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Mediterranean Diet and Healthy Eating in Subjects with Prediabetes from the Mollerussa Prospective Observational Cohort Study.
Falguera, M, Castelblanco, E, Rojo-López, MI, Vilanova, MB, Real, J, Alcubierre, N, Miró, N, Molló, À, Mata-Cases, M, Franch-Nadal, J, et al
Nutrients. 2021;(1)
Abstract
We aimed to assess differences in dietary patterns (i.e., Mediterranean diet and healthy eating indexes) between participants with prediabetes and those with normal glucose tolerance. Secondarily, we analyzed factors related to prediabetes and dietary patterns. This was a cross-sectional study design. From a sample of 594 participants recruited in the Mollerussa study cohort, a total of 535 participants (216 with prediabetes and 319 with normal glucose tolerance) were included. The alternate Mediterranean Diet score (aMED) and the alternate Healthy Eating Index (aHEI) were calculated. Bivariable and multivariable analyses were performed. There was no difference in the mean aMED and aHEI scores between groups (3.2 (1.8) in the normoglycemic group and 3.4 (1.8) in the prediabetes group, p = 0.164 for the aMED and 38.6 (7.3) in the normoglycemic group and 38.7 (6.7) in the prediabetes group, p = 0.877 for the aHEI, respectively). Nevertheless, women had a higher mean of aMED and aHEI scores in the prediabetes group (3.7 (1.9), p = 0.001 and 40.5 (6.9), p < 0.001, respectively); moreover, they had a higher mean of aHEI in the group with normoglycemia (39.8 (6.6); p = 0.001). No differences were observed in daily food intake between both study groups; consistent with this finding, we did not find major differences in nutrient intake between groups. In the multivariable analyses, the aMED and aHEI were not associated with prediabetes (odds ratio (OR): 1.19, 95% confidence interval (CI): 0.75-1.87; p = 0.460 and OR: 1.32, 95% CI: 0.83-2.10; p = 0.246, respectively); however, age (OR: 1.04, 95% CI: 1.02-1.05; p < 0.001), dyslipidemia (OR: 2.02, 95% CI: 1.27-3.22; p = 0.003) and body mass index (BMI) (OR: 1.09, 95% CI: 1.05-1.14; p < 0.001) were positively associated with prediabetes. Physical activity was associated with a lower frequency of prediabetes (OR: 0.48, 95% CI: 0.31-0.72; p = 0.001). In conclusion, subjects with prediabetes did not show a different dietary pattern compared with a normal glucose tolerance group. However, further research is needed on this issue.
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Observational study of the efficacy of prolonged-release metformin in people with prediabetes.
Hostalek, U, Zilahi, Z
Current medical research and opinion. 2020;(3):397-401
Abstract
Objectives: Prediabetes is characterized by elevation of indices of blood glucose that is insufficient to provoke a diagnosis of type 2 diabetes, but markedly increases the risk of developing type 2 diabetes in the future. Lifestyle interventions are the main therapeutic intervention for the management of prediabetes. Current guidelines also support treatment of prediabetes with metformin for selected subgroups of patients, and metformin has a therapeutic indication for this use in a number of countries.Methods: We performed an observational, non-interventional study of the effects on glycaemia of prolonged-release metformin (Glucophage XR, referred to henceforth as metformin XR) in 686 subjects with prediabetes. Metformin was prescribed according to physicians' usual care practices, and the study duration was 12 weeks.Results: Mean (SD) fasting plasma glucose (FPG) at baseline was 6.2 (0.4) mmol/L [111 (8) mg/dL) and was reduced by -0.55 (0.7) mmol/L [-10 (13) mg/dL] after 12 weeks of metformin XR. FPG was normalized to below the American Diabetes Association cut-off for the diagnosis of prediabetes (<5.7 mmol/L [100 mg/dL]) in 43% of subjects. Increasing age, increasing body mass index, not following a weight-loss diet and alcohol use predicted a lower probability of normalized FPG. Metformin was well tolerated, with most side effects occurring in the gastrointestinal system, as expected.Conclusions: Metformin XR normalized FPG in about two-fifths of subjects with prediabetes. These real-world data add further support a role for metformin in the management of prediabetes, in line with current guidelines in this area.
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Relationship between multiple lifestyle behaviors and health-related quality of life among elderly individuals with prediabetes in rural communities in China: A STROBE-compliant article.
Hu, Z, Qin, L, Kaminga, AC, Xu, H
Medicine. 2020;(15):e19560
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Evidence of the effect of lifestyle behaviors on health-related quality of life (HRQoL) is scarce or ambiguous. The objective of the present study was to explore the associations between multiple lifestyle behaviors and HRQoL among the elderly individuals with prediabetes.Four hundred thirty-four elderly individuals with prediabetes were included in this cross-sectional study. The Medical Outcomes Study 36-Item Short Form Health Survey Questionnaire (SF-36) was used to assess HRQoL. Multiple lifestyle behaviors, including smoking, alcohol consumption, physical activity, dietary habits, daily sedentary time and sleep duration were self-reported. The associations between HRQoL and multiple lifestyle behaviors were examined using a multivariate linear regression analysis.Lower-risk physical activities (β =3 .19, 95% CI: 1.32, 5.64), dietary habits (β = 2.60, 95% CI: 1.50, 4.72), and sedentary time (β = 2.49, 95% CI: 1.21, 4.81) were positively associated with the physical health component score (PCS) for HRQoL. Meanwhile, a lower-risk behavior, such as sleep duration (β = 2.64, 95% CI: 1.77, 4.51), was associated with a higher mental health component score (MCS) for HRQoL after adjusting for socio-demographic factors, chronic diseases, anthropometric data and all other lifestyle behaviors. Engaging in a greater number of lower-risk lifestyle behaviors was positively correlated with a better HRQoL.Multiple lifestyle behaviors were associated with HRQoL among the elderly individuals with prediabetes in rural areas. These results highlight the need for multiple lifestyle behavioral interventions to maintain and improve HRQoL in the elderly individuals with prediabetes.
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Reach and Use of Diabetes Prevention Services in the United States, 2016-2017.
Ali, MK, McKeever Bullard, K, Imperatore, G, Benoit, SR, Rolka, DB, Albright, AL, Gregg, EW
JAMA network open. 2019;(5):e193160
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IMPORTANCE Coordinated efforts by national organizations in the United States to implement evidence-based lifestyle modification programs are under way to reduce type 2 diabetes (hereinafter referred to as diabetes) and cardiovascular risks. OBJECTIVE To provide a status report on the reach and use of diabetes prevention services nationally. DESIGN, SETTING, AND PARTICIPANTS This nationally representative, population-based cross-sectional analysis of 2016 and 2017 National Health Interview Survey data was conducted from August 3, 2017, through November 15, 2018. Nonpregnant, noninstitutionalized, civilian respondents 18 years or older at high risk for diabetes, defined as those with no self-reported diabetes diagnosis but with diagnosed prediabetes or an elevated American Diabetes Association (ADA) risk score (>5), were included in the analysis. Analyses were conducted for adults with (and in sensitivity analyses, for those without) elevated body mass index. MAIN OUTCOMES AND MEASURES Absolute numbers and proportions of adults at high risk with elevated body mass index receiving advice about diet, physical activity guidance, referral to weight loss programs, referral to diabetes prevention programs, or any of these, and those affirming engagement in each (or any) activity in the past year were estimated. To identify where gaps exist, a prevention continuum diagram plotted existing vs desired goal achievement. Variation in risk-reducing activities by age, sex, race/ethnicity, educational attainment, insurance status, history of gestational diabetes mellitus, hypertension, or body mass index was also examined. RESULTS This analysis included 50 912 respondents (representing 223.0 million adults nationally) 18 years or older (mean [SE] age, 46.1 [0.2] years; 48.1% [0.3%] male) with complete data and no self-reported diabetes diagnosis by their health care professional. Of the represented population, 36.0% (80.0 million) had either a physician diagnosis of prediabetes (17.9 million), an elevated ADA risk score (73.3 million), or both (11.3 million). Among those with diagnosed prediabetes, 73.5% (95% CI, 71.6%-75.3%) reported receiving advice and/or referrals for diabetes risk reduction from their health care professional, and, of those, 35.0% (95% CI, 30.5%-39.8%) to 75.8% (95% CI, 73.2%-78.3%) reported engaging in the respective activity or program in the past year. Half of adults with elevated ADA risk scores but no diagnosed prediabetes (50.6%; 95% CI, 49.5%-51.8%) reported receiving risk-reduction advice and/or referral, of whom 33.5% (95% CI, 30.1%-37.0%) to 75.2% (95% CI, 73.4%-76.9%) reported engaging in activities and/or programs. Participation in diabetes prevention programs was exceedingly low. Advice from a health care professional, age range from 45 to 64 years, higher educational attainment, health insurance status, gestational diabetes mellitus, hypertension, and obesity were associated with higher engagement in risk-reducing activities and/or programs. CONCLUSIONS AND RELEVANCE Among adults at high risk for diabetes, major gaps in receiving advice and/or referrals and engaging in diabetes risk-reduction activities and/or programs were noted. These results suggest that risk perception, health care professional referral and communication, and insurance coverage may be key levers to increase risk-reducing behaviors in US adults. These findings provide a benchmark from which to monitor future program availability and coverage, identification of prediabetes, and referral to and retention in programs.
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Directional Relationship Between Vitamin D Status and Prediabetes: A New Approach from Artificial Neural Network in a Cohort of Workers with Overweight-Obesity.
Vigna, L, Silvia Tirelli, A, Grossi, E, Turolo, S, Tomaino, L, Napolitano, F, Buscema, M, Riboldi, L
Journal of the American College of Nutrition. 2019;(8):681-692
Abstract
Objective: Despite the increasing literature on the association of diabetes with inflammation, cardiovascular risk, and vitamin D (25(OH)D) concentrations, strong evidence on the direction of causality among these factors is still lacking. This gap could be addressed by means of artificial neural networks (ANN) analysis.Methods: Retrospective observational study was carried out by means of an innovative data mining analysis-known as auto-contractive map (AutoCM)-and semantic mapping followed by Activation and Competition System on data of workers referring to an occupational-health outpatient clinic. Parameters analyzed included weight, height, waist circumference, body mass index (BMI), percentage of fat mass, glucose, insulin, glycated hemoglobin (HbA1c), creatinine, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, uric acid, fibrinogen, homocysteine, C-reactive protein (CRP), diastolic and systolic blood pressure, and 25(OH)D.Results: The study included 309 workers. Of these, 23.6% were overweight, 40.5% were classified into the first class of obesity, 23.3% were in the second class, and 12.6% were in the third class (BMI > 40 kg/m ). All mean biochemical values were in normal range, except for total cholesterol, low- and high-density lipoprotein cholesterol, CRP, and 25(OH)D. HbA1c was between 39 and 46 mmol/mol in 51.78%. 25(OH)D levels were sufficient in only 12.6%. Highest inverse correlation for hyperglycemia onset was with BMI and waist circumference, suggesting a protective role of 25(OH)D against their increase. AutoCM processing and the semantic map evidenced direct association of 25(OH)D with high link strength (0.99) to low CRP levels and low high-density lipoprotein cholesterol levels. Low 25(OH)D led to changes in glucose, which affected metabolic syndrome biomarkers, first of which was homeostatic model assessment index and blood glucose, but not 25(OH)D.Conclusions: The use of ANN suggests a key role of 25(OH)D respect to all considered metabolic parameters in the development of diabetes and evidences a causation between low 25(OH)D and high glucose concentrations.
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Prospective association between late evening food consumption and risk of prediabetes and diabetes: the Whitehall II cohort study.
Faerch, K, Quist, JS, Hulman, A, Witte, DR, Tabak, AG, Brunner, EJ, Kivimäki, M, Jørgensen, ME, Panda, S, Vistisen, D
Diabetic medicine : a journal of the British Diabetic Association. 2019;(10):1256-1260
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AIMS: We examined whether late evening food consumption was prospectively associated with the risk of developing prediabetes or diabetes in a large observational study of individuals with normoglycaemia. METHODS Participants were 2642 men and women with normoglycaemia (HbA1c < 39 mmol/mol; < 5.7%) from the Whitehall II study. Time of last eating episode (TLEE) before the examination day was assessed at baseline. We studied the associations of TLEE with 5-year changes in HbA1c and risk of developing prediabetes or diabetes (HbA1c ≥ 39 mmol/mol; ≥ 5.7%). Potential heterogeneity in the association between TLEE and prediabetes or diabetes was examined using recursive partitioning modelling for time-to-event outcomes. RESULTS There was a tendency of an overall association of TLEE with change in HbA1c but with little effect size [β per 1-h increase in TLEE = 0.2 mmol/mol, 95% CI -0.0 to 0.3 (0.01%, -0.00 to 0.03); P = 0.055] and no association with the risk of developing prediabetes/diabetes (risk ratio per 1-h increase in TLEE = 1.03, 95% CI 0.94 to 1.13; P = 0.511). According to the recursive partitioning modelling, women with HbA1c ≤ 36 mmol/mol and TLEE after 21:00 had a 1.51 times (95% CI 1.16 to 1.93) higher 5-year risk of developing prediabetes or diabetes than those having their TLEE between 16:00 and 21:00 (35.4% vs. 23.5%; P = 0.003). CONCLUSIONS There was no overall association of TLEE with the development of prediabetes or diabetes in the Whitehall II population. However, explorative analyses suggested that eating late in the evening was associated with increased risk of developing prediabetes/diabetes among women with good glycaemic control. Whether restricting late evening food consumption is effective and feasible for the prevention of Type 2 diabetes needs testing in randomized controlled trials.
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Lifestyle intervention programme for Indian women with history of gestational diabetes mellitus.
Kapoor, D, Gupta, Y, Desai, A, Praveen, D, Joshi, R, Rozati, R, Bhatla, N, Prabhakaran, D, Reddy, P, Patel, A, et al
Global health, epidemiology and genomics. 2019;:e1
Abstract
AIM: To evaluate the feasibility and potential effectiveness of a lifestyle intervention (diet and physical activity) among women with history of gestational diabetes mellitus (GDM), delivered by trained facilitators. METHODS Fifty-six normoglycaemic or prediabetic women with prior GDM were recruited at mean of 17 months postpartum. Socio-demographic, medical and anthropometric data were collected. Six sessions on lifestyle modification were delivered in groups (total four groups, with 12-15 women in each group). Pre and post intervention (6 months) weight, body mass index (BMI), waist circumference, 75 g oral glucose tolerance test, blood pressure (BP) and lipid parameters were compared. RESULTS The intervention was feasible, with 80% of women attending four or more sessions. Post-intervention analyses showed a significant mean reduction of 1.8 kg in weight, 0.6 kg/m2 in BMI and 2 cm in waist circumference. There was also a significant drop of 0.3 mmol/L in fasting plasma glucose, 0.9 mmol/L in 2 h post glucose load value of plasma glucose, 3.6 mmHg in systolic BP, and 0.15 mmol/L in triglyceride levels. Changes in total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and diastolic BP were non-significant. CONCLUSIONS This study showed feasibility of the lifestyle intervention delivered in group sessions to women with prior gestational diabetes.
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Macular thinning in prediabetes or type 2 diabetes without diabetic retinopathy: the Maastricht Study.
De Clerck, EEB, Schouten, JSAG, Berendschot, TTJM, Goezinne, F, Dagnelie, PC, Schaper, NC, Schram, MT, Stehouwer, CDA, Webers, CAB
Acta ophthalmologica. 2018;(2):174-182
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PURPOSE To assess macular thinning in individuals with prediabetes or type 2 diabetes without diabetic retinopathy (DM2 w/o DR) compared with individuals with normal glucose metabolism (NGM). METHODS Using spectral domain optical coherence tomography (SD-OCT), we measured macular thickness in six subfields as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) in 1838 participants from The Maastricht Study, a population-based cohort study (mean age 59 ± 8 years, 49% men, 1087 NGM, 279 prediabetes, 472 DM2 w/o DR). Multivariable linear regression was used to assess the association between macular thickness and glucose metabolism status. RESULTS After adjustment for age, sex and spherical equivalent, individuals with prediabetes showed a significant decrease in pericentral superior macular thickness [β = -2.14 μm (95% confidence interval (CI): -4.24 to -0.03), p < 0.05] compared with individuals with NGM. In individuals with DM2 w/o DR, the fovea [β = -4.05 μm (95% CI: -6.30 to -1.79), p < 0.001] and the four pericentral quadrants (range: β = -4.64 to -5.29 μm, p < 0.001) were significantly thinner compared with individuals with NGM. There was a significant linear trend of macular thinning with severity of glucose metabolism status in five subfields (p < 0.001). CONCLUSION Macular thickness is reduced in prediabetes and a greater reduction occurs in DM2, even before DR is clinically present. About half of the thinning observed in DM2 w/o DR was already found in prediabetes. Generalized thinning of the macula could be related to thinning of the temporal side of the optic nerve head through the connecting papillo-macular bundle.
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A unique plasma microRNA profile defines type 2 diabetes progression.
de Candia, P, Spinetti, G, Specchia, C, Sangalli, E, La Sala, L, Uccellatore, A, Lupini, S, Genovese, S, Matarese, G, Ceriello, A
PloS one. 2017;(12):e0188980
Abstract
A major unmet medical need to better manage Type 2 Diabetes (T2D) is the accurate disease prediction in subjects who show glucose dysmetabolism, but are not yet diagnosed as diabetic. We investigated the possibility to predict/monitor the progression to T2D in these subjects by retrospectively quantifying blood circulating microRNAs in plasma of subjects with i) normal glucose tolerance (NGT, n = 9); ii) impaired glucose tolerance (IGT, n = 9), divided into non-progressors (NP, n = 5) and progressors (P, n = 4) based on subsequent diabetes occurrence, and iii) newly diagnosed T2D (n = 9). We found that impaired glucose tolerance associated with a global increase of plasma circulating microRNAs. While miR-148 and miR-222 were specifically modulated in diabetic subjects and correlated with parameters of glucose tolerance, the most accentuated microRNA dysregulation was found in NP IGT subjects, with increased level of miR-122, miR-99 and decreased level of let-7d, miR-18a, miR-18b, miR-23a, miR-27a, miR-28 and miR-30d in comparison with either NGT or T2D. Interestingly, several of these microRNAs significantly correlated with parameters of cholesterol metabolism. In conclusion, we observed the major perturbation of plasma circulating microRNA in NP pre-diabetic subjects and identified a unique microRNA profile that may become helpful in predicting diabetic development.
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Outcomes of a community-based lifestyle programme for adults with diabetes or pre-diabetes.
Higgs, C, Skinner, M, Hale, L
Journal of primary health care. 2016;(2):130-9
Abstract
INTRODUCTION Diabetes, a long-term condition increasing in prevalence, requires ongoing healthcare management. Exercise alongside lifestyle education and support is effective for diabetes management. AIM To investigate clinical outcomes and acceptability of a community-based lifestyle programme for adults with diabetes/prediabetes at programme completion and 3-month follow-up. METHODS The 12-week community programme included twice-weekly sessions of self-management education and exercise, supervised by a physiotherapist, physiotherapy students and a nurse. Clinical outcomes assessed were cardiorespiratory fitness, waist circumference, exercise behaviour and self-efficacy. A standardised evaluation form was used to assess programme acceptability. RESULTS Clinically significant improvements were found from baseline (n = 36) to programme completion (n = 25) and 3-months follow-up (n = 20) for the six minute walk test (87 m (95%CI 65-109; p ≤ 0.01), 60 m (95%CI 21-100; p ≤ 0.01)), waist circumference (-3 cm (95%CI -6 to -1), -3 cm (95%CI -6 to 1)), exercise behaviour (aerobic exercise 53 min/week (95%CI 26 to 81; p ≤ 0.01), 71 min/week (95%CI 25 to 118; p ≤ 0.01)) and self-efficacy (0.7 (95%CI -0.2 to 1.6), 0.8 (95%CI 0.04 to 1.5)). Good programme acceptability was demonstrated by themes suggesting a culturally supportive, motivating, friendly, informative atmosphere within the programme. The attrition rate was 30% but there were no adverse medical events related to the programme. DISCUSSION The programme was safe and culturally acceptable and outcomes demonstrated clinical benefit to participants. The attrition rate was largely due to medical reasons unrelated to the programme. This model of a community-based lifestyle programme has the potential to be reproduced in other regions and in adults with similar long-term conditions. KEYWORDS Diabetes Mellitus Type II; Prediabetic state; Co-morbidity; Exercise; Self-management.