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 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.

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-randomised controlled study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023597 ◽  
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

ObjectiveOne year of comprehensive continuous care intervention (CCI) through nutritional ketosis improves glycosylated haemoglobin(HbA1c), body weight and liver enzymes among patients with type 2 diabetes (T2D). 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-randomised longitudinal study, including adults with T2D who were self-enrolled to the CCI (n=262) or to receive usual care (UC, n=87) during 1 year. An NAFLD liver fat score (N-LFS) >−0.640 defined the presence of fatty liver. An NAFLD fibrosis score (NFS) of >0.675 identified subjects with advanced fibrosis. Changes in N-LFS and NFS at 1 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 1 year, weight loss of ≥5% was achieved in 79% of patients in the CCI versus 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 T2D.Trial registration numberNCT02519309; Results.

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

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

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 Cardiovascular Disease Risk Factor Responses to a Type 2 Diabetes Care Model Including Nutritional Ketosis at One Year: An Open Label, Non-Randomized, Controlled Study

2018 ◽  
Author(s):  
Nasir H. Bhanpuri ◽  
Sarah J. Hallberg ◽  
Paul T. Williams ◽  
Amy L. McKenzie ◽  
Kevin D. Ballard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Controlled Study ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Open Label ◽  
Randomized Controlled ◽  
Continuous Care ◽  
One Year

AbstractBackgroundCardiovascular disease (CVD) is a leading cause of death among adults with type 2 diabetes mellitus (T2D). We recently reported that glycemic control in patients with T2D can be significantly improved through a continuous care intervention (CCI) including nutritional ketosis. The purpose of this study was to examine CVD risk factors in this cohort.MethodsWe investigated CVD risk factors in patients with T2D who participated in a one year open label, non-randomized, controlled study. The CCI group (n = 262) received treatment from a health coach and medical provider. A usual care (UC) group (n = 87) was independently recruited to track customary T2D progression. Circulating biomarkers of cholesterol metabolism and inflammation, blood pressure (BP), carotid intima media thickness (cIMT), multi-factorial risk scores and medication use were examined.ResultsThe CCI group consisted of 262 patients (baseline mean(SD): age 54(8) y, BMI 40.4(8.8) kg/m2). Intention-to-treat analysis (% change) revealed the following at 1-year with P values < 0.0019 indicating statistical significance after adjustment for multiple comparisons: total LDL-particles (LDL-P) (−4.9%, P=0.02), small LDL-P (−20.8%, P=1.2×10−12), LDL-P size (+1.1%, P=6.0×10−10), ApoB (−1.6%, P=0.37), ApoA1 (+9.8%, P<10−16), ApoB/ApoA1 ratio (−9.5%, P=1.9×10−7), triglyceride/HDL-C ratio (−29.1%, P<10−16), large VLDL-P (−38.9%, P=4.2×10−15), and LDL-C (+9.9%, P=4.9×10−5). Additional effects were reductions in blood pressure, high sensitivity C-reactive protein, and white blood cell count (all P<1×10−7) while cIMT was unchanged. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score decreased −11.9% (P=4.9×10−5). Antihypertensive medication use was discontinued in 11.4 % of CCI participants (P=5.3×10−5). The UC group of 87 patients (baseline mean(SD): age 52(10)y, BMI 36.7(7.2) kg/m2) showed no significant changes. After adjusting for baseline differences when comparing CCI and UC groups, significant improvements for the CCI group included small LDL-P, ApoA1, triglyceride/HDL-C ratio, HDL-C, hs-CRP, and ASCVD score. The CCI group showed a greater rise in LDL-C.ConclusionsA continuous care treatment including nutritional ketosis in patients with T2D improved most biomarkers of CVD risk after one year. The increase in LDL-cholesterol appeared limited to the large LDL subfraction. LDL particle size increased, total LDL-P and ApoB were unchanged, and inflammation and blood pressure decreased.Trial registrationClinicaltrials.gov: NCT02519309. Registered 10 August 2015

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