Cardiovascular outcomes trial data from EMPA-REG OUTCOME, CAROLINA and CARMELINA: Assessment of a novel staging system for type 2 diabetes.

AIMS: To apply the diabetes staging system (DSS), a novel disease staging system similar to what is used in oncology but designed to improve diabetes management, to three large type 2 diabetes (T2D) cardiovascular (CV) outcome trials to assess whether increasing DSS stage was associated with higher rates of all-cause mortality (ACM) and/or CV death. MATERIALS AND METHODS: The DSS uses discrete CV events (none to ≥3: Stage 1 to 4), end-stage kidney disease (Stage 5) and microvascular complications (none to 3: A to D) to determine disease stage in individuals with T2D. The DSS stage for patients from the CAROLINA, EMPA-REG OUTCOME and CARMELINA trials was determined. Incidence rates for ACM/CV death were calculated across DSS stages and Cox regression analyses were performed. RESULTS: The risk of ACM or CV death increased with increasing DSS (Stage 1 to 5; P for trend <0.0001) in all trials. In CAROLINA, the risk of ACM and CV death increased with increasing number of microvascular complications (A to D; both P for trend <0.0001), similar in CARMELINA (P for trend = 0.0020 and 0.0005, respectively). In EMPA-REG OUTCOME, having all three microvascular complications (Stage D), versus none, increased the risk of ACM and CV death (P = 0.0015 and 0.0010, respectively). CONCLUSIONS: Applying the DSS across T2D clinical trial populations with different CV risk revealed a significantly increased risk of ACM and CV death with higher DSS stage. The DSS may merit assessment in other T2D populations and evaluation of the impact of additional outcomes, such as heart failure, could also be worthwhile.

Leveraging Lifestyle Medicine Interest Groups Through the COVID-19 Pandemic.

Lifestyle medicine domains, despite accounting for more than 78% of chronic disease risk, are infrequently taught as a part of the medical curriculum. Aspects such as nutrition are taught in less than 25% of medical schools, a statistic that continues to decline, and less than 20% of practicing physicians were required to take even a single course in exercise counseling during their medical school training. To combat this lack of training, the American College of Lifestyle Medicine annually awards the Donald A. Pegg scholarship to fund the development of Lifestyle Medicine Interest Groups (LMIGs) across medical schools worldwide. This scholarship was initiated in 2016 and utilizes private funds to support the development and expansion of LMIGs with the aim of increasing awareness of lifestyle medicine among training practitioners. There are four award winners per year. To date there are sixteen Pegg Award winners. This article will showcase the four 2019-2020 Donald A. Pegg award recipients and their impact on the LMIGs at their institutions. Furthermore, it highlights the ingenuity and adaptation of these LMIGs during the COVID-19 pandemic.

TNM cancer staging: can it help develop a novel staging system for type 2 diabetes?

Type 2 diabetes (DM2) constitutes 90%-95% of the diabetes cases and is increasing at an alarming rate in the world. The Centers for Disease Control and Prevention (CDC) estimates that more than 29 million people in the United States have diabetes, which often causes mortality from macrovascular complications and morbidity from microvascular complications. Despite these troubling facts, there is currently no widely accepted staging system for DM2 like there is for cancer. TNM oncologic staging has taken a complex condition like cancer and conveyed likelihood of survival in simple alpha-numeric terms that both patients and providers can understand. Oncology is now entering the era of precision medicine where cancer treatment is increasingly being tailored to each patient's cancer. In contrast, DM2 lacks a staging system and remains a largely invisible disease even though it kills more Americans and costs more to treat than cancer. Is a comparable staging system for DM2 possible? We propose the Diabetes Staging System for DM2 that utilizes macrovascular events, microvascular complications, estimated glomerular filtration rate (GFR), and hemoglobin A1C to stage DM2.

Nurturing the Seeds of Change: Strengthening the Lifestyle Medicine Movement With the Donald A. Pegg Student Leadership Award.

Student-led Lifestyle Medicine Interest Groups (LMIGs) empower the next generation of healthcare professionals to tackle the pandemic of lifestyle-related chronic diseases and provide important pathways to increasing the visibility of Lifestyle Medicine (LM) in health professions schools. Each year, the Donald A. Pegg Student Leadership Award offers four allied health students a seed grant to start or support LMIGs at their schools as well as financial assistance to attend the annual American College of Lifestyle Medicine (ACLM) conference. The 2017 student winners were Paresh Jaini, Albert Barrera, Alyssa Greenwell, and Alicja Baska. With the support of the Pegg Award, the awardees and their faculty advisors have made great strides in LM at their institutions in the areas of research, community outreach, student education, and global networking. Their LMIG activities have included students presenting research at national conferences, initiating a chapter of the national organization Walk with a Doc, hosting educational lectures on LM principles, sponsoring plant-based cooking sessions, facilitating stress management workshops, and hosting a national-level LM congress in Europe. Through the ACLM, the Pegg Award generates an atmosphere of growth for LMIGs, fostering the expansion, vision, and integration of LM into the education of health professions students worldwide.

Proactive Living: A Unique Model for the Promotion of Lifestyle Medicine.

Lifestyle medicine (LM) is a growing field focused on maintenance of health and reversal of chronic diseases; however, it is still unfamiliar to many as it lacks a mechanism to set itself apart from other medical specialties, which focus primarily on management of established diseases and their symptoms. Given that employers have many incentives to maintain and improve the health of their employees, the corporate wellness space (corporate wellness) represents a considerable opportunity for LM. Proactive Living, a company at the confluence of LM and corporate wellness, promotes and connects LM practitioners with employers and employees through a mobile app (PAL App). The app is designed to improve health literacy, encourage healthy lifestyle behaviors, and engage individuals in their own health, while simultaneously helping LM practitioners market LM and grow their practice.

Impact of the prevention plan on employee health risk reduction.

This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P≤ 0.01 and 1 at P≤0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P<0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P<0.001).