congregants and community members with T2DM or pre-diabetes and overweight were invited to participate in the 12-week LCD. Anti-diabetic medication was discontinued on day-1 of the intervention. Clinical effectiveness was determined from the change in weight, fasting blood glucose (FBG) and BP which were monitored weekly at the FBO by the CHA. HbA1C was performed at week 1 and 12. Results The FBOs were found to be ready as determined by their adequate resources and engagement in health-related matters. Twenty-nine CHAs completed the training; all attained a passing grade at ≥ 1 clinical station, indicating implementation effectiveness. CHA feedback indicated that the program structure was acceptable and provided sufficient access to intervention-related material. Thirty-one persons participated in the LCD (11 T2DM:20 pre-diabetes). Mean (95%CI) weight loss was 6.8kgs (5.4–8.2) p < 0.00001; 7.9kgs in males vs 6.6kgs in females; A1C decreased from 6.6–6.2%, p = 0.003 and FBG from 6.4-6.0mmol/L; p = 0.004. T2DM remission rates were 60% and 90% by A1C < 6.5% and FBG < 7mmol/L respectively. Pre-diabetes remission was 18% and 40% by A1C < 5.7% and FBG < 5.6 respectively. Conclusion Implementation of a community-based diabetes remission protocol is both feasible and clinically effective. Its sustainability is to be determined. Adaptability to other disorders or other settings should be investigated. Trial Registration : NCT03536377 registered 24th May 2018 at https://clinicaltrials.gov/ct2/show/NCT03536377

scholarly journals 3461 A community-based, low calorie dietary intervention for the prevention and remission of type 2 diabetes mellitus

2019 ◽  
Vol 3 (s1) ◽  
pp. 137-137
Author(s):  
Kim Qumby ◽  
Colette George ◽  
Ian Hambleton ◽  
Patrick Olivier ◽  
Nigel Unwin
Keyword(s):  
Weight Loss ◽  
Blood Glucose ◽  
Dietary Intervention ◽  
Fasting Blood Glucose ◽  
Community Setting ◽  
Diabetes Remission ◽  
Dietary Advice ◽  
Low Calorie ◽  
Health Team ◽  
Physical Measurements

OBJECTIVES/SPECIFIC AIMS: The aim is to investigate if sustained weight loss due to caloric restriction can be achieved in a community setting, using faith-based organisations (FBOs) as hubs; and if this weight loss can lead to the re-establishment of normal metabolism (using the normalisation of blood sugar levels while off glucose lowering medication as a proxy) in a person with pre-diabetes or T2DM. METHODS/STUDY POPULATION: Members of the FBO with either a diagnosis of T2DM for <6 years or pre-diabetes as defined by the American Diabetes Association (ADA); and a Body Mass index (BMI) of ≥27 kg/m2 are eligible. After counselling, participants will be placed on a 12 week low calorie liquid diet, supplemented by low carbohydrate vegetables, totalling approximately 840 kcal/day. During this time, participants will be monitored weekly at their FBO by trained members of their congregation, with oversight from the study team, for change in weight, fasting blood glucose, waist and hip circumference and blood pressure. This will be followed by a 3 month period during which participants will receive ongoing dietary advice as they transfer to a balanced, reduced calorie, solid diet. Physical measurements will be monitored monthly during this 3 month period. The next 6 months is a period where the participants and the FBO health team move towards ‘independence’. This involves further training of the FBO health team and participants in healthy lifestyle habits; and a commitment by the leadership of the FBO to assume ‘ownership’ for NCD monitoring within their community. Physical measurements will be repeated at the end of one year. RESULTS/ANTICIPATED RESULTS: Based on previous studies, we expect that participants who are compliant to the diet will lose approximately 2.2 kg per week over the 12 week period. This will be associated with rapid (within 1 week) normalisation of fasting blood glucose levels (<7mmol / L). We expect that, due to the accessibility of NCD monitoring and support, that participants to be satisfied with their care and compliant to their regime and that the results of the first 12 weeks will be sustained at the 12 month follow up. We expect that the FBO leadership will assume the responsibility of continuing and NCD programme, not only for the local congregation but for the surrounding community. DISCUSSION/SIGNIFICANCE OF IMPACT: Diabetes remission with a low calorie diet is a viable intervention for T2DM remission however social support is key to an individual’s success. This novel study which proposes institution of a diabetes remission intervention which fits into the participant’s locale and involves peer support, should increase long-term success.

scholarly journals Factors determining chance of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a nationwide cohort study in 8057 Swedish patients

2021 ◽  
Vol 9 (1) ◽  
pp. e002033
Author(s):  
Erik Stenberg ◽  
Torsten Olbers ◽  
Yang Cao ◽  
Magnus Sundbom ◽  
Anders Jans ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Metabolic Surgery ◽  
First Generation ◽  
Hemoglobin A1c ◽  
Diabetes Remission ◽  
Factors Associated ◽  
Generation Immigrant

IntroductionBariatric and metabolic surgery is an effective treatment option for type 2 diabetes (T2D). Increased knowledge regarding factors associated with diabetes remission is essential in individual decision making and could guide postoperative care. Therefore, we aimed to explore factors known to affect the chance of achieving diabetes remission after bariatric and metabolic surgery and to further investigate the impact of socioeconomic factors.Research design and methodsIn this nationwide study, we assessed all patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) surgery between 2007 and 2015 in the Scandinavian Obesity Surgery Registry. Remission was defined as absence of antidiabetic medication for T2D 2 years after surgery. Multivariable logistic regression was used to evaluate factors associated with diabetes remission, with missing data handled by multiple imputations.ResultsA total of 8057 patients were included. Mean age±SD was 47.4±10.1 years, mean body mass index 42.2±5.7 kg/m2, mean hemoglobin A1c 59.0±17.33, and 61.7% (n=4970) were women. Two years after surgery, 6211 (77.1%) patients achieved T2D remission. Preoperative insulin treatment (OR 0.26, 95% CI 0.22 to 0.30), first-generation immigrant (OR 0.66, 95% CI 0.57 to 0.77), duration of T2D (OR 0.89, 95% CI 0.88 to 0.90), dyslipidemia (OR 0.71, 95% CI 0.62 to 0.81), age (OR 0.97, 95% CI 0.96 to 0.97), and high glycosylated hemoglobin A1c (HbA1c) (OR 0.99, 95% CI 0.98 to 0.99) were all associated with lower T2D remission rate. In contrast, residence in a medium-sized (OR 1.39, 95% CI 1.20 to 1.61) or small (OR 1.46, 95% CI 1.25 to 1.71) town and percentage of total weight loss (OR 1.04, 95% CI 1.03 to 1.04) were associated with higher remission rates.ConclusionAmong patients with T2D undergoing RYGB surgery, increasing age, HbA1c, and diabetes duration decreased the chance of reaching diabetes remission without cut-offs, while postoperative weight loss demonstrated a positive linear association. In addition, being a first-generation immigrant and living in a large city were socioeconomic factors having a negative association.

scholarly journals Inducing remission of Type 2 diabetes in the Caribbean: findings from a mixed methods feasibility study of a low‐calorie liquid diet‐based intervention in Barbados

2019 ◽  
Vol 37 (11) ◽  
pp. 1816-1824 ◽  
Author(s):  
K. Bynoe ◽  
N. Unwin ◽  
C. Taylor ◽  
M. M. Murphy ◽  
L. Bartholomew ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mixed Methods ◽  
Feasibility Study ◽  
Liquid Diet ◽  
Low Calorie ◽  
The Caribbean

scholarly journals Digital Coaching Strategies to Facilitate Behavioral Change in Type 2 Diabetes: A Systematic Review

2020 ◽  
Author(s):  
Bradley D Gershkowitz ◽  
Conor J Hillert ◽  
Bradley H Crotty
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Digital Health ◽  
Evidence Synthesis ◽  
Fasting Blood Glucose ◽  
Health Coaching ◽  
Digital Tools ◽  
Coaching Strategies

Abstract Context In this systematic review, we focus on the clinical impact of digital tools for providing health coaching, education, and facilitating behavior in patients with prediabetes or type 2 diabetes. Our approach was designed to provide insights for clinicians and health care systems that are considering adopting such digital tools. Evidence Acquisition We searched the CINAHL, Scopus, and Ovid/MEDLINE databases using PRISMA guidelines for studies that reported digital coaching strategies for management and prevention of type 2 diabetes published from January 2014 to June 2019. Articles were reviewed by 2 independent blinded reviewers. Twenty-one articles met inclusion criteria. Evidence Synthesis We found that 20 of 21 studies in our analysis showed statistically significant improvements in at least one measure of diabetes control including HbA1c, weight loss, fasting blood glucose, and BMI. Studies that reported weight loss percentage from baseline at 1 year reported values ranging from −3.04% to −8.98%, similar to outcomes with traditional coaching in the Diabetes Prevention Program (N = 4). Additionally, all studies that included a comparison group of in-person or telephone-based coaching showed statistically better or similar outcomes in the digital coaching group (N = 5). Conclusions The evidence reported in this systematic review suggests that digital health coaching offers a promising strategy for long-term management and prevention of type 2 diabetes in diverse populations with similar benefits to in-person or telephone-based health coaching. We argue that, with the potential to treat large numbers of individuals in diverse geographic locations, digital coaching offers a promising solution to the rapid increase in diabetes prevalence.

Eating to stop diabetes

2020 ◽  
Vol 12 (549) ◽  
pp. eabc8952
Author(s):  
Priyathama Vellanki
Keyword(s):  
Weight Loss ◽  
Diabetes Remission ◽  
Significant Weight Loss ◽  
Low Calorie ◽  
Very Low Calorie Diets

Very low-calorie diets can induce and sustain significant weight loss and diabetes remission.

Sign in / Sign up

Export Citation Format

Share Document