RESUMO
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.
Assuntos
Restrição Calórica/métodos , Diabetes Mellitus Tipo 2/dietoterapia , Alimentos Formulados , Obesidade/dietoterapia , Adulto , Barbados , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Jejum , Estudos de Viabilidade , Comportamento Alimentar , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Obesidade/metabolismo , Influência dos Pares , Indução de RemissãoRESUMO
In the present study, a 12-yr-old rubella child exhibiting high rates of aggression was treated through a combination of differential reinforcement and time-out procedures in a residential school program. Following a baseline phase in which differential reinforcement for non-aggression was in effect, the reinforcement method was combined sequentially with three types of response-contingent time-out which varied in the degree of social isolation provided. While acts of aggression decreased from an average of 7 occurrences per day during baseline to 3 per day under the first two treatment conditions, the behavior was rapidly eliminated following application of isolation time-out with effects maintained 7 months post-treatment.