759-P: Analysis of a Two-Year Continuous Care Intervention Including Nutritional Ketosis—Exploring Baseline Predictors of Diabetes Reversal and Remission

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 759-P
Author(s):  
SHAMINIE J. ATHINARAYANAN ◽  
AMY MCKENZIE ◽  
REBECCA N. ADAMS ◽  
SARAH HALLBERG ◽  
JAMES P. MCCARTER ◽  
...  
Keyword(s):  
Continuous Care ◽  
Care Intervention

889-P: Early Engagement in a Continuous Care Intervention Predicts One-Year Improvements in Weight and HbA1c among Adults with T2D

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 889-P
Author(s):  
REBECCA N. ADAMS ◽  
AMY MCKENZIE ◽  
SHAMINIE J. ATHINARAYANAN ◽  
SARAH HALLBERG ◽  
JAMES P. MCCARTER ◽  
...  
Keyword(s):  
Continuous Care ◽  
Care Intervention ◽  
One Year

scholarly journals Effect of continuous care intervention on the quality of life in patients with neurogenic bladder dysfunction

2019 ◽  
Vol 47 (5) ◽  
pp. 2011-2017 ◽  
Author(s):  
Fang Tang ◽  
Zongyan Cheng ◽  
Xianxiu Wen ◽  
Jinying Guan
Keyword(s):  
Quality Of Life ◽  
Neurogenic Bladder ◽  
Bladder Dysfunction ◽  
World Health ◽  
Neurogenic Bladder Dysfunction ◽  
World Health Organization Quality ◽  
Continuous Care ◽  
Care Intervention ◽  
Cord Injury

Objective This study aimed to evaluate the effect of continuous care intervention on the quality of life (QoL) of patients with neurogenic bladder. Methods Eighty-two patients with neurogenic bladder dysfunction caused by spinal cord injury were included into the study. All of the patients had continuous care intervention (for 3 months), including clean intermittent self-catheterization, drinking guidance, and bladder training guidance. A health record was established for each patient before discharge and was used to record changes in the patients when followed up. Scores of QoL, which were based on the World Health Organization Quality of Life-BREF, occurrence of complications, and compliance of all patients were recorded. Results After 3-month care intervention, there were significantly fewer complications than before the intervention. Patients’ compliance and QoL were significantly higher after 3 months of care intervention than before the intervention. Conclusion Continuous care intervention can improve patients’ compliance and reduce urinary complications.

scholarly journals Improvement in patient-reported sleep in type 2 diabetes and prediabetes participants receiving a continuous care intervention with nutritional ketosis

2019 ◽  
Vol 55 ◽  
pp. 92-99 ◽  
Author(s):  
Morgan J. Siegmann ◽  
Shaminie J. Athinarayanan ◽  
Sarah J. Hallberg ◽  
Amy L. McKenzie ◽  
Nasir H. Bhanpuri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Care ◽  
Care Intervention ◽  
Patient Reported

scholarly journals Improvement in Patient-Reported Sleep in Type 2 Diabetes and Prediabetes Participants Receiving a Continuous Care Intervention with Nutritional Ketosis

2018 ◽  
Author(s):  
Morgan J. Siegmann ◽  
Shaminie J Athinarayanan ◽  
Sarah J Hallberg ◽  
Amy L. McKenzie ◽  
Nasir H. Bhanpuri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Dietary Intervention ◽  
Poor Sleep ◽  
Continuous Care ◽  
Care Intervention ◽  
Patient Reported ◽  
One Year

AbstractObjectiveSleep disruption is frequently associated with type 2 diabetes (T2D) and hyperglycemia. We recently reported the effectiveness of a continuous care intervention (CCI) emphasizing nutritional ketosis for improving HbA1c, body weight and cardiovascular risk factors in T2D patients. The present study assessed the effect of this CCI approach on sleep quality using a subjective patient-reported sleep questionnaire.MethodsA non-randomized, controlled longitudinal study; 262 T2D and 116 prediabetes patientsenrolled in the CCI and 87 separately recruited T2D patients continued usual care (UC) treatment. Patients completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. A PSQI score of >5 (scale 0 to 21) was used to identify poor sleepers.ResultsGlobal sleep quality improved in the CCI T2D (p<0.001) and prediabetes (p<0.001) patients after one year of intervention. Subjective sleep quality (component 1), sleep disturbance (component 5) and daytime dysfunction (component 7), also showed improvements in the CCI T2D (p<0.01 for sleep quality and sleep disturbance; and p<0.001 for daytime dysfunction) and prediabetes patients (p<0.001 for all three components); compared to the UC T2D group after one year. The proportion of patients with poor sleep quality was significantly reduced after one year of CCI (T2D; from 68.3% at baseline to 56.5% at one year, p=0.001 and prediabetes; from 77.9% at baseline to 48.7% at one year, p<0.001).ConclusionThis study demonstrates improved sleep quality as assessed by PSQI in patients with T2D and prediabetes undergoing CCI including nutritional ketosis but not in T2D patients receiving UC. The dietary intervention benefited both sleep quality and the severity of T2D symptoms suggesting that nutritional ketosis improves overall health via multiple mechanisms.

scholarly journals Post-hoc analyses of Surrogate Markers of Non-Alcoholic Fatty Liver Disease (NAFLD) and Liver Fibrosis in Patients with Type 2 Diabetes in a Digitally-Supported Continuous Care Intervention: An Open Label, Non-Randomized, Controlled Study

2018 ◽  
Author(s):  
Eduardo Vilar-Gomez ◽  
Shaminie J. Athinarayanan ◽  
Rebecca N. AdamS ◽  
Sarah J. Hallberg ◽  
Nasir H. Bhanpuri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Advanced Fibrosis ◽  
Alcoholic Fatty Liver ◽  
Continuous Care ◽  
Care Intervention ◽  
One Year ◽  
Alcoholic Fatty Liver Disease

ABSTRACTObjectiveOne-year of comprehensive continuous care intervention (CCI) through nutritional ketosis improves HbA1c, body weight and liver enzymes among type 2 diabetes (T2D) patients. Here, we report the effect of the CCI on surrogate scores of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis.MethodsThis was a non-randomized longitudinal study, including adults with T2D who were self-enrolled to the CCI (n=262) or to receive usual care (UC, n=87) during one year. A NAFLD liver fat score [N-LFS] > −0.640 defined the presence of fatty liver. A NAFLD fibrosis score [NFS] of > 0.675 identified subjects with advanced fibrosis. Changes in N-LFS and NFS at one year were the main endpoints.ResultsAt baseline, NAFLD was present in 95% of patients in the CCI and 90% of patients in the UC. At one year, weight loss of > 5% was achieved in 79% of patients in the CCI vs. 19% of patients in UC (P<0.001). N-LFS mean score was reduced in the CCI group (−1.95±0.22, P<0.001) whereas it was not changed in the UC (0.47±0.41, P=0.26) (CCI vs. UC, P<0.001). NFS was reduced in the CCI group (−0.65±0.06, P<0.001) compared with UC (0.26±0.11, P=0.02) (P<0.001 between two groups). In the CCI group, the percentage of individuals with a low probability of advanced fibrosis increased from 18% at baseline to 33% at 1 year (P<0.001).ConclusionsOne year of a digitally-supported CCI significantly improved surrogates of NAFLD and advanced fibrosis in patients with type 2 diabetes.DATA SHARINGData sets and statistical code used for the current study are available from the corresponding author on reasonable request.Article Summary Strengths and limitations of this studyThis study highlights the beneficial effect of the CCI on NAFLD in high risk patients with T2DThis study also identifies positive associations between glycemic improvements and improvements in ALT levelsThe assessment of resolution of steatosis and fibrosis is limited by the sensitivity and specificity of the non-invasive markers used in the studyThe patients were restricted in their carbohydrate intake and monitored for their nutritional ketosis state, but dietary energy, macronutrient and micronutrient intakes were not assessed.

65-LB: Regression of Prediabetes following Two Years Treatment with a Continuous Care Intervention Emphasizing Carbohydrate Restriction: A Single-Arm, Prospective, Longitudinal Study

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 65-LB
Author(s):  
AMY MCKENZIE ◽  
SHAMINIE J. ATHINARAYANAN ◽  
JACKSON MCCUE ◽  
REBECCA N. ADAMS ◽  
JAMES P. MCCARTER ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Carbohydrate Restriction ◽  
Prospective Longitudinal Study ◽  
Continuous Care ◽  
Care Intervention ◽  
Prospective Longitudinal

760-P: Factors Associated with Resolution of Steatosis and Fibrosis in T2D Patients Following Two Years of Continuous Care Intervention

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 760-P
Author(s):  
SHAMINIE J. ATHINARAYANAN ◽  
REBECCA N. ADAMS ◽  
AMY MCKENZIE ◽  
SARAH HALLBERG ◽  
STEPHEN PHINNEY ◽  
...  
Keyword(s):  
Factors Associated ◽  
Continuous Care ◽  
Care Intervention

scholarly journals The Impact of a Continuous Care Intervention for Treatment of Type 2 Diabetes on Health Care Utilization

2019 ◽  
Author(s):  
Zachary Wagner ◽  
Nasir H. Bhanpuri ◽  
James P. McCarter ◽  
Neeraj Sood
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Post Intervention ◽  
Continuous Care ◽  
Care Intervention ◽  
Remote Care ◽  
The Impact

Introduction: Type 2 diabetes (T2D) is a major driver of health care costs, thus treatments enabling T2D reversal may reduce expenditures. We examined the impact of a T2D continuous care intervention (CCI) on health care utilization. Previous research documented that CCI, including individualized nutrition supported by remote care, simultaneously reduced hemoglobin A1c and medication use and improved cardiovascular status after two years; however, the impact on utilization is unknown.&nbsp;Methods: This study used four years of data (two years pre-intervention, two years post-intervention) from the Indiana Network for Patient Care (INPC) health record. Two methods estimated the impact of CCI on utilization. First, an interrupted time series (ITS) including only CCI participants (n=193) compared post-intervention utilization to expected utilization had the pre-intervention trend persisted. Deviation from the trend was estimated non-parametrically for each 6-month interval after the implementation of CCI . Second, a 1:3 matched comparator group (n=579) was constructed and used for a difference-in-differences (DiD) analysis. The primary outcome was annualized outpatient encounters. Secondary outcomes included emergency encounters and hospitalizations.&nbsp;Results: In two years prior to intervention, CCI participants had a mean of 5.77 annualized encounters (5.62 outpatient, 0.04 hospitalizations, 0.11 emergency). The CCI group showed a reduction in outpatient utilization after intervention. In ITS analysis, 1.6 to 1.9 fewer annualized outpatient encounters occurred in each 6-month interval post-intervention relative to expected utilization based on pre-intervention trends (p&lt;0.01 each 6-month period; 28-33% reduction). The DiD analysis suggested a larger reduction; 5 fewer annualized outpatient encounters in the quarter after intervention, diminishing to 2.5 fewer after 2 years (p&lt;0.01 each quarter). The study was underpowered to draw conclusions about hospitalization and emergency encounters due to the limited number of CCI patients and the rarity of encounters.&nbsp;Conclusions: Outpatient encounters were significantly reduced for a T2D patient population up to 2 years after receiving an individualized intervention supporting nutrition and behavior change through remote care.

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