At any Level of Adiposity, Relatively Elevated Leptin Concentrations Are Associated With Decreased Insulin Sensitivity.

CONTEXT: The impact of obesity on glucose homeostasis has high interindividual variability, which may be partially explained by different adipokine concentrations. Leptin regulates energy balance and metabolism, and although its plasma levels are proportional to fat mass, they vary significantly across individuals with the same level of adiposity. OBJECTIVE: We tested whether glucose homeostasis differs in subjects with similar degrees of adiposity but different leptin levels. METHODS: We analyzed 1290 healthy adults from the Relationship Between Insulin Sensitivity and Cardiovascular Disease study cohort (30-60 years; male/female, 577/713; body mass index [BMI], 25 ± 3 kg/m2) characterized for body composition and metabolic variables with a 75-g oral glucose tolerance test, euglycemic-hyperinsulinemic clamp, ß-cell function, and lipidomics. RESULTS: Individuals were divided into relatively high and low leptin (RHL and RLL) if they were above or below the sex-specific leptin-fat mass (%) regression. Despite similar glucose tolerance, RHL showed markedly higher fasting and oral glucose tolerance test insulin concentration (+30% and +29%, respectively; P < .0001) and secretion (+17% and +11%, respectively; P < .0001). Regardless of BMI, RHL individuals had lower whole-body (-17-23%, P < .0001) and adipose tissue insulin sensitivity (-24%, P < .0001) compared with RLL. Notably, lean RHL individuals showed similar insulin sensitivity and ß-cell function to RLL individuals with overweight/obesity. CONCLUSION: Subjects with leptin levels that are inappropriately elevated for their fat mass show whole-body/adipose tissue insulin resistance and hyperinsulinemia, regardless of BMI.

A randomized controlled trial investigating the effect of liraglutide on self-reported liking and neural responses to food stimuli in participants with obesity.

BACKGROUND/OBJECTIVES: Obesity is a complex condition and the mechanisms involved in weight gain and loss are not fully understood. Liraglutide, a GLP-1 receptor agonist, has been demonstrated to successfully promote weight loss in patients with obesity (OB). Yet, it is unclear whether the observed weight loss is driven by an alteration of food liking. Here we investigated the effects of liraglutide on food liking and the cerebral correlates of liking in OB. SUBJECTS/METHODS: This study was a randomized, single-center, double-blind, placebo-controlled, parallel group, prospective clinical trial. 73 participants with OB and without diabetes following a multidisciplinary weight loss program, were randomly assigned (1:1) to receive liraglutide 3.0 mg (37.40 ± 11.18 years old, BMI = 35.89 ± 3.01 kg) or a placebo (40.04 ± 14.10 years old, BMI = 34.88 ± 2.87 kg) subcutaneously once daily for 16 weeks. INTERVENTIONS/METHODS: We investigated liking during food consumption. Participants reported their hedonic experience while consuming a high-calorie food (milkshake) and a tasteless solution. The solutions were administered inside the scanner with a Magnetic Resonance Imaging (MRI)-compatible gustometer to assess neural responses during consumption. The same procedure was repeated during the pre- and post-intervention sessions. RESULTS: None of the effects involving the intervention factor reached significance when comparing liking between the pre- and post-intervention sessions or groups. Liking during food reward consumption was associated with the activation of the ventromedial prefrontal cortex (vmPFC) and the amygdala. The liraglutide group lost more weight (BMI post-pre = -3.19 ± 1.28 kg/m2) than the placebo group (BMI post-pre = -0.60 ± 1.26 kg/m2). CONCLUSIONS: These results suggest that liraglutide leads to weight loss without self-report or neural evidence supporting a concomitant reduction of food liking in participants with OB.

Effectiveness of Therapeutic Patient Education Interventions in Obesity and Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Diabetes mellitus (DM) and obesity account for the highest burden of non-communicable diseases. There is increasing evidence showing therapeutic patient education (TPE) as a clinically and cost-effective solution to improve biomedical and psychosocial outcomes among people with DM and obesity. The present systematic review and meta-analysis present a critical synthesis of the development of TPE interventions for DM and obesity and the efficacy of these interventions across a range of biomedical, psychosocial and psychological outcomes. A total of 54 of these RCTs were identified among patients with obesity and diabetes and were thus qualitatively synthesized. Out of these, 47 were included in the quantitative synthesis. There was substantial heterogeneity in the reporting of these outcomes (I2 = 88.35%, Q = 317.64), with a significant improvement noted in serum HbA1c levels (standardized mean difference (SMD) = 0.272, 95% CI: 0.118 to 0.525, n = 7360) and body weight (SMD = 0.526, 95% CI: 0.205 to 0.846, n = 1082) in the intervention group. The effect sizes were comparable across interventions delivered by different modes and delivery agents. These interventions can be delivered by allied health staff, doctors or electronically as self-help programs, with similar effectiveness (p < 0.001). These interventions should be implemented in healthcare and community settings to improve the health outcomes in patients suffering from obesity and DM.

Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis.

Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes, and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, CiteSpace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions, and institutes contributing to this field. Besides these, significant theoretical and empirical contributions that shaped this field were mapped. Our analysis revealed several important insights. Most of the important theories that helped shape TPE were inspired from the social sciences. Five important research themes were identified: disorders, study designs utilized in TPE research, the scope of the TPE literature and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes toward health promotion, reducing stigma, self-management and medication adherence. Most of the research was developed in the context of high-income countries. Future research should involve patients and use digital technology. Meta-analytical studies need to be done to identify the effectiveness and moderators of TPE interventions across different disorders. Further research should involve low and middle-income countries (LMIC) to ensure knowledge and technology transfer.

[Evolution and effectiveness of therapeutic patient education for obesity and diabetes]. / Évolution et efficacité de l'éducation thérapeutique du patient pour l'obésité et le diabète.

Therapeutic patient education (TPE) aims to help patients acquire or maintain the skills they need to best manage their lives with a chronic disease. Through a scientometric analysis of the literature, we identified the most influential bibliographic data related to TPE research that have strengthened the field and increased its effectiveness. These were studies from the fields of education, philosophy, psychology, anthropology and medical sociology. We have conducted a meta-analysis that has demonstrated the effectiveness of TPE for the management of obesity and diabetes on biological and psychological parameters. It allowed patients to improve their knowledge, their therapeutic adherence and their sense of self-efficacy.

L'éducation thérapeutique du patient (ETP) vise à aider les patients à acquérir ou maintenir les compétences dont ils ont besoin pour gérer au mieux leur vie avec une maladie chronique. À travers une analyse scientométrique de la littérature, nous avons identifié les données bibliographiques les plus influentes, relatives à la recherche en ETP, qui ont permis de renforcer le domaine et augmenter son efficacité. Ce sont des études issues des sciences de l'éducation, de la philosophie, de la psychologie, de l'anthropologie et de la sociologie médicale. Nous avons mené une méta-analyse qui a permis de démontrer l'efficacité de l'ETP pour la prise en charge de l'obésité et du diabète sur les paramètres biologiques et psychologiques. Elle a permis aux patients d'améliorer leurs connaissances, leur adhérence thérapeutique et le sentiment d'efficacité personnelle.

Effectiveness of therapeutic patient education interventions for chronic diseases: A systematic review and meta-analyses of randomized controlled trials.

Background: Chronic disorders are highly prevalent and are a major contributor to death and disability worldwide. Evidence has shown that therapeutic patient education (TPE) interventions are effective in improving a range of biomedical and psychological outcomes for a variety of chronic disorders. This has been demonstrated in scores of randomized controlled and evidence-synthesis studies. However, no quantitative evidence has been published so far on the content and effective teaching strategies in TPE programs. The present systematic review and meta-analysis aim to bridge this gap by answering the who, what, and how of TPE programs. Methods: Using a pretested search strategy, we searched the Web of Science, MEDLINE, CINAHL, PsycINFO, and the COCHRANE databases, from inception to August 2019. The search strategy was based on four comprehensive search concepts (patient education, chronic diseases, study design, and outcomes). After a careful screening for eligible studies, two reviewers extracted qualitative and quantitative data from the randomized controlled trials on the TPE interventions. We also developed a taxonomy of curriculum skills and intervention delivery techniques to aid the extraction of data in these domains. Results: We found that these interventions were effective in improving biological outcomes (SMD = 0.48; 95% CI: 0.38-0.57), adherence to the treatment regimen (SMD = 0.73; 95% CI: 0.46-1.002), knowledge (SMD = 1.22; 95% CI: 0.79-1.65), self-efficacy (SMD = 0.43; 95% CI: 0.30-0.56), and psychological health (SMD = -0.41; 95% CI: -0.53 to -0.29). This effectiveness was consistent across different delivery formats (individual, group, and electronic) and delivery agents (non-specialists vs. specialists). Conclusion: The flexibility in the choice of mode of delivery and curriculum development gives stakeholders an opportunity to scale up TPE interventions in healthcare settings. Systematic review registration: Identifier: CRD42019141294.

Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. METHODS: We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties. FINDINGS: We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of -0.38 for glycated haemoglobin (95% confidence interval, CI: -0.52 to -0.23; I 2 = 86.70%), -0.20 for fasting blood sugar (95% CI: -0.32 to -0.08; I 2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I 2 = 93.75%), 0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; I 2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I 2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of -0.04 for body mass index (95% CI: -0.13 to 0.05; I 2 = 35.94%), -0.06 for total cholesterol (95% CI: -0.16 to 0.04; I 2 = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; I 2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. CONCLUSION: Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

[A double pandemic : the impact of anti-Covid measures on obesity]. / Double pandémie : impact des mesures anti-Covid-19 sur l'obésité.

To deal with the COVID-19 pandemic, several restrictive measures have been put in place that cause significant disruption to lifestyle habits. We conducted a review of the literature to study the impact of these changes on the body weight of populations. We observed changes in eating habits (increase in the number of snacks and consumption of sugary products), a decrease in physical activity and an increase in stress that can exacerbate eating disorders. Increased efforts must be made to support patients during this difficult time, including public health measures to counteract these behaviours in order to prevent health complications.

Pour faire face à la pandémie de Covid-19, plusieurs mesures restrictives ont été mises en place, qui engendrent des perturbations importantes des habitudes de vie. Nous avons effectué une revue de la littérature pour étudier l'impact de ces changements sur le poids des populations. On observe des changements des habitudes alimentaires (augmentation du nombre de collations et de la consommation de produits sucrés), une baisse de l'activité physique et un accroissement du stress qui peut exacerber de troubles du comportement alimentaire. Des efforts accrus doivent être fournis pour soutenir les patients pendant cette période difficile, y compris des mesures de santé publique pour contrecarrer ces comportements afin de prévenir les complications de santé.

[The role of stress in obesity]. / Rôle du stress dans l'obésité.

Stress is known to favour weight gain. This can be explained by various physiopathological and behavioural mechanisms. Specifically, chronic stress induces a dysfunction of the sympathetic nervous system and of the hypothalamic-pituitary-adrenal axis which favours obesity, and the other way around. Furthermore, stress promotes eating disorders and a decrease in physical activity. Various studies using strategies that act specifically on stress have shown benefits in terms of weight loss. It is therefore important to evaluate stress in any patient suffering from obesity and to propose a treatment adapted to the patient's needs.

Le stress est connu comme un facteur favorisant la prise de poids. Cela s'explique par différents mécanismes physiopathologiques et comportementaux. Concrètement, le stress chronique induit un dysfonctionnement du système nerveux sympathique et de l'axe hypothalamo-hypophyso-surrénalien qui favorise l'obésité, et inversement. De plus, le stress favorise des troubles du comportement alimentaire et une baisse de l'activité physique. Diverses études utilisant des stratégies agissant spécifiquement sur le stress ont montré des bénéfices en termes de perte pondérale. Il est donc important d'évaluer le stress chez tout patient souffrant d'obésité et de proposer un traitement adapté en fonction des besoins du patient.

Ether lipids, sphingolipids and toxic 1-deoxyceramides as hallmarks for lean and obese type 2 diabetic patients.

AIM: The worldwide increase in obesity and type 2 diabetes (T2D) represents a major health challenge. Chronically altered lipids induced by obesity further promote the development of T2D, and the accumulation of toxic lipid metabolites in serum and peripheral organs may contribute to the diabetic phenotype. METHODS: To better understand the complex metabolic pattern of lean and obese T2D and non-T2D individuals, we analysed the lipid profile of human serum, skeletal muscle and visceral adipose tissue of two cohorts by systematic mass spectrometry-based lipid analysis. RESULTS: Lipid homeostasis was strongly altered in a disease- and tissue-specific manner, allowing us to define T2D signatures associated with obesity from those that were obesity independent. Lipid changes encompassed lyso-, diacyl- and ether-phospholipids. Moreover, strong changes in sphingolipids included cytotoxic 1-deoxyceramide accumulation in a disease-specific manner in serum and visceral adipose tissue. The high amounts of non-canonical 1-deoxyceramide present in human adipose tissue most likely come from cell-autonomous synthesis because 1-deoxyceramide production increased upon differentiation to adipocytes in mouse cell culture experiments. CONCLUSION: Taken together, the observed lipidome changes in obesity and T2D will facilitate the identification of T2D patient subgroups and represent an important step towards personalized medicine in diabetes.

[Obesity†: eat less and move more†? Not so easy]. / Obésité†: manger moins et bouger plus†? Pas si simple.

Obesity is a chronic disease that requires a complex treatment. Establishing a balanced diet and regular physical activity is not always simple, especially in the long term. There are multiple factors (biological and psychological) favoring weight gain, often limiting the effectiveness of lifestyle approaches. Pharmacology offers us another therapeutic option with new molecules effective for weight loss. Bariatric surgery is also effective, but it is not without risks, especially if the patients have not been adequately prepared for this procedure. Furthermore, these approaches should always be proposed as complementary to lifestyle changes. This article summarizes the different treatments for obesity and highlights the importance of a multidisciplinary management and proper patient education.

L'obésité est une maladie chronique dont le traitement est complexe. L'instauration d'un équilibre alimentaire et d'une activité physique régulière n'est pas toujours simple, surtout à long terme. Les facteurs favorisant la prise de poids sont multifactoriels (biologiques et psychologiques), limitant souvent l'efficacité des approches hygiéno-diététiques. La pharmacologie nous offre une autre piste thérapeutique avec de nouvelles molécules efficaces pour perdre du poids. La chirurgie bariatrique est efficace, mais elle n'est pas sans risques, surtout si les patients n'ont pas eu une préparation adéquate. Ces traitements doivent toujours être proposés en complément de modifications d'hygiène de vie. Cet article résume les différents traitements de l'obésité et souligne l'importance de la prise en charge multidisciplinaire et de l'éducation thérapeutique du patient.

[Start to collaborate with partner patients†: an evidence?] / Entrer en collaboration avec des patients partenaires†: une évidence†?

The societal, political and institutional context is today favorable for the establishment of a partnership between patient and healthgivers. Despite the tangible benefits, the perception of partners ambivalent attitudes reinforces the importance of the construction for this collaboration. This article describes this collaborative approach born out of the transformation of a bariatric surgery preparation educational program. In this context, the implementation strategy is the founding stage to explore the needs of partners. This highlights the need to secure the healthgivers regarding power issues, as well as to question the skills required for patient partners. The definition of the partnership model by the partners provides answers.

Le contexte sociétal, politique et institutionnel est aujourd'hui favorable à la mise en place d'un partenariat entre patients et soignants. Malgré des bénéfices tangibles, la perception d'une ambivalence des partenaires renforce l'importance de la construction de cette collaboration. Cet article décrit cette démarche collaborative, née dans le contexte de la transformation d'un programme éducatif de préparation à la chirurgie bariatrique. Dans la stratégie d'implémentation, l'exploration contextuelle des besoins des partenaires constitue l'étape fondatrice. Elle met en lumière un besoin de sécurisation des soignants quant à des enjeux de pouvoir, et questionne sur les compétences requises des patients partenaires. La définition du modèle de partenariat par les partenaires apporte des réponses.

Diabetes management in Guinea Bissau: a situational analysis.

INTRODUCTION: There is an increasing commitment in the African Region towards diabetes care, following acknowledgement that it is an important public health issue which needs to be addressed in order to improve population health. We conducted a situational analysis of diabetes care in Guinea Bissau in order to identify the main issues faced in the management of the disease in this country. METHODS: The study design was qualitative and data collection was done using semi directive interviews and focus groups with participants involved in primary diabetes care and management in Guinea Bissau (health care professionals, non-governmental organization staff, traditional healers) and patients. The data was analyzed using the five-phase approach of the thematic analysis framework. RESULTS: The major themes identified included: the lack of specialists and properly trained healthcare personnel; no standardized care protocol for diagnosis, treatment, follow up and proper management for diabetic patients; resources poor primary health care settings; no validated epidemiological dataset on prevalence and the lack of awareness about diabetes (in general population and also in medical staff). CONCLUSION: This first situational analysis can serve as a baseline to develop an action plan to address the main issues identified.

Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review.

BACKGROUND: Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS: Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS: 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION: Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.

[Therapeutic education program should be adapted to the specificity of chronic kidney disease]. / Comment adapter une offre éducative aux spécificités des patients atteints d'insuffisance rénale chronique ?

INTRODUCTION: Chronic kidney disease (CKD) is an evolutive disease. In its early stages the disease often goes asymptomatic and unrecognized. For CKD patients, disease awareness is usually late, with the occurrence of the first symptoms. In more advanced stages, CKD implies massive consequences on patient's life. Extrarenal substitution methods (such as hemodialysis, peritoneal dialysis or transplantation) are presented to the patient, who is facing a very difficult choice, inducing major changes in his lifestyle. DESCRIPTION: In this article, we share the adaptation process of a therapeutic education program in nephrology, presenting its specificity and the encountered difficulties. We propose to develop an educative program adapted to patient's needs, which differs according to CKD stage. CONCLUSION: Therapeutic patient education (TPE) has become a need in the care of CKD patients, even at early stages of the disease. TPE allows to prepare the patients, favoring autonomy and shared decision making about his disease, in collaboration with healthcare workers and patient's relatives.

Cellular circadian period length inversely correlates with HbA1c levels in individuals with type 2 diabetes.

AIMS/HYPOTHESIS: The circadian system plays an essential role in regulating the timing of human metabolism. Indeed, circadian misalignment is strongly associated with high rates of metabolic disorders. The properties of the circadian oscillator can be measured in cells cultured in vitro and these cellular rhythms are highly informative of the physiological circadian rhythm in vivo. We aimed to discover whether molecular properties of the circadian oscillator are altered as a result of type 2 diabetes. METHODS: We assessed molecular clock properties in dermal fibroblasts established from skin biopsies taken from nine obese and eight non-obese individuals with type 2 diabetes and 11 non-diabetic control individuals. Following in vitro synchronisation, primary fibroblast cultures were subjected to continuous assessment of circadian bioluminescence profiles based on lentiviral luciferase reporters. RESULTS: We observed a significant inverse correlation (ρ = -0.592; p < 0.05) between HbA1c values and circadian period length within cells from the type 2 diabetes group. RNA sequencing analysis conducted on samples from this group revealed that ICAM1, encoding the endothelial adhesion protein, was differentially expressed in fibroblasts from individuals with poorly controlled vs well-controlled type 2 diabetes and its levels correlated with cellular period length. Consistent with this circadian link, the ICAM1 gene also displayed rhythmic binding of the circadian locomotor output cycles kaput (CLOCK) protein that correlated with gene expression. CONCLUSIONS/INTERPRETATION: We provide for the first time a potential molecular link between glycaemic control in individuals with type 2 diabetes and circadian clock machinery. This paves the way for further mechanistic understanding of circadian oscillator changes upon type 2 diabetes development in humans. DATA AVAILABILITY: RNA sequencing data and clinical phenotypic data have been deposited at the European Genome-phenome Archive (EGA), which is hosted by the European Bioinformatics Institute (EBI) and the Centre for Genomic Regulation (CRG), ega-box-1210, under accession no. EGAS00001003622.