Inducing remission of Type 2 diabetes in the Caribbean: findings from a mixed methods feasibility study of a low-calorie liquid diet-based intervention in Barbados.

AIM: In a high proportion of people with recently diagnosed Type 2 diabetes, a short (2-3-month) low-calorie diet is able to restore normal glucose and insulin metabolism. The aim of this study was to determine the feasibility of this approach in Barbados. METHODS: Twenty-five individuals with Type 2 diabetes diagnosed within past 6 years, not on insulin, BMI ≥ 27 kg/m2 were recruited. Hypoglycaemic medication was stopped on commencement of the 8-week liquid (760 calorie) diet. Insulin response was assessed in meal tests at baseline, 8 weeks and 8 months. Semi-structured interviews, analysed thematically, explored participants' experiences. 'Responders' were those with fasting plasma glucose (FPG) < 7 mmol/l at 8 weeks. RESULTS: Ten men and 15 women (mean age 48, range 26-68 years) participated. Mean (sd) BMI was 34.2 kg/m2 (6.0); FPG 9.2 mmol/l (2.2). Mean weight loss at 8 weeks and 8 months was 10.1 kg [95% confidence interval (CI) 8.1, 12.0] and 8.2 kg (95% CI 5.8, 10.6); FPG was lower by 2.2 mmol/l (95% CI 1.2, 3.2) and 1.7 mmol/l (95% CI 0.8, 2.7) respectively. Nine of 11 (82%) of those who lost ≥ 10 kg were 'responders' compared with 6 of 14 (43%) who lost < 10 kg (P = 0.048). The 30-min insulin increment was higher in responders at baseline and follow-up (P ≤ 0.01). A food culture based on starchy foods and pressures to eat large amounts at social events were among the challenges identified by participants. CONCLUSIONS: The feasibility of this approach to weight loss and diabetes remission in a predominantly black population in Barbados was demonstrated.

A checklist that enhances the provision of education during insulin initiation simulation: a randomized controlled trial.

AIM: The study tested the hypothesis that doctors using an insulin information checklist during simulated insulin initiation would impart more information regarding insulin use. METHODS: A total of 128 simulations were conducted. Doctors (n = 64) were recruited from practitioners recently completing internship (n = 19) and those established in primary care (n = 45). Both groups of doctors were strata randomized to control (n = 32) and intervention groups (n = 32), so that each group contained equal numbers. Doctors in each group experienced two identical simulations of insulin initiation with an intervening period of 10 min. Doctors in the intervention arm were introduced to an insulin initiation checklist, which they reviewed independently and utilized in the second simulation. Trained assessors captured the provision of education in 21 predefined educational areas. Differences in the change of the total education provided between the first and second simulations were assessed using linear regression. RESULTS: The difference in the mean change of education provided between the first and second simulations within the 21 educational areas for the control and treatment groups was 9.7 [95% confidence interval (CI): 8.8-11.1, P < 0.001] - an increase of 46.2%. The difference for the 15 areas relevant to pen use was 7.3 (95% CI: 6.2-8.4, P < 0.001) - an increase of 51.6%. CONCLUSIONS: The checklist resulted in doctors providing significantly more education applicable to syringe and insulin pen routes of insulin administration during simulations. Further research is needed on the checklist's impact on healthcare professionals and patient outcomes in the clinical context. (Clinical Trials Registry No: NCT02266303).

Reversing Type 2 Diabetes in the Caribbean: Preliminary findings from a feasibility study in Barbados

OBJECTIVE: In a high proportion of persons recently diagnosed with Type 2 diabetes, a short (2–3 months) very low calorie diet is able to restore normal glucose and insulin metabolism. The objective of this study is to determine the feasibility of this approach in Barbados. SUBJECTS AND METHODS: Twenty-five individuals aged 20to 69 years with Type 2 diabetes diagnosed within the past six years, not on insulin, and body mass index (BMI) > 27kg.m-2 were recruited. Hypoglycaemic medication was stopped on commencement of the eight-week liquid (760calorie) diet, during which participants were assessed weekly. Findings from the liquid diet phase and the following three months are presented. RESULTS: The study participants comprised 10 men and 15women (mean age 48 years, range 26–68 years). Mean(SD, range) BMI was 34.2 kg.m-2 (6.0, 27.0–52.8) and fasting plasma glucose (FPG) was 9.2 mmol.l-1 (2.2, 6.7–14.6). Over the eight-week intervention, mean weight loss was 10.1 kg (4.7, 1.5–20.8) and waist circumference loss10.9 cm (4.0, 5.1–20.8). Fasting plasma glucose fell by 2.2mmol.l-1 (range 1.5–7.9). At eight weeks, FPG was < 7mmol.l-1, the diagnostic cut point for diabetes, in 15 participants compared to three at baseline (p = 0.004). At three months post liquid diet, 17 had FPG < 7 mmol.l-1 (still off medication). CONCLUSION: There was substantial weight loss and fall inFPG in the majority of participants, sustained at three months follow-up. Data on changes in pancreatic function are being analysed. These findings will inform a larger, pragmatic, multi-centre Caribbean trial.