Pilot Test of a Culturally Appropriate Diabetes Prevention Intervention for At-Risk Latina Women.

Purpose The purpose of the study was to test the preliminary effectiveness, feasibility, and acceptability of a peer-led, culturally appropriate, Diabetes Prevention Program (DPP)-based lifestyle intervention for Latina women at high-risk for type 2 diabetes (T2DM). Methods Participants (N = 61) were overweight/obese (body mass index [BMI] ≥25) Latina women with no diabetes, at elevated risk either due to midlife age (45-65 years; n = 37) or history of gestational diabetes mellitus (n = 24). The study used a 1-group pretest-posttest design and offered 12 weeks of peer-led education sessions in a community setting. The intervention targeted physical activity and dietary behaviors to facilitate weight reduction and included culturally appropriate content, age-specific health information, and stress/emotion management strategies. Clinical and self-report assessments were conducted at baseline, month 3, and month 6. Results Mean participant age was 47.8 years (SD = 10.8). Most (91.2%) were born in Mexico, and 43.3% had a ninth-grade education or less. At month 6, participants achieved a mean reduction of 4.1% body weight (7 lb [3.2 kg]). Statistically significant improvements were observed for dietary behaviors, stress, and depression symptoms. Attrition was low, 5% (3 women). Focus groups indicated that intervention content increased knowledge, was applicable, highly valued, culturally relevant, and would be recommended to others. Conclusions This culturally tailored DPP adaptation was feasible and acceptable for 2 groups of Latina women at high-risk for T2DM and showed preliminary effectiveness in reducing weight and modifying self-reported dietary behaviors, stress, and depression symptoms. Further research is needed to identify ways to enhance weight loss and diabetes prevention in this at-risk, underserved population.

A novel option for prandial insulin therapy: inhaled insulin.

Many adults with type 2 diabetes (T2D) do not achieve or maintain glycemic targets on oral antidiabetes drugs (OADs) alone and require insulin therapy. Although initiating basal insulin is common when treatment needs to be intensified, individualization of therapy (in line with current guidelines) may lead more health care professionals (HCPs) to add rapid-acting insulin (RAI) to OAD regimens for treatment of postprandial hyperglycemia to achieve glycated hemoglobin (A1C) targets. HCPs and patients are concerned about the burden associated with injections. Inhaled Technosphere® insulin (inhaled TI) - as an alternative to injectable bolus doses of prandial insulin - may increase patient and HCP willingness to intensify therapy and improve compliance with more complex regimens. Clinical studies have shown that inhaled TI is effective and well tolerated as a prandial insulin, and has the potential to improve treatment satisfaction and quality of life in adults with T2D. The favorable pharmacokinetic profile of inhaled TI (i.e., a very rapid onset of action and a short duration of anti-hyperglycemic effect) may reduce the risk of insulin stacking (overlapping effects of RAI injections taken < 4 hours apart) and postprandial hypoglycemia. In this review, we present inhaled TI as an alternative to OADs or injected insulin as adjunctive therapy, for consideration by HCPs striving to achieve glycemic targets for their patients.

Post-gastric-bypass hypoglycemia successfully treated with alpha-glucosidase inhibitor therapy.

OBJECTIVE: To review the effectiveness of alpha-glucosidase inhibitor (AGI) therapy in the treatment of hypoglycemia after Roux-en-y gastric surgery. METHODS: Retrospective case review. RESULTS: Four patients who previously underwent Roux-en-y gastric bypass were evaluated because of severe symptomatic postprandial hypoglycemia that was unresponsive to a low-carbohydrate diet. Mixed-meal testing confirmed hyperinsulinemia. Other causes of hypoglycemia were ruled out by a combination of clinical examination, endocrine testing, and computed tomography imaging. Symptomatic hypoglycemia resolved in all 4 patients after AGI therapy was started. One patient could not tolerate long-term therapy because of a rash. The other 3 patients were followed for between 5 and 48 months and remained free of symptomatic postprandial hypoglycemia. CONCLUSION: AGI therapy is effective in the long-term treatment of post-Roux-en-y hypoglycemia in patients unresponsive to a low-carbohydrate diet. To our knowledge, this is the first report documenting the long-term usefulness of this therapy in a series of patients.