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1.
BMC Public Health ; 20(1): 1, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31898494

RESUMO

BACKGROUND: Primary care patients with prediabetes is a priority group in the clinical, organisational and policy contexts. Engaging in regular physical activity is crucial to prevent diabetes for this group. The objectives of the study were to assess factors associated with meeting the recommendation of at least 150 min of moderate/vigorous physical activity weekly, and to explore facilitators and barriers related to the behaviour among primary care patients with prediabetes in Singapore. METHODS: This was a mixed methods study, consisting of a cross-sectional survey involving 433 participants from 8 polyclinics, and in-depth interviews with 48 of them. Adjusted prevalence ratios (aPR) were obtained by mixed effects Poisson regression model. The socio-ecological model (SEM) was applied, and thematic analysis performed. RESULTS: The prevalence of meeting the recommendation was 65.8%. This was positively associated with being male (aPR 1.21, 95%CI 1.09-1.34), living in 4-5 room public housing (aPR 1.19, 95%CI 1.07-1.31), living in executive flat/private housing (aPR 1.26, 95%CI 1.06-1.50), having family members/friends to exercise with (aPR 1.57, 95%CI 1.38-1.78); and negatively associated with a personal history of osteoarthritis (aPR 0.75, 95%CI 0.59-0.96), as well as time spent sitting or reclining daily (aPR 0.96, 95%CI 0.94-0.98). The recurrent themes for not meeting the recommendation included lacking companionship from family members/friends, medical conditions hindering physical activity (particularly osteoarthritis), lacking knowledge/skills to exercise properly, "no time" to exercise and barriers pertaining to exercise facilities in the neighbourhood. The recurrent themes for meeting the recommendation included family/peer influence, health/well-being concerns and education by healthcare professionals. CONCLUSIONS: Much more remains to be done to promote physical activity among primary care patients with prediabetes in Singapore. Participants reported facilitators and barriers to physical activity at different levels of the SEM. Apart from the individual and interpersonal levels, practitioners and policy makers need to work together to address the organisational, community and policy barriers to physical activity.


Assuntos
Exercício/psicologia , Fidelidade a Diretrizes/estatística & dados numéricos , Estado Pré-Diabético/terapia , Atenção Primária à Saúde , Idoso , Estudos Transversais , Exercício/fisiologia , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/epidemiologia , Pesquisa Qualitativa , Singapura/epidemiologia , Fatores Socioeconômicos
2.
Curr Diabetes Rev ; 16(2): 143-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30451115

RESUMO

INTRODUCTION: The Diabetes Prevention Program study results indicated that metformin therapy was not as beneficial as a lifestyle modification for delaying the development of type 2 diabetes in individuals at high risk of the disease. A key feature in the etiology of type 2 diabetes mellitus, which appears in the prediabetic phase, is a significant deficiency, compared to healthy controls, in highly flexible poly-cis-unsaturated fatty acyl chains in membrane phospholipids. This deficiency lowers membrane flexibility, which in turn, reduces the amount of all functional Class I glucose transporters, and thereby reduces glucose-mediated ATP production. This leads to an increase in essentially saturated free fatty acid (FFA) levels for fatty-acid-mediated ATP production, which will set up a vicious cycle of raising the levels of essentially saturated FFAs and lowering the level of transmembrane glucose transport. Metformin suppresses hepatic gluconeogenesis, which reduces the plasma glucose concentration. CONCLUSION: We hypothesize that chronic metformin treatment leads to an additional increase in essentially saturated FFAs, which causes an additional rise in membrane stiffness and hypoxia. So we propose that all these metformin-mediated activities accelerated the onset of type 2 diabetes in the participants of the metformin group in the Diabetes Prevention Program study, compared to the participants of the lifestyle-intervention group in this study. We propose that the biochemical reactions, involved in the fatty-acid-mediated ATP production, play an important part in the increase of the observed essentially saturated FFA concentrations. These statements should also extend to the metformin therapy of individuals with type 2 diabetes.


Assuntos
Membrana Celular/efeitos dos fármacos , Diabetes Mellitus Tipo 2/metabolismo , Ácidos Graxos/metabolismo , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Estado Pré-Diabético/metabolismo , Glicemia/metabolismo , Membrana Celular/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/terapia , Progressão da Doença , Membrana Eritrocítica/efeitos dos fármacos , Membrana Eritrocítica/metabolismo , Estilo de Vida Saudável , Humanos , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Metformina/farmacologia , Metformina/uso terapêutico , Estado Pré-Diabético/sangue , Estado Pré-Diabético/tratamento farmacológico , Estado Pré-Diabético/terapia , Medição de Risco , Fatores de Risco
4.
Medicina (Kaunas) ; 55(9)2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31470636

RESUMO

Diabetes, a silent killer, is one of the most widely prevalent conditions of the present time. According to the 2017 International Diabetes Federation (IDF) statistics, the global prevalence of diabetes among the age group of 20-79 years is 8.8%. In addition, 1 in every 2 persons is unaware of the condition. This unawareness and ignorance lead to further complications. Pre-diabetes is the preceding condition of diabetes, and in most of the cases, this ultimately leads to the development of diabetes. Diabetes can be classified into three types, namely type 1 diabetes, type 2 diabetes mellitus (T2DM) and gestational diabetes. The diagnosis of both pre-diabetes and diabetes is based on glucose criteria; the common modalities used are fasting plasma glucose (FPG) test and oral glucose tolerance test (OGTT). A glucometer is commonly used by diabetic patients to measure blood glucose levels with fast and rather accurate measurements. A few of the more advanced and minimally invasive modalities include the glucose-sensing patch, SwEatch, eyeglass biosensor, breath analysis, etc. Despite a considerable amount of data being collected and analyzed regarding diabetes, the actual molecular mechanism of developing type 2 diabetes mellitus (T2DM) is still unknown. Both genetic and epigenetic factors are associated with T2DM. The complications of diabetes can predominantly be classified into two categories: microvascular and macrovascular. Retinopathy, nephropathy, and neuropathy are grouped under microvascular complications, whereas stroke, cardiovascular disease, and peripheral artery disease (PAD) belong to macrovascular complications. Unfortunately, until now, no complete cure for diabetes has been found. However, the treatment of pre-diabetes has shown significant success in preventing the further progression of diabetes. To prevent pre-diabetes from developing into T2DM, lifestyle intervention has been found to be very promising. Various aspects of diabetes, including the aforementioned topics, have been reviewed in this paper.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Estado Pré-Diabético , Adulto , Idoso , Glicemia/análise , Complicações do Diabetes , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/complicações , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/terapia , Fatores de Risco , Pesquisa Médica Translacional
5.
Diabetes Metab Syndr ; 13(4): 2705-2713, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405697

RESUMO

BACKGROUND: Yoga is an ancient system of wellness with Asana and Pranayama as its most popular and propagated modules for management of lifestyle disorders. OBJECTIVES: The aim of the study was to characterise the liver abnormalities, biochemical changes, and stress levels after Yoga intervention in prediabetic females. MATERIALS AND METHODS: 37 females were randomly divided into Yoga practising and non-practising control groups. The Yoga practising group performed Diabetic Yoga Protocol (DYP) for 3 months. Parameters including size of liver, fatty infiltration, and grade of severity were measured using ultrasonography along with biochemical parameters and stress levels at baseline and after Yoga practice. RESULTS: The glycosylated hemoglobin (HbA1c) and glucose levels were found significantly reduced in prediabetic (p = 0.015) women after practising DYP, although cholesterol levels increased in menopausal women. No escalation of fatty liver was noted among women practising DYP. CONCLUSION: DYP reduced the HbA1c and stress levels and therefore, could be a cost-effective tool for preventing prediabetes to diabetes progression.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/prevenção & controle , Fígado/fisiologia , Estado Pré-Diabético/terapia , Estresse Fisiológico , Ioga , Glicemia/análise , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Estilo de Vida , Fígado/diagnóstico por imagem , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico por imagem , Prognóstico , Ultrassonografia/métodos
6.
Medicine (Baltimore) ; 98(27): e16259, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277146

RESUMO

BACKGROUND: The number of people with diabetes and pre-diabetes is growing exponentially. Human studies have shown that zinc supplementation is beneficial for pre-diabetes. However, owing to the low quality, small sample size, and methodological heterogeneity of these studies, this conclusion is not convincing. Consequently, in order to determine whether zinc supplementation is effective and safe in pre-diabetic patients, it is necessary to conduct a meta-analysis of high-quality clinical trials. METHODS: We will retrieve MEDLINE (PubMed), EMBASE, the Web of Science, Cochrane Library, and the ClinicalTrials.gov website without restriction on language. Randomized controlled trials (RCTs) of Zinc supplementation for adult patients with pre-diabetes will be searched in multiple databases from inception to October 2020. The primary outcome of the meta-analysis is the HbA1c. The secondary outcomes include the fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). Two assessors will utilize the Cochrane Collaboration's risk of bias tool to evaluate the RCTs and all statistical data will be analyzed by using the Review Manage software V5.3.0. RESULTS: This study will provide high-quality synthesis of effectiveness and safety of zinc supplementation for pre-diabetes. CONCLUSION: This systematic review and meta-analysis will provide the available evidence to assess whether the zinc supplementation is beneficial to glucose control and insulin resistance in patients with pre-diabetes. PROSPERO REGISTRATION NUMBER: CRD 42018095724.


Assuntos
Glicemia/metabolismo , Protocolos Clínicos , Suplementos Nutricionais , Estado Pré-Diabético/terapia , Zinco/farmacologia , Humanos , Estado Pré-Diabético/sangue
7.
Diabetes Metab Syndr ; 13(2): 1603-1608, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336528

RESUMO

Prediabetes increases an individual's risk for progress to diabetes. The aim of the study is to assess prediabetic profile before and after life style modification only, lifestyle with metformin and lifestyle with DPP-4 inhibitor. This study was carried out at BIRDEM. The subjects were IGT, IFG or combined. In Group A 50 subjects were advised with lifestyle, 42 were follow up with the results showed that highly significant change in BMI, Fasting & 2 h plasma glucose, serum triglyceride, and reduced HbA1c level, reduction rate of DM is 43%. In Group B 50 subjects were advised with lifestyle plus metformin, 44 were follow up with the results showed that significant change in BMI, Fasting, 2 h plasma glucose, triglyceride, and reduced HbA1c, reduction rate of DM is 58%. In Group C 50 subjects were advised with lifestyle plus DPP4i, 37 were follow up with the results showed that significantly change in BMI, Fasting, 2 h plasma glucose, triglyceride and reduced HbA1c level, reduction rate of DM is 43%. There is significant outcome difference in BMI in between A vs. B and A vs. C group. More mean changed in 2hrs after blood glucose level in group A vs. group B and B vs. C group. There is significant outcome difference in TG level in A vs. B, B vs. C group but no difference in A vs. C group.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Dipeptidil Peptidase 4/química , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Hipoglicemiantes/uso terapêutico , Estilo de Vida , Metformina/uso terapêutico , Estado Pré-Diabético/terapia , Adulto , Bangladesh , Biomarcadores/análise , Glicemia/análise , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/metabolismo , Estado Pré-Diabético/patologia , Prognóstico
8.
Diabetes Res Clin Pract ; 154: 35-42, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31238061

RESUMO

AIMS: Physical activity plays an important role in blood glucose management, yet most adults with elevated blood glucose do not engage in regular physical activity. Exercise videogames (EVGs) may be an attractive alternative for persons who have not found standard exercise modalities appealing. METHODS: This sub-study within a larger trial examined the effects of 12 weeks of EVGs versus standard exercise (e.g., treadmill, cycling) and a control condition among individuals with elevated HbA1c (100% prediabetic). This study was conducted at a university research lab. Outcomes included HbA1c and weekly minutes of moderate to vigorous physical activity (MVPA) assessed using self-report and accelerometer.Other health risk indices (e.g., lipids) and psychosocial constructs shown to influence exercise participation (e.g., intrinsic motivation) were assessed. RESULTS: Participants (n = 84), averaged age 51.4 years (range 20-79), 80% were female, and 77.4% were non-Hispanic. Baseline HbA1c ranged from 5.7% to 6.4% (39-49 mmol/mol). At week 12, EVG participants demonstrated an average 2% reduction in HbA1c compared to a 0.6% reduction in Standard and Control groups (p's = 0.04 and 0.03). EVG participants engaged in significantly more MVPA than Standard (+17 min/week) and Controls (+54 min/week) (p's < 0.05), had reduced LDL cholesterol (p = 0.05) and trends suggesting reduced body fat (p = 0.10). EVG participants reported higher exercise enjoyment and motivation compared to other participants. CONCLUSIONS: EVGs may be an attractive and effective tool to improve management of blood glucose that might contribute toward preventing the onset of type 2 diabetes among those with prediabetes.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício/métodos , Hemoglobina A Glicada/análise , Estado Pré-Diabético/terapia , Jogos de Vídeo/estatística & dados numéricos , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Nutrients ; 11(5)2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31109110

RESUMO

Few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken. The present study evaluates the impact of a 6-month intensive lifestyle modification intervention delivered in primary care. Females from SA with prediabetes, aged 18-55 years, were recruited with 190 participants eligible following screening and randomly allocated to receive a 3-month one-on-one, intensive lifestyle modification (intervention group (IG) n = 95) or standard guidance (control group (CG) n = 95). Participants completed questionnaires including demographic, dietary and physical activity data. Blood samples were collected at baseline, 3 and 6 months. A total of 123 (74 IG (age 40.6 ± 9.8 years; body mass index (BMI) 31.2 ± 7.0 kg/m2) and 49 CG (age 40.6 ± 12.7 years; BMI 32.3 ± 5.4 kg/m2)) participants completed the study. After 6 months, haemoglobin A1c (HbA1c; primary endpoint) significantly improved in the IG than CG completers in between-group comparisons (p < 0.001). Comparison between groups showed significant improvements in overall energy intake, total and high density lipoprotein (HDL)-cholesterol in favour of IG (p-values < 0.001, 0.04 and <0.001, respectively). BMI and weight change were not clinically significant in between group comparisons. A 6-month, intense one-on-one intervention in lifestyle modification significantly improves glycaemic and cardio metabolic profile of females living in SA with pre-diabetes delivered in a primary care setting. Longer duration studies, using the same intervention, may determine whether a meaningful weight loss secondary to improved diet can be achieved.


Assuntos
Educação de Pacientes como Assunto/métodos , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/terapia , Adolescente , Adulto , Árabes , Glicemia , Exercício , Feminino , Humanos , Pessoa de Meia-Idade , Sobrepeso , Arábia Saudita/epidemiologia , Perda de Peso , Adulto Jovem
10.
Nutrients ; 11(6)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142056

RESUMO

Nutritional education for pre- and type 2 diabetes empowers individuals to make positive dietary and lifestyle choices. As the world migrates to digital devices, opportunities arise for education resources to reach a broad spectrum of society. This study aimed to develop and test the effectiveness of an electronic nutritional education resource for people with pre- and type 2 diabetes within the multi-ethnic New Zealand population. A needs assessment was conducted via ethnic-specific discussion groups (n = 29), followed by a population-based online survey (n = 448). An educational resource, including an educational video and pre- and post-questionnaires, was developed and tested online among 156 participants (17 with pre- and type 2 diabetes, 118 interested lay public and 21 health professionals). There was a strong desire to learn nutrition through simple, visual, practical, and culturally appropriate online educational resources. After interacting with the educational resource, the accuracy of identifying foods that increase blood glucose concentration improved by 17.4% (p = 0.013) in people with pre- and type 2 diabetes, 12.8% (p = 0.003) in health professionals, and 16.3% (p < 0.001) in interested lay public. There was an improvement among ethnic minority participants of 14.1% (p = 0.003). Most participants expressed intentions to make positive dietary and lifestyle choices. The electronic nutrition education resource was found to be an effective means for delivering education. It has potential to bridge the gap between the limited supply of healthcare resources and the increasing demand for diabetes nutrition education.


Assuntos
Comportamento de Escolha , Diabetes Mellitus Tipo 2/terapia , Estilo de Vida Saudável , Educação de Pacientes como Assunto/métodos , Estado Pré-Diabético/terapia , Comportamento de Redução do Risco , Adulto , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estado Nutricional , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/fisiopatologia , Estado Pré-Diabético/psicologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
11.
Transl Behav Med ; 9(3): 448-450, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31094432

RESUMO

Despite our best efforts, pediatric obesity remains an important public health issue. Although many different approaches to address this condition have been utilized, few have achieved long-term success. Technology is increasingly being explored as a convenient and accessible method for delivering behavioral interventions. Stephens and colleagues report the feasibility of using a behavioral coaching social chatbot, Tess, to extend a multicomponent pediatric obesity intervention for adolescents. We examine the pros and cons of this approach. Although social chatbots offer an interesting and novel method for promoting round-the-clock support, important issues and decisions must be carefully considered during the design phase to help ensure a safe environment for a vulnerable population.


Assuntos
Tutoria , Aplicativos Móveis , Obesidade Pediátrica/terapia , Estado Pré-Diabético/terapia , Mensagem de Texto , Adolescente , Terapia Comportamental , Estudos de Viabilidade , Humanos
12.
Transl Behav Med ; 9(3): 440-447, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31094445

RESUMO

Behavioral intervention technologies (BITs) are unique ways to incorporate the benefits of technology and psychology to address differing health needs through various media, including Internet interventions, mobile apps, and video games. BITs present several possible benefits, including increased dissemination and accessibility, cost-effectiveness, increased engagement, and decreased stigma, especially among youth. A behavioral coaching chatbot, Tess, addresses different facets of behavioral health, such as depression and anxiety. Available 24/7, Tess delivers customized integrative support, psychoeducation, and interventions through brief conversations via existing communication channels (i.e., SMS text messaging and Facebook Messenger). This study assessed the feasibility of integrating Tess in behavioral counseling of adolescent patients (n = 23; Mage = 15.20 years; Rangeage = 9.78-18.54 years; 57% female) coping with weight management and prediabetes symptoms. Tess engaged patients via a preferred method of communication (SMS text messaging) in individualized conversations to promote treatment adherence, behavior change, and overall wellness. Adolescent patients reported experiencing positive progress toward their goals 81% of the time. The 4,123 messages exchanged and patients' reported usefulness ratings (96% of the time) illustrate that adolescents engaged with and viewed this chatbot as helpful. These results highlight the feasibility and benefit of support through artificial intelligence, specifically in a pediatric setting, which could be scaled to serve larger groups of patients. As a partner to clinicians, Tess can continue the therapeutic interaction outside office hours while maintaining patient satisfaction. Due to Tess's capacity for continuous learning, future iterations may have additional features to increase the user experience.


Assuntos
Tutoria , Aplicativos Móveis , Obesidade Pediátrica/terapia , Estado Pré-Diabético/terapia , Mensagem de Texto , Adolescente , Terapia Comportamental , Comunicação , Estudos de Viabilidade , Feminino , Humanos , Masculino
14.
J Vasc Interv Radiol ; 30(6): 790-796, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31040059

RESUMO

PURPOSE: To evaluate the effect of left gastric artery embolization (LGAE) on glycated hemoglobin (HbA1c) in a prospective obese, prediabetic cohort. MATERIALS AND METHODS: This prospective pilot study included 10 obese, prediabetic patients (7 females and 3 males; mean age 37.5 ± 8.8 years; range 28-51 years) admitted to the Interventional Radiology Unit between January 2017 and June 2018 for LGAE for weight reduction. The main inclusion criteria were body mass index (BMI) >30 kg/m2 and HbA1c ranging from 5.7 to 6.4. Body weight, BMI, and HbA1c were assessed for each patient preprocedure and at 6 months postprocedure. Statistical analysis was performed using a paired sample t test. RESULTS: The baseline mean body weight, BMI, and HbA1c were 107.4 ± 12.8 kg, 37.4 ± 3.3 kg/m2, and 6 ± 0.2, respectively. Concerning complications, no serious adverse events were detected. Six months after the procedure, the mean body weight and BMI significantly decreased to 98 ± 11.6 kg and 34.1 ± 3 kg/m2, respectively (P < .0001). A paired sample t test showed a significant reduction in HbA1c from pre- to postprocedure (6.1 ± 0.2 preprocedure vs 4.7 ± 0.6 postprocedure, P < .0001). The mean percent reductions in body weight, BMI, and HbA1c were 8.9% ± 1.2, 8.8% ± 1, and 21.4% ± 8.9, respectively. A statistically significant positive correlation was found between BMI and HbA1c after the procedure (r = 0.91, P = .0002). CONCLUSIONS: LGAE is well tolerated and leads to clinically significant decreases in weight and HbA1c in obese, prediabetic patients.


Assuntos
Embolização Terapêutica/métodos , Artéria Gástrica , Hemoglobina A Glicada/metabolismo , Obesidade/terapia , Estado Pré-Diabético/terapia , Perda de Peso , Adulto , Biomarcadores/metabolismo , Índice de Massa Corporal , Embolização Terapêutica/efeitos adversos , Feminino , Artéria Gástrica/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/diagnóstico , Obesidade/fisiopatologia , Projetos Piloto , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/fisiopatologia , Estudos Prospectivos , Radiografia Intervencionista , Fatores de Tempo , Resultado do Tratamento
15.
JMIR Mhealth Uhealth ; 7(4): e13204, 2019 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-31017586

RESUMO

BACKGROUND: Preventing progression from prediabetes to diabetes-or slowing the progression of diabetes-is an urgent task worldwide. Previous studies have shown that mobile health (mHealth) may powerfully support self-management for patients with type 2 diabetes. Certainly, mHealth improves health care efficiency and gives patients convenient access to self-management of their own health. Many health care apps are available right now, and their use in clinical studies with large-scale real-life data is expected. However, the usage patterns of those apps-especially in the absence of intervention by medical professionals-remain unknown. OBJECTIVE: We developed GlucoNote, an app that uses Apple's ResearchKit to support self-management for patients with type 2 diabetes and prediabetes; the app does not require prescription or intervention by medical professionals. We evaluated its usage patterns via a remotely conducted study. METHODS: iPhone users across Japan who have type 2 diabetes or prediabetes were free to download GlucoNote and to participate in the study after they provided consent electronically on the app. The 522 users who enrolled in the study within 1 year of its release were analyzed. We analyzed the retention rates of 357 participants who recorded at least 1 of 4 items-body weight, blood sugar, blood pressure, or dietary information. Characteristics of participants who used GlucoNote longer than 4 weeks (robust users) were compared with those of participants who did not (nonrobust users). The changes among robust users were evaluated. RESULTS: The median observation and retention durations were 382 days (interquartile range [IQR] 275-423) and 8 days (IQR 1-63), respectively. The retention rates for 2 days and for 4, 8, and 12 weeks were 0.627 (95% CI 0.575-0.675), 0.353 (0.304-0.403), 0.272 (0.227-0.319), and 0.220 (0.179-0.265), respectively. Men were more likely to be robust users than women (P=.02). At week 0, robust users were more likely than nonrobust users to have a higher daily energy intake (median 1595 [IQR 1198-1788] kcal vs 1451 [IQR 769-1657] kcal; P=.04) and have higher daily step counts (median 6108 [IQR 3797-9227] vs 5171 [IQR 2885-7258]; P=.001). Among robust users, body weight decreased from weeks 0 to 4 (mean 71.3 [SD 14.1] kg to 70.8 [SD 13.9] kg; P=.002) by mean 0.6% (SD 1.6). CONCLUSIONS: GlucoNote offered a valuable opportunity to evaluate usage patterns of apps. Future challenges include improving low retention rates and evaluating their effects.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Aplicativos Móveis/normas , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Estado Pré-Diabético/psicologia , Estado Pré-Diabético/terapia , Autogestão/métodos , Autogestão/psicologia , Autogestão/estatística & dados numéricos
16.
J Pak Med Assoc ; 69(4): 527-532, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000858

RESUMO

OBJECTIVE: To explore the knowledge and perceptions about pre-diabetes screening and management amongst physicians, final year medical students, and patients. METHODS: The cross-sectional observational study was conducted at Shifa International Hospital, Shifa Foundation Clinic and Shifa College of Medicine, Islamabad, Pakistan, from November 2017 to February 2018. A structured questionnaire was used to assess doctors' and final year medical students' knowledge about screening and management of pre-diabetes. A group of patients were also interviewed about pre-diabetes awareness and their primary resources for health-related information. Data was analysed using SPSS 23. RESULTS: Of the 267 participants, there were 85(32%) doctors, 82(31%) medical students and 100(37%) patients. Only 61(71.8%), 44(51.7%) and 34(39.8%) physicians and 53(64.6%), 30(36.5%) and 26(31.6%) students could accurately identify impaired fasting blood glucose, glycated haemoglobin and impaired glucose tolerance criteria for pre-diabetes, respectively. Regarding risk factors for pre-diabetes screening, ethnicity, cardiovascular diseases and gestational diabetes were identified by 8(9.4%), 6(7.1%) and 9(10.6%) physicians and 10(12.2%), 6(7.3%) and 15(18.3%) students, respectively. There was no statistically significant relation of correct identification of pre-diabetes criteria with specialties, designations and years of experience post-qualification (p>0.5). Only 3(3%) patients were aware of pre-diabetes or borderline diabetes. CONCLUSIONS: Knowledge and perception of doctors, medical students and patients about pre-diabetes was found to be deficient. Efforts are required to reinforce its identification and management at all levels..


Assuntos
Competência Clínica , Conhecimentos, Atitudes e Prática em Saúde , Médicos , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/terapia , Estudantes de Medicina , Adulto , Glicemia/metabolismo , Informação de Saúde ao Consumidor , Feminino , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/metabolismo , Intolerância à Glucose/terapia , Hemoglobina A Glicada/metabolismo , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Paquistão , Estado Pré-Diabético/metabolismo , Televisão , Centros de Atenção Terciária , Adulto Jovem
17.
Eur J Appl Physiol ; 119(7): 1503-1512, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30980133

RESUMO

PURPOSE: The present study was designed to evaluate the 16 weeks diabetes prevention program (DPP) combined with instructed run sprint interval training (INT) or moderate-intensity continuous training (MICT) on glycemic control, body composition, fitness, exercise adherence, and perceived exercise enjoyment in sedentary, adults with prediabetes. METHODS: Participants completed three weekly supervised sessions of INT (4-10 bouts of 30 s maximal sprints followed by a 4 min active recovery) or MICT (30-60 min at 45-55% HRR) exercise coupled with the DPP for 16 weeks. At baseline, 8 and 16 weeks, participants completed fitness and clinical assessments as well as questionnaires to assess group and time differences. RESULTS: Twenty-nine study participants (INT n = 17, MICT n = 12) were randomized, however, significantly (p = 0.024) more participants withdrew from the INT (n = 11) than MICT (n = 4) treatment. There was no significant difference between groups in perceived exercise enjoyment, but, the MICT group significantly improved their perceived exercise enjoyment (10.8 ± 14.2; p = 0.021) from baseline to 16 weeks. Both INT and MICT groups decreased their body weight (2.0 ± 0.8 vs. - 5.5 ± 1.4 kg; p < 0.001), BMI (- 0.6 ± 0.3 vs. - 2.1 ± 0.5 kg/m2; p < 0.001), body fat mass (1.4 ± 0.6 vs. - 4.2 ± 1.0 kg; p < 0.001), fasting glucose (- 0.09 ± 0.01 vs. - 0.18 ± 0.02 mmol/L; p = 0.020), and HbA1c (- 0.21 ± 0.09 vs. - 0.12 ± 0.12%; p = 0.001), respectively, however, the MICT had greater reductions (GxT: p ≤ 0.05) in body weight, BMI, and body fat than the INT group. CONCLUSION: Sixteen weeks of MICT is adhered to better and elicits greater improvements in body composition than INT. Nevertheless, both interventions similarly reduced fasting glucose and HbA1c in adults with prediabetes, suggesting either treatment could be effective for T2D prevention.


Assuntos
Condicionamento Físico Humano/métodos , Estado Pré-Diabético/terapia , Corrida , Adolescente , Adulto , Idoso , Glicemia/análise , Composição Corporal , Humanos , Masculino , Pessoa de Meia-Idade , Condicionamento Físico Humano/efeitos adversos , Aptidão Física , Prazer
18.
S D Med ; 72(2): 67-73, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30855734

RESUMO

The enormous implications caused by type 2 diabetes on patients, families and health systems in the U.S. require health care providers to apply measures that reduce its burden. Scientific evidence clearly shows that proper screening of populations at risk, implementation of interventions proven beneficial in preventing type 2 diabetes and the use of modern technology in educating patients to adopt a healthier lifestyle are paramount in decreasing the incidence of type 2 diabetes. In this article, we try to answer some of the questions raised by both patients and health care providers about how lifestyle modifications can play a key role in ameliorating and reversing impaired glucose tolerance and type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Intolerância à Glucose/diagnóstico , Estado Pré-Diabético/diagnóstico , Intolerância à Glucose/terapia , Humanos , Estilo de Vida , Programas de Rastreamento , Estado Pré-Diabético/terapia
19.
Pediatr Diabetes ; 20(3): 330-338, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30737875

RESUMO

OBJECTIVE: To evaluate primary care presentations during the prodrome (12 months prior to onset type-1 diabetes (T1D), with or without diabetic ketoacidosis [DKA]), to identify opportunities for earlier diagnosis. METHODS: This was a case-control study, linking 16 years of data from children (≤15 years) registered at diagnosis of T1D, and routinely collected primary care records in Wales (United Kingdom). Controls (without T1D) were matched on a 3:1 ratio. Conditional logistic regression modeling was used to compare characteristics occurring in cases (children with T1D) and controls; and cases that presented with/without DKA. RESULTS: A total of 1345 children with T1D (19% DKA) and 4035 controls were identified. During the 12 months prior to diagnosis, cases were 6.5 times more likely to have at least one primary care contact (P < 0.001). One to 30 days prior to diagnosis, contacts relating to blood tests, fungal conditions, respiratory tract infections (RTIs), urinary conditions, vomiting, and weight were independently associated with T1D, as were contacts relating to blood tests, between 91 and 180 days prior to diagnosis. Children with a contact up to a month prior to diagnosis, relating to RTIs, antibiotic prescriptions, and vomiting, were more likely to present in DKA, as were boys (P = 0.047). CONCLUSION: There are opportunities in primary care for an earlier diagnosis of T1D in childhood. These data could be used to create a predictive diagnostic tool, as a potential aid for primary care health professionals, to prevent presentation in DKA.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Visita a Consultório Médico/estatística & dados numéricos , Estado Pré-Diabético/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Sintomas Prodrômicos , Adolescente , Fatores Etários , Estudos de Casos e Controles , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/terapia , Diagnóstico Precoce , Intervenção Médica Precoce/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Armazenamento e Recuperação da Informação , Masculino , Pediatria/estatística & dados numéricos , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/terapia , Reino Unido/epidemiologia
20.
Diabetes Metab Res Rev ; 35(5): e3143, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30768758

RESUMO

AIM: The purpose of this study is to explore the long-term effects of aerobic training (AT), resistance training (RT), and combined training (AT + RT) on the prevention of T2D incidence in patients with prediabetes. MATERIALS AND METHODS: In this randomised controlled trial, people with prediabetes (fasting glucose ≥5.6 and <7.0 mmol/L and/or 2-h glucose ≥7.8 and <11.1 mmol/L on the 75-g oral glucose tolerance test and/or haemoglobin A1c ≥5.7% and <6.4%) were randomly assigned to the control group, AT group, RT group, or AT + RT group. Supervised exercise programmes, including AT, RT, and AT + RT, were completed for 60 minutes per day, three non-consecutive days per week for 24 months. The primary outcome was the incidence of T2D; secondary outcomes were blood glucose and lipid levels, including total cholesterol (TC) and standard 2-hour oral glucose tolerance (2hPG). RESULTS: A total of 137 (80%) subjects with a mean age of 59 years (45 men, 92 women) entered the final analysis. After 24 months of intervention, the incidences of T2D adjusted by sex and age were significantly decreased by 74% (95% CI, 38-89), 65% (95% CI, 21-85), and 72% (95% CI, 36-87) in the AT + RT, RT, and AT groups compared with the control group (HR: AT + RT 0.26 [95% CI, 0.11-0.62], RT 0.35 [95% CI, 0.15-0.79], and AT 0.28 [95% CI, 0.13-0.64]). The cumulative T2D incidences were significantly lower in the AT + RT, RT, and AT groups than in the control group (21%, 26%, and 22% vs 69%). The blood glucose and lipid profiles improved more in the AT, RT, and AT + RT groups than in the control group. CONCLUSION: RT and RT plus AT were as effective as isolated AT in preventing progression to T2D.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Terapia por Exercício/métodos , Estado Pré-Diabético/terapia , Treinamento de Resistência/métodos , Idoso , Glicemia/análise , China/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Jejum , Feminino , Teste de Tolerância a Glucose , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Condicionamento Físico Humano/métodos , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Resultado do Tratamento
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