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1.
REME rev. min. enferm ; 24: e-1279, fev.2020.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1051306

RESUMEN

Objetivo: verificar a associação entre a adesão ao tratamento medicamentoso e não medicamentoso e as práticas assistenciais prestadas às pessoas com diabetes Mellitus tipo 2 (DM2) pelas equipes da Estratégia Saúde da Família (ESF). Método: estudo transversal, do tipo inquérito domiciliar, realizado com pessoas com DM2 cadastradas nas 65 equipes urbanas da ESF, selecionadas aleatoriamente e de forma estratificada por equipe. Os dados foram coletados no primeiro semestre 2014 mediante entrevista estruturada e na análise, usando-se regressão logística, considerando-se associação significativa quando p≤0,05. Resultados: as 408 pessoas participantes tinham idade média de 66,5 anos, 84,1% relataram aderir ao tratamento medicamentoso, 29,4% realizavam atividade física regularmente e 24% tinham alimentação adequada. Após ajustes, as variáveis que permaneceram associadas ao tratamento medicamentoso foram: não participação em atividade de educação em saúde (p=0,012) e ser atendido pelo mesmo enfermeiro (p=0,048). Em relação ao medicamentoso, a adoção de alimentação adequada apresentou associação com verificação trimestral da glicemia capilar (p=0,011) e ser questionado, durante o atendimento, sobre a prática de atividade física (p=0,012) e a prática de atividade física regular com participação em atividades de educação em saúde (p=0,031), estar satisfeito com a assistência (p=0,04), ser atendido no mesmo dia em que procurou a UBS (p=0,017) e os profissionais perguntarem sobre sua saúde (p=0,011). Conclusão: as pessoas com DM2 apresentaram boa adesão ao tratamento medicamentoso e baixa adesão ao não medicamentoso, indicando que as equipes da ESF precisam ampliar a implementação de ações de promoção da saúde, prevenção e controle da doença e suas complicações.(AU)


Objective: to verify the association between adherence to medication and nonmedication treatment and the care practices provided to people with type 2 diabetes Mellitus (DM2) by the Family Health Strategy (ESF) teams. Method: cross-sectional study, of the household survey type, carried out with people with DM2 registered in the 65 urban teams of the ESF, randomly selected and stratified by team. Data were collected in the first semester of 2014 through a structured interview and in the analysis, using logistic regression, considering a significant association when p≤0.05. Results: the 408 people participating had an average age of 66.5 years, 84.1% reported adhering to drug treatment, 29.4% performed regular physical activity and 24% had adequate nutrition. After adjustments, the variables that remained associated with drug treatment were non-participation in health education activities (p=0.012) and being attended by the...(AU)


Objetivo: verificar la asociación entre la adhesión al tratamiento con medicación y sin medicación y las prácticas de atención de los equipos de la Estrategia de salud familiar (ESF) a las personas con diabetes Mellitus tipo 2 (DM2). Método: estudio transversal, tipo encuesta domiciliaria, realizado con personas con DM2 inscritas en los 65 equipos urbanos de la ESF, seleccionados al azar y estratificados por equipo. Los datos se recogieron el primer semestre de 2014 a través de una entrevista estructurada y durante el análisis, utilizando regresión logística, considerando la asociación significativa cuando p≤0.05. Resultados: las 408 personas que participaron tenían edad promedio de 66,5 años; el 84,1% indicó adhesión al tratamiento farmacológico; el 29,4% realizó actividad física regular y el 24% tenía nutrición adecuada. Después de los ajustes, las variables que permanecieron asociadas con el tratamiento farmacológico fueron: la no participación en actividades de educación para la salud (p = 0,012) y atención del mismo enfermero (p = 0,048). Con respecto a la medicación, la adopción de la alimentación adecuada se asoció con el control trimestral de la glucemia capilar (p = 0,011) y que le preguntasen, mientras lo atendían, sobre la práctica de actividad física (p = 0,012) y la práctica de actividad física regular con participación en actividades de educación para la salud (p = 0,031), estar satisfecho con la atención brindada (p = 0,04), ser atendido el mismo día que fue a la UBS (p = 0,017) y que los profesionales preguntasen sobre su salud (p = 0,011). Conclusión: las personas con DM2 mostraron buena adhesión al tratamiento con medicación y baja adhesión al tratamiento sin medicación, lo que indica que los equipos de ESF deben ampliar la implementación de acciones para promover la salud, prevenir y controlar la enfermedad y sus complicaciones.(AU)


Asunto(s)
Humanos , Anciano , Atención Primaria de Salud , Diabetes Mellitus , Diabetes Mellitus Tipo 2/prevención & control , Cumplimiento y Adherencia al Tratamiento , Estrategia de Salud Familiar , Promoción de la Salud
2.
BMJ ; 368: l6669, 2020 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915124

RESUMEN

OBJECTIVE: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366). MAIN EXPOSURES: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). MAIN OUTCOME: Life expectancy free of diabetes, cardiovascular diseases, and cancer. RESULTS: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50. CONCLUSION: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Estilo de Vida Saludable/fisiología , Esperanza de Vida , Neoplasias , Conducta de Reducción del Riesgo , Adulto , Consumo de Bebidas Alcohólicas , Índice de Masa Corporal , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/psicología , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Mellitus Tipo 2/psicología , Ejercicio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/prevención & control , Neoplasias/psicología , Investigación en Enfermería , Estudios Prospectivos , Fumar
3.
J Appl Oral Sci ; 28: e20190248, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31939522

RESUMEN

OBJECTIVE: The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis. To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). METHODOLOGY: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. RESULTS: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). CONCLUSIONS: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.


Asunto(s)
Raspado Dental/métodos , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Mellitus Tipo 2/fisiopatología , Periodontitis/fisiopatología , Periodontitis/terapia , Aplanamiento de la Raíz/métodos , Proteína C-Reactiva/análisis , Hemoglobina A Glucada/análisis , Humanos , Sesgo de Publicación , Resultado del Tratamiento
4.
J Ethnopharmacol ; 247: 112263, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-31580944

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: Cocoa extracts rich in polyphenols are used as potential agent for treating diabetes. Cocoa polyphenols have been proved to ameliorate important hallmarks of type-2 diabetes (T2D). They can regulate glucose levels by increasing insulin secretion, promoting ß-cell proliferation and a reduction of insulin resistance. In addition, epidemiological evidence indicates that consumption of flavonoid decreases the incidence of T2D. AIM OF THE STUDY: T2D is preceded by a prediabetic state in which the endocrine-metabolic changes described in T2D are already present. Since epidemiological evidence indicates that consumption of flavonoid decreases its incidence, we evaluated possible preventive effects of polyphenol-enriched cocoa extract on a model of prediabetes induced by sucrose. MATERIALS AND METHODS: We determined circulating parameters and insulin sensitivity indexes, liver protein carbonyl groups and reduced glutathione, liver mRNA expression levels of lipogenic enzymes, expression of different pro-inflammatory mediators, fructokinase activity and liver glycogen content. For that, radioimmunoassay, real-time polymerase chain reaction, Western blot, spectrophotometry, and immunohistochemistry were used. RESULTS: We demonstrated that sucrose administration triggered hypertriglyceridemia, insulin-resistance, and liver increased oxidative stress and inflammation markers compared to control rats. Additionally, we found an increase in glycogen deposit, fructokinase activity, and lipogenic genes expression (SREBP-1c, FAS and GPAT) together with a decrease in P-Akt and P-eNOS protein content (P < 0.05). Sucrose-induced insulin resistance, hepatic carbohydrate and lipid dysmetabolism, oxidative stress, and inflammation were effectively disrupted by polyphenol-enriched cocoa extract (PECE) co-administration (P < 0.05). CONCLUSION: Dietary administration of cocoa flavanols may be an effective and complementary tool for preventing or reverting T2D at an early stage of its development (prediabetes).


Asunto(s)
Cacao/química , Diabetes Mellitus Tipo 2/prevención & control , Extractos Vegetales/farmacología , Polifenoles/farmacología , Estado Prediabético/tratamiento farmacológico , Animales , Diabetes Mellitus Tipo 2/metabolismo , Sacarosa en la Dieta/efectos adversos , Modelos Animales de Enfermedad , Humanos , Resistencia a la Insulina , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Estrés Oxidativo/efectos de los fármacos , Extractos Vegetales/aislamiento & purificación , Extractos Vegetales/uso terapéutico , Polifenoles/aislamiento & purificación , Polifenoles/uso terapéutico , Estado Prediabético/sangre , Estado Prediabético/etiología , Estado Prediabético/metabolismo , Ratas , Triglicéridos/sangre , Triglicéridos/metabolismo
5.
Rev Saude Publica ; 53: 101, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31800912

RESUMEN

OBJECTIVE: To evaluate the effectiveness of interventions aimed at the prevention of risk factors and incidence of type 2 diabetes in the workers population. METHODS: Systematic review of interventions aimed at adult workers at risk of type 2 diabetes published in Medline, Embase, Web of Science, Central Cochrane Registry of Controlled Trials, and Lilacs. Randomized trials, quasi-experimental research and cohort studies were selected; in English, Spanish and Portuguese; published from 2000 to 2017. Intervention effectiveness was evaluated concerning the incidence of type 2 diabetes and a significant reduction in body weight, or another anthropometric or metabolic parameter. RESULTS: 3,024 articles were generated, of which 2,825 that did not answer the research question were eliminated, as well as 130 that did not evaluate original interventions, 57 carried out outside the workplace and two reviews; so that 10 selected items remained. Interventions based on structured programs previously evaluated and integrated into the workplace had a favorable impact on the reduction of body weight and other risk factors. CONCLUSIONS: The effectiveness of lifestyle interventions for the prevention of type 2 diabetes should be based on structured programs with proven effectiveness and adapted to the workplace, with employer participation in the provision of schedules and work environments.


Asunto(s)
Diabetes Mellitus Tipo 2/etiología , Diabetes Mellitus Tipo 2/prevención & control , Salud Laboral , Conducta de Reducción del Riesgo , Lugar de Trabajo , Peso Corporal , Femenino , Humanos , Masculino , Factores de Riesgo , Conducta Sedentaria
6.
BMC Health Serv Res ; 19(1): 991, 2019 Dec 23.
Artículo en Inglés | MEDLINE | ID: mdl-31870371

RESUMEN

BACKGROUND: Type 2 diabetes mellitus is preventable through lifestyle intervention. Diabetes prevention programmes (DPPs) aim to deliver prevention-based behaviour change interventions to reduce incidence. Such programmes vary from usual primary care in terms of where, how, and by whom they are delivered. Implementation is therefore likely to face new commissioning, incentive and delivery challenges. We report on the implementation of a national DPP in NHS England, and identify lessons learned in addressing the implementation challenges. METHODS: In 2017/18, we conducted 20 semi-structured telephone interviews covering 16 sampled case sites with the designated lead(s) responsible for local implementation of the programme. Interviews explored the process of implementation, including organisation of the programme, expectations and attitudes to the programme, funding, target populations and referral and clinical pathways. We drew on constant comparative methods to analyse the data and generate over-arching themes. We complemented our qualitative data with a survey focused on variation in the financial incentives used across sites to ensure usual primary care services recruited patients to new providers. RESULTS: We identified five over-arching areas of learning for implementing this large-scale programme: 1) managing new providers; 2) promoting awareness of services; 3) recruiting patients; 4) incentive payments; and 5) mechanisms for sharing learning. In general, tensions appeared to be caused by a lack of clear roles/responsibilities between hierarchical actors, and lack of communication. Both local sites and the national NHS coordination team gained experience through learning by doing. Initial tensions with roles and expectations have been worked out during implementation. CONCLUSIONS: Implementing a national disease prevention programme is a major task, and one that will be increasingly faced by health systems globally as they aim to adjust to demand pressures. We provide practical learning opportunities for the wider uptake and sustainability of prevention programmes. Future implementers might wish to define clear responsibilities for each actor prior to implementation, ensure early engagement with new providers, offer mechanisms/forums for sharing learning, generate evidence and provide advice on incentive payments, and prioritise public and professional awareness of the programme.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Desarrollo de Programa , Medicina Estatal/organización & administración , Inglaterra , Humanos
7.
BMC Health Serv Res ; 19(1): 824, 2019 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-31711499

RESUMEN

BACKGROUND: Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. METHODS: Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. RESULTS: The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). CONCLUSIONS: The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken. TRIAL REGISTRATION: The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.


Asunto(s)
Diabetes Mellitus Tipo 2/economía , Atención Primaria de Salud/economía , Adulto , Anciano , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/prevención & control , Femenino , Medicina General/educación , Gastos en Salud , Estilo de Vida Saludable , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Estudios Retrospectivos , Encuestas y Cuestionarios
8.
Nat Genet ; 51(11): 1596-1606, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31676859

RESUMEN

A rare loss-of-function allele p.Arg138* in SLC30A8 encoding the zinc transporter 8 (ZnT8), which is enriched in Western Finland, protects against type 2 diabetes (T2D). We recruited relatives of the identified carriers and showed that protection was associated with better insulin secretion due to enhanced glucose responsiveness and proinsulin conversion, particularly when compared with individuals matched for the genotype of a common T2D-risk allele in SLC30A8, p.Arg325. In genome-edited human induced pluripotent stem cell (iPSC)-derived ß-like cells, we establish that the p.Arg138* allele results in reduced SLC30A8 expression due to haploinsufficiency. In human ß cells, loss of SLC30A8 leads to increased glucose responsiveness and reduced KATP channel function similar to isolated islets from carriers of the T2D-protective allele p.Trp325. These data position ZnT8 as an appealing target for treatment aimed at maintaining insulin secretion capacity in T2D.


Asunto(s)
Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/prevención & control , Glucosa/metabolismo , Células Madre Pluripotentes Inducidas/metabolismo , Secreción de Insulina , Islotes Pancreáticos/metabolismo , Transportador 8 de Zinc/metabolismo , Adolescente , Adulto , Anciano , Diabetes Mellitus Tipo 2/patología , Femenino , Genotipo , Humanos , Células Madre Pluripotentes Inducidas/patología , Islotes Pancreáticos/patología , Masculino , Persona de Mediana Edad , Adulto Joven , Transportador 8 de Zinc/genética
9.
BMC Public Health ; 19(1): 1550, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752774

RESUMEN

BACKGROUND: There is high prevalence of prediabetes and type 2 diabetes mellitus (T2DM) in Saudi Arabia that is still increasing. Early diagnosis of prediabetes, and immediate, effective intervention is yet unestablished. Conventional health promotion approaches are used to educate prediabetic patients. Behavior modification is very effective in prediabetics to delay T2DM. Thus, the main objective of this study is to examine the effect of the new behavioral model, the Transtheoretical Model short messages (text 4 change) to modify lifestyle to prevent or delay the onset of T2DM, through promotion of a healthy diet and increased physical activity, in impaired glucose tolerance patients. Another objective is to estimate the impact of this model on markers of cardiovascular and metabolic risks as T2DM is one of the modifiable risk factors to prevent cardiovascular diseases. METHODS: This is a randomized controlled trial. One thousand and sixteen, eligible Saudi adults will be recruited from the Heart Health Promotion study (HHP), which was conducted at the King Saud University from July 2013 to April 2014. These adults were at a higher risk of developing T2DM within 2-3 years. The research team's database has a contact list and they will recruit individuals over 6-8 weeks. All participants will be randomized at a 1:1 ratio into two groups, receive group education about lifestyle modifications and written information about diet and physical activity. Text 4 change SMS texts will be sent only to the intervention group. All participants will be assessed at baseline, 6, 12, 18, 24, 30, and 36 months for behavioral change using a World Health Organization (WHO) STEPS questionnaire and for glycated hemoglobin, biochemical and anthropometric measurements using standard methods. DISCUSSION: This new approach for promoting the importance of behavior modification in prediabetics is expected to delay and/or prevent the development of T2DM in Saudi Arabia, subsequently reducing the risk of cardiovascular morbidity and mortality too. Results from this study will promote an innovative and high-tech way to decrease the burden of cardiovascular diseases in Saudi Arabia. TRIAL REGISTRATION: International Standard Randomized Control Trial, registration number ISRCTN10857643. Registered 4 June, 2018.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Intolerancia a la Glucosa/terapia , Promoción de la Salud/métodos , Estado Prediabético/psicología , Mensaje de Texto , Adulto , Diabetes Mellitus Tipo 2/epidemiología , Ejercicio/psicología , Femenino , Humanos , Estilo de Vida , Masculino , Modelos Psicológicos , Estado Prediabético/epidemiología , Evaluación de Programas y Proyectos de Salud , Proyectos de Investigación , Arabia Saudita/epidemiología
10.
BMC Public Health ; 19(1): 1287, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615456

RESUMEN

BACKGROUND: Gestational diabetes (GDM) is a known risk factor for type 2 diabetes mellitus (T2DM), and women with a history of GDM have a 7-fold increased risk of developing the disease. Achieving a healthy weight post-delivery is key in reducing the risk of future diabetes in these women. The aim of this trial is to investigate the use of an interactive smartphone application (APP) to restore women to optimal weight following delivery. METHODS: This will be an open-label randomized controlled trial. Two hundred women with gestational diabetes will be randomized to receive the intervention or standard care following delivery. Participants will be reviewed at 6 weeks and 4 months post-delivery. The intervention is an APP serving as a platform for weight, diet and physical activity tracking. The APP provides 3-5 min educational videos suggesting suitable lifestyle adjustments relevant to postnatal period such as breast feeding, diet and exercise. Lastly, the APP will allow real-time interaction between users and the team of dietitians, physiotherapists and occupational therapists to encourage restoration of optimal weight. Women in the control arm will be informed about the increased risk of developing T2DM and advised to maintain a healthy weight. Primary outcome measure is the restoration of participants' booking weight if booking BMI ≤ 23, or weight loss of at least 5% from booking weight if booking BMI > 23 over the 4 month period. Secondary outcome measures will assess serum metabolic and inflammatory markers, quality of life via questionnaires and cost-effectiveness of the intervention at each follow-up visit. DISCUSSION: This will be the first randomised controlled trial investigating the use of a smartphone application for postpartum weight loss in women with gestational diabetes. The major ethnic groups in our study population represent the majority of ethnic groups in Asia, amongst which the prevalence of diabetes is high. If shown to be effective, this APP may be used in wider clinical settings to improve postpartum weight loss and reduce the risk of developing T2DM in these women. TRIAL REGISTRATION: This study was registered on clintrials.gov on the 30th of October 2017, under the trial registration number: NCT03324737 .


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Diabetes Gestacional/epidemiología , Aplicaciones Móviles , Teléfono Inteligente , Programas de Reducción de Peso/métodos , Adulto , Protocolos Clínicos , Femenino , Humanos , Embarazo , Singapur/epidemiología
11.
Int J Behav Nutr Phys Act ; 16(1): 86, 2019 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615522

RESUMEN

BACKGROUND: Living in walkable neighborhoods may provide long-term cardio-metabolic health benefits to residents. Little empirical research has examined the behavioral mechanisms in this relationship. In this longitudinal study, we examined the potential mediating role of physical activity (baseline and 12-year change) in the relationships of neighborhood walkability with 12-year changes in cardio-metabolic risk markers. METHODS: The Australian Diabetes, Obesity and Lifestyle study collected data from adults, initially aged 25+ years, in 1999-2000, 2004-05, and 2011-12. We used 12-year follow-up data from 2023 participants who did not change their address during the study period. Outcomes were 12-year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein cholesterol, and triglycerides. A walkability index was calculated, using dwelling density, intersection density, and destination density, within 1 km street-network buffers around participants' homes. Spatial data for calculating these measures were sourced around the second follow-up period. Physical activity was assessed by self-reported time spent in moderate-to-vigorous physical activity (including walking). Multilevel models, adjusting for potential confounders, were used to examine the total and indirect relationships. The joint-significance test was used to assess mediation. RESULTS: There was evidence for relationships of higher walkability with smaller increases in weight (P = 0.020), systolic blood pressure (P < 0.001), and high-density lipoprotein cholesterol (P = 0.002); and, for relationships of higher walkability with higher baseline physical activity (P = 0.020), which, in turn, related to smaller increases in waist circumference (P = 0.006), weight (P = 0.020), and a greater increase in high-density lipoprotein cholesterol (P = 0.005). There was no evidence for a relationship of a higher walkability with a change in physical activity during the study period (P = 0.590). CONCLUSIONS: Our mediation analysis has shown that the protective effects of walkable neighborhoods against obesity risk may be in part attributable to higher baseline physical activity levels. However, there was no evidence of mediation by increases in physical activity during the study period. Further research is needed to understand other behavioral pathways between walkability and cardio-metabolic health, and to investigate any effects of changes in walkability.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Planificación Ambiental , Enfermedades Metabólicas/prevención & control , Características de la Residencia , Caminata/fisiología , Adulto , Anciano , Australia , Presión Sanguínea , Peso Corporal , Diabetes Mellitus Tipo 2/prevención & control , Ejercicio/fisiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad/prevención & control , Autoinforme , Circunferencia de la Cintura
12.
BMC Health Serv Res ; 19(1): 694, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615525

RESUMEN

BACKGROUND: Group-based Diabetes Prevention Programs (DPP), aligned with recommendations from the Centers for Disease Control and Prevention, promote clinically significant weight loss and reduce cardio-metabolic risks. Studies have examined implementation of the DPP in community settings, but less is known about its integration in healthcare systems. In 2010, a group-based DPP known as the Group Lifestyle Balance (GLB) was implemented within a large healthcare delivery system in Northern California, across three geographically distinct regional administration divisions of the organization within 12 state counties, with varying underlying socio-demographics. The regional divisions implemented the program independently, allowing for natural variation in its real-world integration. We leveraged this natural experiment to qualitatively assess the implementation of a DPP in this healthcare system and, especially, its fidelity to the original GLB curriculum and potential heterogeneity in implementation across clinics and regional divisions. METHODS: Using purposive sampling, we conducted semi-structured interviews with DPP lifestyle coaches. Data were analyzed using mixed-method techniques, guided by an implementation outcomes framework consisting of eight constructs: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. RESULTS: We conducted 33 interviews at 20 clinics across the three regional administrative divisions. Consistencies in implementation of the program were found across regions in terms of satisfaction with the evidence base (acceptability), referral methods (adoption), eligibility criteria (fidelity), and strategies to increase retention and effectiveness (sustainability). Heterogeneity in implementation across regions were found in all categories, including: the number and frequency of sessions (fidelity); program branding (adoption); lifestyle coach training (adoption), and patient-facing cost (cost). Lifestyle coaches expressed differing attitudes about curriculum content (acceptability) and suitability of educational level (appropriateness). While difficulties with recruitment were common across regions (feasibility), strategies used to address these challenges differed (sustainability). CONCLUSIONS: Variation exists in the implementation of the DPP within a large multi-site healthcare system, revealing a dynamic and important tension between retaining fidelity to the original program and tailoring the program to meet the local needs. Moreover, certain challenges across sites may represent opportunities for considering alternative implementation to anticipate these barriers. Further research is needed to explore how differences in implementation domains impact program effectiveness.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Promoción de la Salud/métodos , California , Consejo , Prestación de Atención de Salud/organización & administración , Femenino , Educación en Salud/métodos , Personal de Salud , Estilo de Vida Saludable , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Proyectos de Investigación , Pérdida de Peso
13.
Zhonghua Nei Ke Za Zhi ; 58(10): 713-735, 2019 Oct 01.
Artículo en Chino | MEDLINE | ID: mdl-31594170

RESUMEN

National handbook for the prevention and control of diabetes in primary care (2019) is made for the use in combination with the national guidelines for the prevention and control of diabetes in primary care (2018). It provides detailed information and supplementary for the contents involved in the guidelines.


Asunto(s)
Prestación de Atención de Salud/normas , Diabetes Mellitus Tipo 2/prevención & control , Guías de Práctica Clínica como Asunto/normas , Atención Primaria de Salud/normas , Humanos
15.
J Coll Physicians Surg Pak ; 29(10): 967-971, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31564272

RESUMEN

OBJECTIVE: To determine the influence of bariatric surgery on remission of type 2 diabetes mellitus (T2DM) in obese patients along with improvements in other obesity-associated comorbidities. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Doncaster and Bassetlaw NHS Trust, UK, from August 2010 to August 2018. METHODOLOGY: All the cases of bariatric surgery in obese patients with T2DM who had completed 2 years of follow up were included in the study. Remission of T2DM was defined as glycated hemoglobin (HbA1C) <48 mmol/mol (<6.5%) or fasting blood sugar of <7.0 mmol/L, not on hypoglycemic agents 2 years after having bariatric surgery. Student's t-test was used to see any difference in baseline HbA1C, BMI, percentage of weight loss, and duration of diabetes between remitters and non-remitters. RESULTS: Two years follow-up data after bariatric surgery for remission of T2DM or otherwise was available for (n=121) patients. Majority (70.2%, n=85) were females and (29.8%, n=36) were males. Mean age was 48.21 ±9.77 years. Eightythree (68.6%) patients achieved remission of T2DM at 2 years and 31.4% (n=38) did not. Remission of other comorbidities was 33.3% (n=53 out of 159) for hypertension (HTN), 50.8% (n=60 out of 118) for dyslipidemia, 67.2% (n=43 out of 64) for obstructive sleep apnea (OSA), 52.1% (n=37 out of 71) for gastro esophageal reflux disease (GERD), 25.7% (n=18 out of 70) for asthma, and 23.3% (n=24 out of 103) for depression. CONCLUSION: Bariatric surgery effectively achieves remission of T2DM and other obesity associated comorbidities.


Asunto(s)
Cirugía Bariátrica , Diabetes Mellitus Tipo 2/prevención & control , Obesidad Mórbida/cirugía , Biomarcadores/sangre , Inglaterra , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
Rev. Ciênc. Plur ; 5(2): 94-110, ago. 2019. tab
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1021764

RESUMEN

Introdução:Diabetes Mellitus tipo 2 é uma doença crônica, silenciosa, caracterizada por hiperglicemia causada pela produção insuficiente, ou resistência a ação da insulina. No Brasil, em 2017, diagnosticou 12,5 milhões de pessoas com diabetes mellitus, com uma prevalência de 8 a 9%, ocupando o quinto lugar no mundo. Dianteda transição nutricional, várias pesquisas tem demonstrado prevalência desta patologia em crianças, adolescentes e jovens. Objetivo:Identificar o risco de desenvolver Diabetes mellitus tipo 2 nos estudantes do curso de Biomedicina, da Faculdade Unigran Capital, Campo Grande, MS. Método:Trata-se de um Estudo Epidemiológico Descritivo Quantitativo Transversal, com uma amostra de 132 estudantes, através da aplicação de um questionário, determinação de glicemia capilar, coleta do peso, altura, cintura abdominal, e aferição da pressão arterial. Resultados:Foi identificado fatores de riscos importantes nos estudantes de biomedicina: obesidade, sedentarismo, hipertensão, consumo de dieta não saudável e a predisposição genética. Os homens apresentaram mais fatores dos que as mulheres, as faixas etárias mais jovens de 18-20 anos encontravam-se mais sedentários e mais obesos, e, as faixas etárias mais velhas apresentaram hipertensão e consumo de dieta não saudável. Conclusões:Há necessidade de promover medidas de prevenção: consumo de dieta saudável e prática de atividade física entre os estudantes, para evitar o desenvolvimento desta patologia (AU).


Introduction:Type 2 Diabetes Mellitus is a chronic silent disease characterized by hyperglycemia caused by insufficient production, or resistance to the action of insulin. In Brazil, in 2017, diagnosed 12.5 million people with Diabetes Mellitus, with prevalence of 8 to9%, ranking fifth in the world. Faced with the nutritional transition, several studies have demonstrated the prevalence of this pathology in children, adolescents and young people. Objective:To identify the risk of developing Type 2 Diabetes Mellitus instudents of Biomedicine, Faculty of Unigran Capital, Campo Grande, MS.Methods:This is an Epidemiological Descriptive Cross-Sectional Study, with a sample of 132 students, through the application of a questionnaire, determination of capillary glycemia, weight, height, abdominal waist, and blood pressure measurement. Results:: Important risk factors were identified in biomedicine students: obesity, sedentary lifestyle, hypertension, consumption of unhealthy diet and genetic predisposition. Males presentedmore factors than females, the younger age groups of 18-20 years were more sedentary and more obese, and the older age groups presented hypertension and unhealthy diet consumption.Conclusions:There is a need to promote prevention measures: consumption of healthy diet and practice of physical activity among students, to avoid the development of this pathology (AU).


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Estudiantes del Área de la Salud , Factores de Riesgo , Diabetes Mellitus Tipo 2/prevención & control , Conducta Sedentaria , Brasil , Epidemiología Descriptiva , Encuestas y Cuestionarios , Estadísticas no Paramétricas
18.
Nutrients ; 11(9)2019 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-31533272

RESUMEN

The incidence of type 2 diabetes mellitus (DM) has increased in the US over the last several years. The consumption of low-fat dairy foods has been linked with decreasing the risk of DM but studies have yet to show a clear correlation. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) evaluating the effects of dairy intake on homeostatic model assessment of insulin resistance (HOMA-IR), waist circumference, and body weight. In MEDLINE and Embase, we identified and reviewed 49 relevant RCTs: 30 had appropriate data format for inclusion in the meta-analysis. Using the Review Manager 5 software, we calculated the pooled standardized mean differences comparing dairy dietary interventions to control for our outcomes of interest. For HOMA-IR (794 individuals), we found a mean difference of -1.21 (95% CI -1.74 to -0.67; p-value < 0.00001; I2 = 92%). For waist circumference (1348 individuals), the mean difference was -1.09 cm (95% CI 1.68 to -0.58; p-value < 0.00001; I2 = 94%). For body weight (2362 individuals), the dairy intake intervention group weighed 0.42 kg less than control (p-value < 0.00001; I2 = 92%). Our findings suggest that dairy intake, especially low-fat dairy products, has a beneficial effect on HOMA-IR, waist circumference, and body weight. This could impact dietary recommendations to reduce DM risk.


Asunto(s)
Glucemia/metabolismo , Productos Lácteos , Diabetes Mellitus Tipo 2/prevención & control , Dieta con Restricción de Grasas , Grasas de la Dieta/administración & dosificación , Resistencia a la Insulina , Insulina/sangre , Valor Nutritivo , Adulto , Anciano , Biomarcadores/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/fisiopatología , Grasas de la Dieta/metabolismo , Ingestión de Energía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Ingesta Diaria Recomendada , Circunferencia de la Cintura , Pérdida de Peso , Adulto Joven
19.
BMJ ; 366: l5003, 2019 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-31511236

RESUMEN

OBJECTIVE: To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes. DESIGN: Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines. DATA SOURCES: Medline, Embase, CINAHL, and reference lists of relevant publications. ELIGIBILITY CRITERIA: Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year. RESULTS: Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively. CONCLUSIONS: The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42018092287.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Carga Global de Enfermedades/tendencias , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/prevención & control , Humanos , Incidencia
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