scholarly journals Effectiveness of a Digital Lifestyle Change Program in Obese and Type 2 Diabetes Populations: Service Evaluation of Real-World Data

JMIR Diabetes ◽  
10.2196/15189 ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. e15189 ◽  
Author(s):  
Iskandar Idris ◽  
James Hampton ◽  
Fiona Moncrieff ◽  
Michael Whitman
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Weight Management ◽  
Lifestyle Change ◽  
Service Evaluation ◽  
Lifestyle Changes ◽  
Real World Data ◽  
Structured Education ◽  
Change In Mean

Background The prevalence of type 2 diabetes mellitus (T2DM) and obesity is increasing, and the way people interact with health care is evolving. People traditionally access advice and support to improve their lifestyle and learn more about the self-management of T2DM in a face-to-face setting. Although these services have a strong evidence base, they have limitations for reaching specific groups of people. Digital programs could provide a new delivery model to help more people access health education and behavior change support, but long-term data supporting these programs are limited. Objective The purpose of this service evaluation was to analyze the weight change of people who participated in OurPath (also known as Second Nature), a UK-based digital lifestyle change program, for either weight management or diabetes-related weight management and structured education at 6 and 12 months. Methods Participants either paid to access the program privately (self-funded clients) or were referred by their general practitioner to participate in the program free of charge (funded by the National Health Service). Additional follow-up support was provided to help people to maintain lifestyle changes. To retrospectively assess potential weight loss, the analysis included data from participants who submitted weight readings at baseline and 6 and 12 months after starting the program. Changes in weight after 6 and 12 months were primary outcome measures. Results For the 896 participants who submitted baseline and 6- and 12-month data, a significant change in mean weight of −7.12 kg (−7.50%; SD 6.37; P<.001) was observed at 6 months. Data from the same participants at 12 months showed a change in mean weight when compared with a baseline of −6.14 kg (−6.48%; SD 6.97; P<.001). Conclusions The data presented here had several limitations, and there were too many uncertainties to make any reliable conclusions. However, these results suggest that digital lifestyle change programs could provide a new way to help people to access nutritional advice and support to achieve weight loss. Further research into digital education and coaching platforms is needed to establish their effectiveness.

scholarly journals Effectiveness of a Digital Lifestyle Change Program in Obese and Type 2 Diabetes Populations: Service Evaluation of Real-World Data (Preprint)

2019 ◽  
Author(s):  
Iskandar Idris ◽  
James Hampton ◽  
Fiona Moncrieff ◽  
Michael Whitman
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Weight Management ◽  
Lifestyle Change ◽  
Service Evaluation ◽  
Lifestyle Changes ◽  
Real World Data ◽  
Structured Education ◽  
Change In Mean

BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) and obesity is increasing, and the way people interact with health care is evolving. People traditionally access advice and support to improve their lifestyle and learn more about the self-management of T2DM in a face-to-face setting. Although these services have a strong evidence base, they have limitations for reaching specific groups of people. Digital programs could provide a new delivery model to help more people access health education and behavior change support, but long-term data supporting these programs are limited. OBJECTIVE The purpose of this service evaluation was to analyze the weight change of people who participated in OurPath (also known as Second Nature), a UK-based digital lifestyle change program, for either weight management or diabetes-related weight management and structured education at 6 and 12 months. METHODS Participants either paid to access the program privately (self-funded clients) or were referred by their general practitioner to participate in the program free of charge (funded by the National Health Service). Additional follow-up support was provided to help people to maintain lifestyle changes. To retrospectively assess potential weight loss, the analysis included data from participants who submitted weight readings at baseline and 6 and 12 months after starting the program. Changes in weight after 6 and 12 months were primary outcome measures. RESULTS For the 896 participants who submitted baseline and 6- and 12-month data, a significant change in mean weight of −7.12 kg (−7.50%; SD 6.37; <italic>P</italic>&lt;.001) was observed at 6 months. Data from the same participants at 12 months showed a change in mean weight when compared with a baseline of −6.14 kg (−6.48%; SD 6.97; <italic>P</italic>&lt;.001). CONCLUSIONS The data presented here had several limitations, and there were too many uncertainties to make any reliable conclusions. However, these results suggest that digital lifestyle change programs could provide a new way to help people to access nutritional advice and support to achieve weight loss. Further research into digital education and coaching platforms is needed to establish their effectiveness.

scholarly journals The Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE

2019 ◽  
Vol 105 (1) ◽  
pp. 152-162 ◽  
Author(s):  
Alexandra K Lee ◽  
Mark Woodward ◽  
Dan Wang ◽  
Toshiaki Ohkuma ◽  
Bethany Warren ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Weight Change ◽  
Cox Regression ◽  
Lifestyle Changes ◽  
Baseline Body Mass Index ◽  
Diabetes Medication ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Context Weight loss is strongly recommended for overweight and obese adults with type 2 diabetes. Unintentional weight loss is associated with increased risk of all-cause mortality, but few studies have examined its association with cardiovascular outcomes in patients with diabetes. Objective To evaluate 2-year weight change and subsequent risk of cardiovascular events and mortality in established type 2 diabetes. Design and Setting The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation was an international, multisite 2×2 factorial trial of intensive glucose control and blood pressure control. We examined 5 categories of 2-year weight change: &gt;10% loss, 4% to 10% loss, stable (±&lt;4%), 4% to 10% gain, and &gt;10% gain. We used Cox regression with follow-up time starting at 2 years, adjusting for intervention arm, demographics, cardiovascular risk factors, and diabetes medication use from the 2-year visit. Results Among 10 081 participants with valid weight measurements, average age was 66 years. By the 2-year examination, 4.3% had &gt;10% weight loss, 18.4% had 4% to 10% weight loss, and 5.3% had &gt;10% weight gain. Over the following 3 years of the trial, &gt;10% weight loss was strongly associated with major macrovascular events (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.26-2.44), cardiovascular mortality (HR, 2.76; 95% CI, 1.87-4.09), all-cause mortality (HR, 2.79; 95% CI, 2.10-3.71), but not major microvascular events (HR, 0.91; 95% CI, 0.61-1.36), compared with stable weight. There was no evidence of effect modification by baseline body mass index, age, or type of diabetes medication. Conclusions In the absence of substantial lifestyle changes, weight loss may be a warning sign of poor health meriting further workup in patients with type 2 diabetes.

scholarly journals Frequency of self-monitoring of blood glucose in relation to weight loss and A1C during intensive multidisciplinary weight management in patients with type 2 diabetes and obesity

2019 ◽  
Vol 7 (1) ◽  
pp. e000659 ◽  
Author(s):  
Shaheen Tomah ◽  
Noor Mahmoud ◽  
Adham Mottalib ◽  
David M Pober ◽  
Mhd Wael Tasabehji ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Body Weight ◽  
Blood Glucose ◽  
Weight Management ◽  
Average Frequency ◽  
Baseline Body Mass Index ◽  
Self Monitoring ◽  
Median Change

ObjectiveWe evaluated the relationship between frequency of self-monitoring of blood glucose (SMBG) and body weight, A1C, and cardiovascular risk factors in patients with type 2 diabetes (T2D) and obesity enrolled in a 12-week intensive multidisciplinary weight management (IMWM) program.Research design and methodsWe conducted a retrospective analysis of 42 patients who electronically uploaded their SMBG data over 12 weeks of an IMWM program and divided them into tertiles based on their average frequency of SMBG per day. Mean (range) SMBG frequencies were 2.3 (1.1–2.9) times/day, 3.4 (3–3.9) times/day, and 5 (4–7.7) times/day in the lowest, middle, and highest tertiles, respectively. Anthropometric and metabolic parameters were measured at baseline and after 12 weeks of intervention.ResultsParticipants in the highest tertile achieved a median change (IQR) in body weight of −10.4 kg (−7.6 to −14.4 kg) compared with −8.3 kg (−5.2 to −12.2 kg), and −6.9 kg (−4.2 to −8.9 kg) in the middle and lowest tertiles, respectively (p=0.018 for trend). Participants in the highest tertile had a median change (IQR) in A1C of −1.25% (−0.6 to −3.1%) compared with −0.8% (−0.3% to −2%) and −0.5% (−0.2% to −1.2%) in the middle and lowest tertiles, respectively (p=0.048 for trend). The association between change in body weight and SMBG frequency remained significant after adjusting for age, sex, baseline body mass index, diabetes duration, and use of insulin therapy.ConclusionsIncreased frequency of SMBG during IMWM is associated with significantly better weight loss and improvement of A1C in patients with T2D and obesity. These findings may suggest future clinical recommendations aimed at increasing SMBG frequency to achieve the most favorable outcomes.

scholarly journals Diet composition and the risk of type 2 diabetes: epidemiological and clinical evidence

2004 ◽  
Vol 92 (1) ◽  
pp. 7-19 ◽  
Author(s):  
M. Parillo ◽  
G. Riccardi
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Diet Composition ◽  
Intervention Studies ◽  
Epidemiological Studies ◽  
Lifestyle Changes ◽  
Lifestyle Modifications ◽  
Body Weight Reduction ◽  
Increased Risk

In the last 10 years nutritional research on diabetes has improved dramatically in terms of both number of studies produced and quality of methodologies employed. Therefore, it is now possible to attempt to provide the evidence on which nutritional recommendations for the prevention of type 2 diabetes could be based. We therefore performed a literature search and, among the papers published in indexed journals, we selected relevant epidemiological (mostly prospective) and controlled intervention studies. Lifestyle factors that have, so far, been consistently associated with increased risk of type 2 diabetes are overweight and physical inactivity. However, recent evidence from epidemiological studies has shown that the risk of type 2 diabetes is also associated with diet composition, particularly with: (1) low fibre intake; (2) a high trans fatty acid intake and a low unsaturated:saturated fat intake ratio; (3) absence of or excess alcohol consumption. All these factors are extremely common in Western populations and therefore the potential impact of any intervention on them is large: indeed, >90% of the general population has one or more of these risk factors. The ability to correct these behaviours in the population is estimated to reduce the incidence of diabetes by as much as 87%. Recent intervention studies have shown that type 2 diabetes can be prevented by lifestyle changes aimed at body-weight reduction, increased physical activity and multiple changes in the composition of the diet. Within this context, the average amount of weight loss needed is not large, about 5% initial weight, which is much less than the weight loss traditionally considered to be clinically significant for prevention of type 2 diabetes. In conclusion, new emphasis on prevention by multiple lifestyle modifications, including moderate changes in the composition of the habitual diet, might limit the dramatic increase in incidence of type 2 diabetes envisaged worldwide.

scholarly journals Thromboxane-Dependent Platelet Activation in Obese Subjects with Prediabetes or Early Type 2 Diabetes: Effects of Liraglutide- or Lifestyle Changes-Induced Weight Loss

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1872 ◽  
Author(s):  
Paola Simeone ◽  
Rossella Liani ◽  
Romina Tripaldi ◽  
Augusto Di Castelnuovo ◽  
Maria Guagnano ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lipid Peroxidation ◽  
Weight Loss ◽  
Insulin Sensitivity ◽  
Glycemic Control ◽  
Platelet Activation ◽  
Glycosylated Hemoglobin ◽  
Lifestyle Changes ◽  
Obese Subjects

Thromboxane (TX)-dependent platelet activation and lipid peroxidation, as reflected in vivo by the urinary excretion of 11-dehydro-TXB2 and 8-iso-prostaglandin (PG)F2α, play a key role in atherothrombosis in obesity and type 2 diabetes mellitus (T2DM) since the earlier stages. Thirty-five metformin-treated obese subjects with prediabetes or newly-diagnosed T2DM were randomized to the glucagon-like peptide receptor agonist (GLP-RA) liraglutide (1.8 mg/day) or lifestyle counseling until achieving a comparable weight loss (−7% of initial body weight), to assess whether changes in subcutaneous (SAT) and visceral (VAT) adipose tissue distribution (MRI), insulin sensitivity (Matsuda Index) and beta-cell performance (multiple sampling OGTT beta-index), with either intervention, might affect TX-dependent platelet activation, lipid peroxidation and inflammation. At baseline, Ln-8-iso-PGF2α (Beta = 0.31, p = 0.0088), glycosylated hemoglobin (HbA1c) (Beta = 2.64, p = 0.0011) Ln-TNF-α (Beta = 0.58, p = 0.0075) and SAT (Beta = 0.14, p = 0.044) were significant independent predictors of 11-dehydro-TXB2. After achievement of the weight loss target, a comparable reduction in U-11-dehydro-TXB2 (between-group p = 0.679) and 8-iso-PGF-2α (p = 0.985) was observed in both arms in parallel with a comparable improvement in glycemic control, insulin sensitivity, SAT, high-sensitivity C-reactive protein (hs-CRP). In obese patients with initial impairment of glucose metabolism, the extent of platelet activation is related to systemic inflammation, isoprostane formation and degree of glycemic control and abdominal SAT. Successful weight loss, achieved with either lifestyle changes or an incretin-based therapy, is associated with a significant reduction in lipid peroxidation and platelet activation.

scholarly journals Adhering to lifestyle change recommendations via the trans-theoretical model: a mixed-methods study among type 2 diabetes patients

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Noraishah Mohamed Nor ◽  
Suriati Sidek ◽  
Nurulwahidah Saad ◽  
Nurul Hazirah Jaafar ◽  
Nor Azwani Mohd Shukri
Keyword(s):  
Type 2 Diabetes ◽  
Theoretical Model ◽  
Stages Of Change ◽  
Lifestyle Change ◽  
Lifestyle Changes ◽  
Care Providers ◽  
Content Type ◽  
Action Group ◽  
Trans Theoretical Model

Purpose This paper aims to identify and explore the factors affecting type 2 diabetes mellitus (T2DM) patients' adherence to lifestyle change recommendations, with the guidance of the trans-theoretical model (stages of change). Design/methodology/approach This study was conducted in two parts. In Part A, 163 randomly selected participants were asked to complete a cross-sectional survey. Data regarding demographics, stages of change and levels of confidence to engage in lifestyle changes were collected. In Part B, in-depth interviews were conducted among 30 individuals, aged between 30 and 65 years, had been diagnosed with T2DM and had seen dietitian at least once. Purposive sampling was used to recruit participants with different sociodemographic characteristics. Findings Part A showed that most of the participants were in the pre-action group (60%), with a higher mean HbA1c (8.9%) as compared to the action group (40%) which had a mean HbA1c of 6.9%. Part B further revealed the pre-action group and action group identified four key themes concerning lifestyle changes adherence: stumbling block; self-care belief; knowledge implementation; and self-empowerment. Practical implications Health-care providers should identify patients' stages of change before lifestyle changes implementation. Originality/value This study highlighted that many factors might influence a T2DM patient's adherence to lifestyle change recommendations. Determining the stages of change and self-confidence of T2DM patients is needed to ascertain long-term adherence.

scholarly journals A common variant in the CLDN7/ELP5 locus predicts adiponectin change with lifestyle intervention and improved fitness in obese individuals with diabetes

2015 ◽  
Vol 47 (6) ◽  
pp. 215-224 ◽  
Author(s):  
L. Maria Belalcazar ◽  
George D. Papandonatos ◽  
Jeanne M. McCaffery ◽  
Inga Peter ◽  
Nicholas M. Pajewski ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Genetic Variants ◽  
Association Studies ◽  
Lifestyle Changes ◽  
Genome Wide Association Studies ◽  
Look Ahead ◽  
Genome Wide

Overweight/obese individuals with Type 2 diabetes have low adiponectin levels, which may improve with lifestyle changes. We investigated whether genetic variants associated with adiponectin levels in genome-wide association studies (GWAS) would also be related with adiponectin changes in response to an intensive lifestyle intervention (ILI), potentially through mechanisms altering the adipose microenvironment via weight loss and/or improved cardiorespiratory fitness. Look AHEAD was a randomized trial comparing the cardiovascular benefits of ILI-induced weight loss and physical activity compared with diabetes support and education among overweight/obese individuals with Type 2 diabetes. In a subsample of Look AHEAD with adiponectin data and genetic consent ( n = 1,351), we evaluated the effects of 24 genetic variants, demonstrated by GWAS to be cross-sectionally associated with adiponectin, on adiponectin change 1-yr postintervention. We explored via mediational analyses whether any differential effects by treatment arm were occurring through weight loss and/or improved fitness. A variant, rs222857, in the CLDN7 locus, potentially associated with epithelial barrier integrity and tight junction physiology, and a putative cis expression quantitative trail locus for elongator acetyltransferase complex subunit 5 ( ELP5), predicted adiponectin increases within ILI (log-adiponectin in overall sample per copy: β ± SE = 0.05 ± 0.02, P = 0.008; in non-Hispanic whites: 0.06 ± 0.02, P = 0.009). The favorable effects of rs222857 (minor allele frequency 45.5%) appeared to be mediated by mechanisms associated with improved fitness, and not weight loss. This is the first study to identify a genetic variant that modifies adiponectin response to lifestyle intervention in overweight/obese diabetic individuals.

scholarly journals Use of the TIDieR checklist to describe an online structured education programme for type 2 diabetes

2020 ◽  
Vol 6 ◽  
pp. 205520762097564
Author(s):  
Shoba Poduval ◽  
Jamie Ross ◽  
Kingshuk Pal ◽  
Nicola Newhouse ◽  
Fiona Hamilton ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mode Of Delivery ◽  
Health Behaviours ◽  
Education Programme ◽  
Lifestyle Changes ◽  
Behaviour Change Techniques ◽  
Structured Education ◽  
The Uk ◽  
Intervention Description

Objectives The aim of structured education for type 2 diabetes is to improve knowledge, skills and confidence in self-management. It is recommended in the UK for everyone who is newly diagnosed with type 2 diabetes. We developed an on-line programme called HeLP-Diabetes: Starting Out to address poor uptake of face-to-face structured education. The aim of this paper is to describe the intervention in line with the Template for Intervention Description and Replication guide, which calls for better reporting of interventions. Methods The Template for Intervention Description and Replication guide provided the item headings for the description. These included the theoretical underpinning, materials, procedures, providers, and mode of delivery. Results The programme was developed to meet NICE requirements for structured education and therefore followed a structured curriculum with four sessions covering content such as what diabetes is and how it is treated, possible complications, and how lifestyle changes can improve health. Content was delivered in text, images and video, and behaviour change techniques, self-assessment and feedback were used to help people target key health behaviours. The programme was delivered entirely online, but the team were available for support via telephone. Email feedback and reminders were sent. Conclusions The TIDieR checklist allowed us to provide a clear structure for the description of the intervention. However, it could not capture the full complexity of the programme, and intervention developers considering using it in the future may find that it needs to be adapted to make it more specific to their intervention.

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