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BACKGROUND & AIMS: This was a randomized, double-blind, placebo-controlled study to assess the effects of pemvidutide, a glucagon-like peptide-1 (GLP-1)/glucagon dual receptor agonist, on liver fat content (LFC) in subjects with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: Subjects with a BMI ≥28.0 kg/m2 and LFC ≥10% by magnetic resonance imaging-proton density fat fraction were randomized 1:1:1:1 to pemvidutide at 1.2 mg, 1.8 mg, or 2.4 mg, or placebo administered subcutaneously once weekly for 12 weeks. Participants were stratified according to a diagnosis of type 2 diabetes mellitus (T2DM). The primary efficacy endpoint was relative reduction (%) from baseline in LFC after 12 weeks of treatment. RESULTS: 94 subjects were randomized and dosed. Median baseline BMI and LFC across the study population were 36.2 kg/m2 and 20.6%; 29% of subjects had T2DM. At Week 12, relative reductions in LFC from baseline were (1.2 mg) 46.6% [95% CI -63.7 to -29.6], (1.8 mg) 68.5% [95% CI -84.4 to -52.5], and (2.4 mg) 57.1% [95% CI -76.1 to -38.1] versus 4.4% [95% CI -20.2 to 11.3] in placebo subjects (p <0.001 vs. placebo, all treatment groups), with 94.4% and 72.2% of subjects achieving 30% and 50% reductions in LFC and 55.6% achieving normalization (≤5% LFC) at the 1.8 mg dose. Maximal responses for weight loss (-4.3%; p <0.001), alanine aminotransferase (-13.8 IU/L; p = 0.029), and corrected cT1 (-75.9 ms; p = 0.002) were all observed at the 1.8 mg dose. Pemvidutide was well-tolerated at all doses with no severe or serious adverse events. CONCLUSIONS: In subjects with MASLD, weekly pemvidutide treatment yielded significant reductions in LFC, markers of hepatic inflammation, and body weight compared to placebo. IMPACT AND IMPLICATIONS: MASLD, and MASH, are strongly associated with overweight and obesity and it is believed that the excess liver fat associated with obesity is an important driver of these diseases. Glucagon-like peptide-1 receptor (GLP-1R) agonists elicit weight loss through centrally and peripherally mediated effects on appetite. Unlike GLP-1R agonists, glucagon receptor (GCGR) agonists act directly on the liver to stimulate fatty acid oxidation and inhibit lipogenesis, potentially providing a more potent mechanism for liver fat content (LFC) reduction than weight loss alone. This study demonstrated the ability of once-weekly treatment with pemvidutide, a dual GLP-1R/GCGR agonist, to significantly reduce LFC, hepatic inflammatory activity, and body weight, suggesting that pemvidutide may be an effective treatment for both MASH and obesity. CLINICAL TRIAL NUMBER: NCT05006885.
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BACKGROUND: Effect of intensive lifestyle intervention (ILI) on A1C in participants with diabetes is underestimated. A1C improvement is presumed to be dependent on the amount of weight loss. Here, we evaluate the magnitude of A1C change in relation to baseline A1C and the amount of weight loss in participants with diabetes who underwent ILI over 13 years in real-world clinical practice. METHODS: A total of 590 participants with diabetes were enrolled in the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week multidisciplinary ILI program designed for real-world clinical practice between September 2005 and May 2018. We stratified participants based on baseline A1C into three groups: group A: A1C ≥ 9%, group B: A1C 8 to <9%, and group C: A1C ≥6.5% to <8%. RESULTS: After 12-weeks of intervention, body weight decreased in all groups, and pairwise comparisons of A1C changes showed that: group A had 1.3% greater A1C reduction than group B (p = 0.0001) and 2% greater than group C (p = 0.0001), while group B had 0.7% greater A1C reduction than group C (p = 0.0001). CONCLUSION: We conclude that ILI may decrease A1C by up to 2.5% in participants with diabetes. At similar magnitude of weight loss, A1C reduction was more prominent in participants with higher baseline A1C. This may be valuable for clinicians to set a realistic expectation of A1C change in response to ILI.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobinas Glicadas , Redução de Peso , Estilo de VidaRESUMO
INTRODUCTION: Intensive lifestyle intervention (ILI) has significantly reduced incidence of diabetes and improved many cardiovascular disease risk factors. We evaluated long-term effects of ILI on cardiometabolic risk factors, and microvascular and macrovascular complications among patients with diabetes in real-world clinical practice. RESEARCH DESIGN AND METHODS: We evaluated 129 patients with diabetes and obesity enrolled in a 12-week translational model of ILI. At 1 year, we divided participants into group A, who maintained <7% weight loss (n=61, 47.7%), and group B, who maintained ≥7% weight loss (n=67, 52.3%). We continued to follow them for 10 years. RESULTS: The total cohort lost an average of 10.8±4.6 kg (-9.7%) at 12 weeks and maintained an average weight loss of 7.7±10 kg (-6.9%) at 10 years. Group A maintained 4.3±9.5 kg (-4.3%) and group B maintained 10.8±9.3 kg (-9.3%) of weight loss at 10 years (p<0.001 between groups). In group A, A1c decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but rebounded to 7.7±1.4% at 1 year and 8.0±1.9% at 10 years. In group B, A1c decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks then increased to 6.8±1.2% at 1 year and 7.3±1.5% at 10 years (p<0.05 between groups). Maintenance of ≥7% weight loss at 1 year was associated with a 68% lower risk of developing nephropathy for up to 10 years compared with maintenance of <7% weight loss (adjusted HR for group B: 0.32, 95% CI 0.11, 0.9, p=0.007). CONCLUSIONS: Weight reduction in patients with diabetes can be maintained for up to 10 years in real-world clinical practice. Sustained weight loss is associated with significantly lower A1c at 10 years and improvement in lipid profile. Maintenance of ≥7% weight loss at 1 year is associated with decreased incidence of diabetic nephropathy at 10 years.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Estudos Longitudinais , Hemoglobinas Glicadas , Fatores de Risco Cardiometabólico , Estilo de Vida , Redução de PesoRESUMO
BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing among patients with type 1 diabetes (T1D) paralleling the increasing prevalence of obesity among this population. However, little is known about the impact of intensive lifestyle intervention (ILI) on NAFLD in patients with T1D. METHODS: Using Hepatic Steatosis Index (HSI), a noninvasive surrogate predictor of NAFLD, we retrospectively evaluated 88 adult patients with T1D and obesity after one year of participating in a 12-week ILI program in real-world clinical practice. Using the NAFLD guidelines of the American Association for the Study of Liver Diseases (AASLD), we excluded 11 participants. We matched the remaining ILI cohort (age 43 ± 12 years, females 65%, diabetes duration 22 ± 9 years, A1C 8.2 ± 0.9%, body weight 101 ± 17 kg, BMI 35.3 ± 4.9 kg/m2) in 1:1 ratio with a similar cohort of patients with T1D and obesity who received standard diabetes care (SC) at the same practice and during the same period. Matching criteria included: sex, age, BMI, A1C and duration of T1D. HSI [8 + ALT/AST + BMI (+ 2 if female, + 2 if T2D)] was calculated at baseline and after 12 months of intervention. RESULTS: At baseline, HSI was similar between the two cohorts (46.2 ± 6.1 in the ILI cohort and 44.9 ± 5.7 in the SC cohort). After 12 months, the ILI group lost an average of 5.6 ± 2.7 kg (5.8%, p < 0.05) while the SC group maintained their baseline body weight (p < 0.001 between groups). HSI decreased significantly from baseline in the ILI group (-2.7 ± 1.1, p = 0.01), but did not change in the SC group (0.6 ± 0.9, p = 0.53, p < 0.001 between groups). Percentage of patients with high likelihood of NAFLD diagnosis decreased from 100% at baseline to 88.3% in the ILI group, and was 10.4% less compared to SC (p < 0.01). Total daily insulin dose decreased in the ILI cohort compared to the SC cohort (-6.1 ± 4.2 versus 1.34 ± 4.3 units/day, p < 0.01). CONCLUSIONS: Twelve weeks of ILI improved HSI and decreased total daily insulin requirements in patients with T1D and obesity at one year. Short-term ILI should be implemented in the management of NAFLD for obese patients with type 1 diabetes.
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Background: Intensive lifestyle intervention (ILI) is essential for diabetes management. The Weight Achievement and Intensive Treatment (Why WAIT) program is a 12-week multidisciplinary weight management program that has been implemented in real-world clinical practice since 2005 and has shown long-term maintenance of weight reduction for 5 and 10 years. During the COVID-19 pandemic, the program went virtual using telemedicine and mobile health applications. Aims: This retrospective pilot study aims to evaluate the effectiveness of a virtual model of an already established and successful in-person program for diabetes and weight management since 2005. Methods: We evaluated 38 patients with diabetes and obesity enrolled in the Why WAIT program between February 2019 and December 2020. Sixteen participants were enrolled in virtual program (VP) and were compared with 22 participants who completed the latest two physical programs (PPs) before COVID-19. We evaluated changes in body weight, A1C, blood pressure (BP), and lipid profile after 12 weeks of ILI. Results: Body weight decreased by -7.4 ± 3.6 kg from baseline in VP compared with -6.8 ± 3.5 kg in PP (p = 0.6 between groups). A1C decreased by -1.03% ± 1.1% from baseline in VP, and by -1.0% ± 1.2% in PP (p = 0.9 between groups). BP, lipid profile, and all other parameters improved in both groups with no significant difference between them. Conclusion: Virtual multidisciplinary ILI is as effective as the in-person intervention program in improving body weight, A1C, BP, and lipid profile, and in reducing the number of anti-hyperglycemic medications. Results from our study suggest that scaling the Why WAIT program in a virtual format to a larger population of patients with diabetes and obesity is feasible and is potentially as successful as the in-person program.
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OBJECTIVE: Limited literature has examined the epidemiology of non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt, a country with one of the highest obesity rates globally. We assessed the prevalence of steatosis and fibrosis among college students in Egypt. DESIGN: In this cross-sectional study, we recruited students unaware of having fatty liver via a call-for-participation at a private university in the Dakahlia governorate of Egypt. Primary outcomes were the prevalence of steatosis as determined by the controlled attenuation parameter component of transient elastography and fibrosis as determined by the liver stiffness measurement component of transient elastography. Secondary outcomes were clinical parameters and socioeconomic factors associated with the presence and severity of steatosis and fibrosis. RESULTS: Of 132 participants evaluated for the study, 120 (91%) were included (median (IQR) age, 20 (19-21) years; 65 (54.2%) female). A total of 38 participants (31.6%) had steatosis, among whom 22 (57.9%) had S3 (severe) steatosis. There was a higher risk for steatosis in persons with overweight (adjusted OR 9.67, 95% CI (2.94 to 31.7, p<0.0001) and obesity (adjusted OR 13.87, 95% CI 4.41 to 43.6, p<0.0001) compared with lean persons. Moreover, higher level of parental education was associated with progressing steatosis stages (S1-S3). Six (5%) participants had transient elastography values equivalent to F2-F3 fibrosis (four with F2 fibrosis (≥7.9 kPa), and two with F3 fibrosis (≥8.8 kPa)). CONCLUSION: In this cohort of college students in Egypt, around 1 in 3 had steatosis, and 1 in 20 had moderate-to-advanced fibrosis, an established risk factor for hepatic and extrahepatic morbidity and mortality. These data underscore the urgency to address the silent epidemic of NAFLD among young adults in the Middle East-North Africa region.
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Hepatopatia Gordurosa não Alcoólica , Adulto , Estudos Transversais , Egito/epidemiologia , Feminino , Humanos , Cirrose Hepática/epidemiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Prevalência , Fatores de Risco , Adulto JovemRESUMO
Most nutrition studies looking at the association of food with cardiometabolic markers rely on food frequency questionnaires, which are prone to recall bias. Pentadecanoic acid, heptadecanoic acid and trans-palmitoleic acid are fatty acids that are not synthesized endogenously but are obtained from the diet, particularly dairy, making them reasonable biomarkers of dairy consumption. We investigated the association of dairy fatty acid biomarkers with glycated hemoglobin (HbA1c) and cardiovascular risk factors in type 2 diabetes (T2D). In a clinical trial, 111 participants with T2D (age 58.5 ± 8.9 years, HbA1c 8.09 ± 0.96%) were randomized into three groups: a control group that maintained baseline dairy intake, a low-fat (LF) group that incorporated ≥3 servings/day of LF dairy and a high-fat (HF) group that incorporated ≥3 servings/day of HF dairy. We compared the fatty acids (FA) composition between the three groups at 24 weeks. Pentadecanoic acid and trans-palmitoleic acid increased in the HF group by 14.1% ± 5.4% and 17.5% ± 5.1%, respectively, but not in the control and LF groups (p = 0.0474 and p = 0.0025 for group-by-time interaction, respectively). Those increases were positively associated with changes in total cholesterol, very-low-density lipoprotein cholesterol VLDL-C and triglycerides but were not associated with changes in HbA1c from baseline to 24 weeks. These results suggest that the intervention was successful and that participants were likely compliant, which supports the validity of the main trial.
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Laticínios , Ácidos Graxos não Esterificados/sangue , Avaliação Nutricional , Idoso , Biomarcadores/sangue , Peso Corporal , Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Dieta , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. The increasing prevalence of NAFLD mirrors that of obesity and type 2 diabetes over the last two decades. MAIN: In a two-way pathophysiologic relationship, NAFLD increases the risk of developing type 2 diabetes, while the latter promotes the progression of simple fatty liver to a more advanced form called nonalcoholic steatohepatitis (NASH). NASH increases the risk of cirrhosis and hepatocellular carcinoma (HCC), which may require liver transplantation. With the absence of FDA-approved medications for NAFLD treatment, lifestyle intervention remains the only therapy. Lately, extensive research efforts have been aimed at modifying NASH fibrosis and developing noninvasive screening methods. CONCLUSION: We highlight the pathophysiologic relationships between NAFLD and type 2 diabetes, discuss disease recognition, models of care, and current and emerging therapies for NASH treatment.
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BACKGROUND: Dietary Guidelines for Americans recommend the consumption of 3 servings/d of low-fat/nonfat dairy. The effects of higher dairy consumption and its fat content are unknown in patients with type 2 diabetes. OBJECTIVE: Evaluate the impact of higher consumption of high- compared with low-fat dairy on glycated hemoglobin (HbA1c), body weight, and cardiovascular disease risk factors in patients with type 2 diabetes. METHODS: We enrolled 111 subjects with type 2 diabetes (aged 58.5 ± 8.9 y, 47% females, diabetes duration 13.2 ± 8.3 y, HbA1c 8.09 ± 0.96%) who consumed <3 servings of dairy/d. We randomly assigned them into 3 groups: control group maintained baseline dairy intake, low-fat (LF) group incorporated ≥3 servings/d of LF dairy, and the high-fat (HF) group incorporated ≥3 servings/d of HF dairy. We evaluated HbA1c, body weight, BMI, body composition parameters, blood pressure (BP), lipid parameters, homeostatic model assessment of insulin resistance (HOMA-IR), and total energy and macronutrient intake at baseline, and after 12 and 24 wk. RESULTS: At 24 wk, percent energy from saturated fat increased from baseline in the HF group by 3.6%, (95% CI: 2.2, 5.1) and decreased in the LF group by -1.9% (95% CI: -3.3, -0.4). The LF group increased their percent energy from protein by 4.5% (95% CI: 2.6, 6.4), whereas the HF group decreased their percent energy from carbohydrates by -3.4% (95% CI: -0.2, -6.7). There were no differences in the mean changes in HbA1c, body weight, BMI, body composition or lipid parameters, or BP between the 3 groups at 24 wk. CONCLUSION: In patients with type 2 diabetes, increased dairy consumption to ≥3 servings/d compared with <3 servings/d, irrespective of its fat content, while maintaining energy intake has no effect on HbA1c, body weight, body composition, lipid profile, or BP. This trial was registered at clinicaltrials.gov as NCT02895867.
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Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Gorduras , Adulto , Idoso , Glicemia/metabolismo , Pressão Sanguínea , Peso Corporal , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Gorduras na Dieta/análise , Gorduras na Dieta/metabolismo , Ingestão de Energia , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
Dairy products are integral parts of healthy diets; however, their association with cardiometabolic (CM) health among patients with type 2 diabetes (T2D) undergoing weight management is debated. We examined the relationship between dairy consumption and CM biomarkers in 45 subjects with T2D and obesity (mean age 56 ± 9 yrs, 40% female) enrolled in a 12-week intensive multidisciplinary weight management (IMWM) program. After the IMWM program (intervention phase), subjects were followed for 12 weeks (maintenance phase). We stratified subjects based on initial average dairy consumption into infrequent (IFR), less-frequent (LFR), and frequent (FR) consumers. Outcomes were assessed at baseline, 12, and 24 weeks. There were no differences between tertiles at baseline except for higher total energy intake among FR compared with IFR. HbA1c changes showed no association with dairy consumption at 12 or 24 weeks. FR Females achieved greater weight loss at 12 weeks compared with IFR peers (-4.5 kg; 95%CI: -5.5, -3.5). There was a trend towards lower HDL-C with increasing dairy consumption during the intervention phase. In subjects with T2D and overweight or obesity, dairy consumption during weight management is not associated with HbA1c changes but with lower HDL-C and with higher magnitude of weight loss among females.
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Laticínios , Diabetes Mellitus Tipo 2/metabolismo , Ingestão de Alimentos/fisiologia , Fatores de Risco de Doenças Cardíacas , Fenômenos Fisiológicos da Nutrição/fisiologia , Obesidade/metabolismo , Programas de Redução de Peso/métodos , Idoso , Manutenção do Peso Corporal , HDL-Colesterol/metabolismo , Laticínios/efeitos adversos , Diabetes Mellitus Tipo 2/complicações , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Fatores SexuaisRESUMO
OBJECTIVES: Diabetes-specific nutritional formulas (DSNFs) are frequently used by patients with type 2 diabetes (T2D) as part of nutrition therapy to improve glycemic control and reduce body weight. However, their effects on hunger and satiety hormones when compared to an isocaloric standardized breakfast are not fully understood. This study aims to evaluate the postprandial effects of two DSNFs-Glucerna (GL) and Ultra Glucose Control (UGC)-versus oatmeal on selected satiety and hunger hormones. METHOD: After an overnight fast, 22 patients with T2D (mean age 62.3 ± 6.8 years, A1C 6.8 ± 0.7%, body weight 97.4 ± 21.3 kg, and BMI 33.2 ± 5.9 kg/m²) were given 200 kcal of each meal on three separate days. Blood samples for amylin, cholecystokinin (CCK), ghrelin, glucagon, leptin, and peptide-YY (PYY) were collected at baseline and 30, 60, 90, 120, 180, and 240 min after the start of each meal. Incremental area under the curve (iAUC0-240) for each hormone was calculated. RESULTS: iAUC0-240 for glucagon and PYY were significantly higher after GL and UGC than after oatmeal (p < 0.001 for both). No difference was observed between the three meals on postprandial amylin, CCK, ghrelin, and leptin hormones. CONCLUSIONS: Intake of DSNFs significantly increases secretion of PYY and glucagon, two important satiety hormones. While subjective satiety was not directly evaluated, the increased effect on satiety hormones may partially explain the mechanism of body weight loss associated with DSNF use.
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Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/dietoterapia , Alimentos Formulados , Fome/fisiologia , Período Pós-Prandial/fisiologia , Saciação/fisiologia , Idoso , Glicemia , Colecistocinina/sangue , Estudos Cross-Over , Feminino , Grelina/sangue , Glucagon/sangue , Humanos , Polipeptídeo Amiloide das Ilhotas Pancreáticas/sangue , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Peptídeo YY/sangueRESUMO
Objective: We evaluated the relationship between frequency of self-monitoring of blood glucose (SMBG) and body weight, A1C, and cardiovascular risk factors in patients with type 2 diabetes (T2D) and obesity enrolled in a 12-week intensive multidisciplinary weight management (IMWM) program. Research design and methods: We conducted a retrospective analysis of 42 patients who electronically uploaded their SMBG data over 12 weeks of an IMWM program and divided them into tertiles based on their average frequency of SMBG per day. Mean (range) SMBG frequencies were 2.3 (1.1-2.9) times/day, 3.4 (3-3.9) times/day, and 5 (4-7.7) times/day in the lowest, middle, and highest tertiles, respectively. Anthropometric and metabolic parameters were measured at baseline and after 12 weeks of intervention. Results: Participants in the highest tertile achieved a median change (IQR) in body weight of -10.4 kg (-7.6 to -14.4 kg) compared with -8.3 kg (-5.2 to -12.2 kg), and -6.9 kg (-4.2 to -8.9 kg) in the middle and lowest tertiles, respectively (p=0.018 for trend). Participants in the highest tertile had a median change (IQR) in A1C of -1.25% (-0.6 to -3.1%) compared with -0.8% (-0.3% to -2%) and -0.5% (-0.2% to -1.2%) in the middle and lowest tertiles, respectively (p=0.048 for trend). The association between change in body weight and SMBG frequency remained significant after adjusting for age, sex, baseline body mass index, diabetes duration, and use of insulin therapy. Conclusions: Increased frequency of SMBG during IMWM is associated with significantly better weight loss and improvement of A1C in patients with T2D and obesity. These findings may suggest future clinical recommendations aimed at increasing SMBG frequency to achieve the most favorable outcomes.
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Automonitorização da Glicemia/estatística & dados numéricos , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Hemoglobinas Glicadas/análise , Hipoglicemiantes/uso terapêutico , Cooperação do Paciente/estatística & dados numéricos , Redução de Peso , Biomarcadores/análise , Peso Corporal , Boston/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Nutricional , Obesidade/fisiopatologia , Prognóstico , Estudos RetrospectivosRESUMO
AIMS: Recent studies report that approximately 50% of patients with type 1 diabetes (T1D) are overweight or obese. This work studies the effects of intensive multidisciplinary weight management (IMWM) in patients with T1D and obesity. METHODS: We retrospectively evaluated 68 patients with T1D and obesity who enrolled in a 12-week IMWM program (IMWM cohort: mean age, 42 ± 11 years; HbA1c, 8.3% ± 1.0%; body weight, 104.3 ± 18.2 kg; BMI, 36.2 ± 4.9 kg/m2 ). We matched them 1:1 with a similar cohort of patients receiving standard care (SC cohort: mean age, 42 ± 12 years; HbA1c, 8.3% ± 1.0%; body weight, 102.4 ± 17.9 kg; BMI, 36.1 ± 4.7 kg/m2 ). Data were collected at baseline and at 12 months. RESULTS: Participants in the IMWM cohort had a body weight change of -6.6 ± 1.8 kg or -6.4% ± 1.6% of their initial body weight, while participants in the SC cohort had no change (P < 0.01 for group*time interaction). Participants in the IMWM cohort had a change in HbA1c of -0.4% ± 0.1% from baseline (P < 0.01), while participants in the SC cohort had no change. There was no difference in glycaemic control between cohorts at 12 months. Total daily insulin dose changed by -5.9 ± 1.8 units/d from baseline in the IMWM cohort while there was no change in the SC cohort (P < 0.01 for group*time interaction). CONCLUSIONS: In comparison to standard care, patients with T1D and obesity who participated in an IMWM programme achieved significant weight loss and significant reduction in daily insulin dose at 1 year. Weight reduction was associated with improvements in glycaemic control compared to baseline.
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Diabetes Mellitus Tipo 1 , Obesidade , Programas de Redução de Peso , Adulto , Peso Corporal , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/terapia , Estudos Retrospectivos , Redução de PesoRESUMO
PURPOSE OF REVIEW: The prevalence of combined obesity and diabetes has increased dramatically in the last few decades. Although medical and surgical weight management are variably effective in addressing this epidemic, it is essential to parallel these strategies with a hypocaloric diet comprising the appropriate macronutrient composition to induce weight loss, enhance glycemic control, and improve cardiovascular risk factors. This review reports the current evidence of the role of carbohydrates and fat-based diets for weight management in patients with combined type 2 diabetes (T2D) and obesity. RECENT FINDINGS: Low-carbohydrate diets were shown to decrease postprandial glucose levels whereas high-carbohydrate, low-fat diets are considered cardio-protective. A diet with an optimal macronutrient composition remains uncertain for patients with combined T2D and obesity. Further research is still needed to define the best dietary composition that achieves the maximum benefits on weight management, glycemic control, and cardiovascular risk factors.