Behavioral Strategies to Lower Postprandial Glucose in Those with Type 2 Diabetes May Also Lower Risk of Coronary Heart Disease.

INTRODUCTION: Efforts to lower glycosylated hemoglobin (A1c) in patients with type 2 diabetes (T2D) are intended to reduce the risk of diabetic complications, but A1c is not the only factor contributing to this risk. Consequently, we re-analyzed published data from a broad-spectrum lifestyle intervention that lowered A1c to assess its effectiveness in lowering the overall risk of two complications of T2D, namely, coronary heart disease (CHD) and stroke. METHODS: Data from 37 adults who participated in a randomized clinical trial of a lifestyle intervention intended to reduce postprandial glucose (PPG) were re-analyzed for their pre- and post-treatment risk of CHD and stroke using the T2D-specific UK Prospective Diabetes Study (UKPDS) v2.0 risk algorithm. RESULTS: Compared to participants who received routine care, those using the lifestyle intervention had a significantly greater reduction in 10-year risk for CHD, but not for stroke. CONCLUSION: These secondary analyses suggest that broad-spectrum lifestyle interventions that focus on lowering PPG may lower the risk of future CHD, which could guide future research. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02432391.

Glycemic load, exercise, and monitoring blood glucose (GEM): A paradigm shift in the treatment of type 2 diabetes mellitus.

AIMS: This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postprandial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose (GEM) could improve metabolic control of adults with type 2 diabetes mellitus, without compromising other physiological parameters. METHODS: Forty-seven adults (mean age 55.3 years) who were diagnosed with type 2 diabetes mellitus for less than 5 years (mean 2.1 years), had HbA1c ≥ 7% (mean 8.4%) and were not taking blood glucose lowering medications, were randomized to routine care or five 1-h instructional sessions of GEM. Assessments at baseline and 6 months included a physical exam, metabolic and lipid panels, and psychological questionnaires. RESULTS: The GEM intervention led to significant improvements in HbA1c (decreasing from 8.4 to 7.4% [69-57 mmol/mol] compared with 8.3 to 8.3% [68-68 mmol/mol] for routine care; Interaction p<.01) and psychological functioning without compromising other physiological parameters. CONCLUSIONS: Consistent with a patient-centered approach, GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus.

Effects of antioxidant supplementation on insulin sensitivity, endothelial adhesion molecules, and oxidative stress in normal-weight and overweight young adults.

The objective of the study was to determine whether short-term antioxidant (AOX) supplementation affects insulin sensitivity, endothelial adhesion molecule levels, and oxidative stress in overweight young adults. A randomized, double-blind, controlled study tested the effects of AOXs on measures of insulin sensitivity (homeostasis model assessment [HOMA]) and quantitative insulin sensitivity check index), endothelial adhesion molecules (soluble intercellular adhesion molecule-1, vascular adhesion molecule, and endothelial-leukocyte adhesion molecule-1), adiponectin, and oxidative stress (lipid hydroperoxides) in overweight and normal-weight individuals (N = 48, 18-30 years). Participants received either AOX (vitamin E, 800 IU; vitamin C, 500 mg; beta-carotene, 10 mg) or placebo for 8 weeks. The HOMA values were initially higher in the overweight subjects and were lowered with AOX by week 8 (15% reduction, P = .02). Adiponectin increased in both AOX groups. Soluble intercellular adhesion molecule-1 and endothelial-leukocyte adhesion molecule-1 decreased in overweight AOX-treated groups by 6% and 13%, respectively (P < .05). Plasma lipid hydroperoxides were reduced by 0.31 and 0.70 nmol/mL in the normal-weight and overweight AOX-treated groups, respectively, by week 8 (P < .05). Antioxidant supplementation moderately lowers HOMA and endothelial adhesion molecule levels in overweight young adults. A potential mechanism to explain this finding is the reduction in oxidative stress by AOX. Long-term studies are needed to determine whether AOXs are effective in suppressing diabetes or vascular activation over time.

Effects of alpha-lipoic acid supplementation in peripheral arterial disease: a pilot study.

OBJECTIVE: To examine whether 3 months of lipoic acid (LA) supplementation improved walking tolerance and delayed claudication pain onset in peripheral arterial disease (PAD). DESIGN: Randomized, double-blind, controlled study. SETTING: General Clinical Research Center. SUBJECTS: Twenty-eight (28) participants (15 men, 13 women) with PAD (ankle brachial index range 0.9-0.4, mean age 73.2 +/- 1.6 years). INTERVENTION: LA (600 mg/day) or placebo for 3 months. OUTCOME MEASURES: Walking tolerance was assessed by 6-minute walk test distance, 4-meter walk time, initial claudication pain time (ICT) and distance (ICD), and peak claudication pain. Serum was assessed for inflammation (C-reactive protein [CRP]) and oxidative stress (lipid hydroperoxides) as potential mechanisms for changes in walking tolerance. RESULTS: ICT increased 34.4% and 15%, ICD was reduced by 40.5% and 18%, and peak claudication pain ratings were reduced by 93% and 7% in LA and placebo groups, respectively. Although the improvements in peak pain and ICT achieved significance within the LA group (both p<0.05), the interactions of group by time were not found to be significant (p>0.05). Oxidative stress and CRP measures were not different between groups by month 3 (p>0.05). There were no serious side-effects associated with the LA. CONCLUSIONS: LA may confer pain relief during exercise. However, longer and larger trials are warranted to determine long-term effects of LA alone or combined with other interventions on PAD symptoms.

Antioxidant supplementation lowers exercise-induced oxidative stress in young overweight adults.

OBJECTIVE: To determine whether antioxidant (AOX) supplementation attenuates post-exercise oxidative stress and contributors to oxidative stress (inflammation, blood lipids) in overweight young adults. RESEARCH METHODS AND PROCEDURES: This was a randomized, double-blind, controlled study. Overweight (BMI, 33.2 +/- 1.9 kg/m(2)) and comparative normal-weight (BMI, 21.9 +/- 0.5 kg/m(2)) adults 18 to 30 years old (total N = 48) were enrolled. Participants received either daily antioxidant (AOX) treatment (800 IU of vitamin E, 500 mg of vitamin C, 10 mg of beta-carotene) or placebo (PL) for 8 weeks for a total of four groups. All participants completed a standardized 30-minute cycle exercise bout at baseline and 8 weeks. Exercise-induced changes in lipid hydroperoxide (DeltaPEROX), C-reactive protein (DeltaCRP), interleukin-6 (DeltaIL-6), cholesterol subfractions, triglycerides, total AOX status (DeltaTAS), and adiponectin were assessed. RESULTS: Exercise-induced DeltaPEROX was lower in the overweight-AOX group (0.09 nM/kg per min) compared with PL-treated overweight and normal-weight groups (0.98, 0.53 nM/kg per min) by 8 weeks (p < 0.05). Adiponectin was increased in both overweight and normal-weight AOX groups (22.1% vs. 3.1%; p < 0.05) but reduced in PL groups. DeltaIL-6, Deltatotal cholesterol, and Deltalow-density lipoprotein-cholesterol concentrations during exercise were lower in the AOX-treated groups compared with PL groups (all p < 0.05). After controlling for BMI, the Deltatotal cholesterol, Deltalow-density lipoprotein-cholesterol, Deltaadiponectin, and DeltaTAS explained 59.1% of the variance of the regression model of the DeltaPEROX by 8 weeks (total model R(2) = 0.600; p = 0.015). DISCUSSION: AOX lowers exercise-induced oxidative stress in overweight adults. Inflammatory and lipid markers may also be attenuated with AOX. Further studies are needed to determine whether AOX may be used in cardiovascular disease prevention in the overweight population.

Effect of a gentle Iyengar yoga program on gait in the elderly: an exploratory study.

OBJECTIVE: To determine if a tailored yoga program could improve age-related changes in hip extension, stride length, and associated indices of gait function in healthy elders, changes that have been linked to increased risk for falls, dependency, and mortality in geriatric populations. DESIGN: Single group pre-post test exploratory study. A 3-dimensional quantitative gait evaluation, including kinematic and kinetic measurements, was performed pre- and postintervention. Changes over time (baseline to postintervention) in primary and secondary outcome variables were assessed using repeated-measures analysis of variance. SETTING: Yoga exercises were performed in an academic medical center (group classes) and in the subjects' homes (yoga home-practice assignments). Pre- and postassessments were performed in a gait laboratory. PARTICIPANTS: Twenty-three healthy adults (age range, 62-83 y) who were naive to yoga were recruited; 19 participants completed the program. INTERVENTION: An 8-week Iyengar Hatha yoga program specifically tailored to elderly persons and designed to improve lower-body strength and flexibility. Participants attended two 90-minute yoga classes per week, and were asked to complete at least 20 minutes of directed home practice on alternate days. MAIN OUTCOME MEASURES: Peak hip extension, average anterior pelvic tilt, and stride length at comfortable walking speed. RESULTS: Peak hip extension and stride length significantly increased (F1,18=15.44, P<.001; F1,18=5.57, P=.03, respectively). We also observed a trend toward reduced average pelvic tilt (F1,18=4.10, P=.06); adjusting for the modifying influence of frequency of home yoga practice strengthened the significance of this association (adjusted F1,17=14.30, P=.001). Both the frequency and duration of yoga home practice showed a strong, linear, dose-response relationship to changes in hip extension and average pelvic tilt. CONCLUSIONS: Findings of this exploratory study suggest that yoga practice may improve hip extension, increase stride length, and decrease anterior pelvic tilt in healthy elders, and that yoga programs tailored to elderly adults may offer a cost-effective means of preventing or reducing age-related changes in these indices of gait function.