Ayurvedic polyherbal combination (PDBT) for prediabetes: A randomized double blind placebo controlled study

Background: Increasing prevalence of type 2 diabetes mellitus (DM) has become alarming, burdeninghealth care systems throughout the world. Prediabetes is an intermediate step before manifestation offull blown DM. Effective intervention at this step would help stop/slow progression to DM.Objective: This study aimed at use of a polyherbal combination (PDBT e constituted of Tinospora cordifolia, Pterocarpus marsupium, Gymnema sylvestre, Zingiber officinale and Momordica charantia) alongwith life style modification compared to a placebo in prevention of DM among prediabetic individuals.Materials and Methods: The study was a double blinded, placebo controlled randomized clinical trial.Participants were divided in to a group on PDBT and life style management (LSM) and second on placeboand LSM. Participants in the intervention group received 2 gm/day of PDBT. All participants received theintervention for a period of 6 months.Results: One hundred and fourteen participants were enrolled in the study, 57 each in intervention andcontrol group. At the end of the study, 8 participants from the intervention group, compared to 15participants in the control group had converted to DM. There was a 47% risk reduction in the interventiongroup. Participants in the intervention group showed statistically significant decrease in their bloodglucose level (fasting and PP), HbA1c, fasting serum insulin and HOMA-IR values. There was no significant change in BMI. No adverse effects were reported by any participants.Conclusion: PDBT along with LSM in prediabetic participants was associated with reduction in conversion to DM than placebo along with LSM without any adverse effects.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Effectiveness of bariatric surgery in diabetes prevention in high-risk Asian individuals

<p><b>INTRODUCTION</b>Obesity is a key risk factor in the development of Type 2 diabetes mellitus (T2DM). Bariatric surgery causes a large amount of durable weight loss in those with clinically severe obesity. We reported the effect of weight loss via bariatric surgery on DM prevention in those at high risk of developing DM.</p><p><b>METHODS</b>This was a retrospective cohort study of 44 patients with obesity (mean body mass index 43.8 kg/m) and pre-DM who underwent bariatric surgery and were followed up for up to three years. We also reviewed a non-surgical cohort of patients with obesity and pre-DM seen at the weight management clinic.</p><p><b>RESULTS</b>91% of patients attained normal glycaemic status at one year after bariatric surgery. At the three-year follow-up, 87.5% of the patients maintained normoglycaemia. None of the patients developed T2DM after surgery. 26.9% of patients achieved absolute weight loss at one year after bariatric surgery and maintained this at two and three years post surgery (p < 0.001 vs. baseline). The homeostatic model assessment-insulin resistance index in patients also decreased from 5.50 at baseline to 1.20, 1.14 and 1.44 at one, two and three years, respectively (p < 0.001).</p><p><b>CONCLUSION</b>Bariatric surgery produces significant weight loss, and leads to reversion from the pre-diabetic state to normal glycaemic status and reduction of the incident DM rate in those with pre-DM and morbid obesity.</p>

Lifestyle intervention using the psychoeducational approach is associated with greater cardiometabolic benefits and retention of individuals with worse health status

ABSTRACT Objective This study aimed to compare the effects of two lifestyle intervention programs for type 2 diabetes mellitus (T2DM) prevention – traditional or interdisciplinary psychoeducation-based intervention – in daily habits and cardiometabolic risk factors and investigate the role of the psychoeducational approach for the retention of individuals in the program. Subjects and methods Between 2008 and 2010, in a public health service, 183 pre-diabetic individuals were allocated to two 18-month interventions involving diet and physical activity. Physical activity, diet, quality of life (QOL) and depression and biochemical measurements were obtained. Linear mixed-effect models were used to assess the effect of the interventions. A student t test was used to compare dropouts versus non-dropouts. Results Improvements in energy intake and physical activity were greater in the interdisciplinary than the traditional intervention. A decrease in fat mass and blood pressure was more pronounced with interdisciplinary intervention. Dropouts from the traditional intervention only had higher BMI and lower fiber intake and QOL than non-dropouts. Conclusion The interdisciplinary psychoeducation-based intervention revealed useful for reducing cardiometabolic risk and retaining individuals with worse health profiles. This approach represents a feasible strategy for motivating high-risk individuals to adopt a long-term healthy lifestyle.

The Needs of Nursing Education about Pre-Diabetic Patients / 임상당뇨병

The most effective method for prevention of diabetes in a pre-diabetic patient is improvement in life style. Thus, methods of nursing management rely on diabetes prevention education. A pre-diabetic patient needs to receive accurate diagnosis and undergo regular checkups focusing on diabetes through physician counseling. As diabetes education focuses on habit improvement including dietary therapy, exercise, and weight maintenance, efforts are needed to decrease risk factors of diabetes. Pre-diabetes education helps to prevent diabetes. Hence, general diabetes education and support should start in the pre-diabetic stage.

Rastreamento do risco de desenvolvimento de diabetes mellitus em pais de estudantes de uma escola privada na cidade de Jundiaí, São Paulo / Diabetes mellitus risk screening of parents of private school students in the city of Jundiaí, São Paulo, Brazil

OBJETIVO: Este trabalho objetivou rastrear em indivíduos adultos o risco de vir a desenvolver diabetes mellitus (DM) tipo 2. MÉTODOS: Diversos fatores de risco para DM (sedentarismo, doença coronariana prévia, uso de medicação hiperglicemiante, índice de massa corporal (IMC), pressão arterial, níveis séricos de triglicerídeos e colesterol HDL-col) foram avaliados em 314 adultos, em funçãodosexoe faixa etária. RESULTADOS: 73,2% da população somou dois ou mais fatores de risco simultaneamente, e 26,8% apresentaram menos de dois fatores. Observou-se a ocorrência de fatores de risco para o desenvolvimento da DM mesmo entre adultos jovens, e a ocorrência dos mesmos tende a estra associada com o avanço da idade. Foram observadas diferenças nos fatores e incidência de risco entre homens e mulheres na mesma faixa etária. CONCLUSÃO: Independentemente da idade estudada, os fatores de risco associados a DM de maior prevalência foram: IMC, sedentarismo e diminuição do HDL-colesterol, os quais podem ser modificáveis, reforçando a importância de medidas preventivas. Divergências encontradas entre os fatores de risco prevalentes em homens e mulheres sugerem também que diferenças socioculturais influenciam o risco de desenvolvimento da DM.

OBJECTIVE: To screen the risk of developing diabetes mellitus type 2 (DM2) in adult individuals. METHODS: Several risk factors for DM2 (sedentary lifestyle, previous coronary artery disease, hyperglycemia-inducing medications, body mass index [BMI], blood pressure, serum triglyceride, and HDL-cholesterol levels) were assessed in 314 adults as a function of gender and age group. RESULTS: 73.2% of the population had two or more concurrent risk factors and 26.8% had less than two factors. The occurrence of risk factors for DM2 development was observed even in young adults, and the risk factors are likely associated with aging. Differences in risk factors and incidence were observed between men and women in the same age group. CONCLUSION: Regardless the age studied, the most prevalent risk factors associated with DM2 were: BMI, sedentary lifestyle, and reduced serum HDL-cholesterol, which are modifiable, thus increasing the importance of preventive measures. Discrepancies found in prevalent risk factors in men and women also suggest that sociocultural differences influence the risk of developing DM.

Implementação de programa estruturado de hábitos de vida saudáveis para redução de risco cardiometabólico / Implementation of a structured healthy lifestyle program to reduce cardiometabolic risk

O objetivo deste estudo foi descrever a metodologia e a implementação de programa de mudanças no estilo de vida em indivíduos de risco cardiometabólico, usuários da rede pública de saúde em São Paulo. O Programa de Prevenção de Diabetes Mellitus (PDM) visa à melhora do quadro metabólico global de indivíduos com pré-diabetes ou síndrome metabólica sem diabetes, tendo como metas redução mínima de 5% do peso corporal inicial, consumo > 20 g de fibras alimentares e < 10% de gorduras saturadas por dia, além de prática > 150 minutos de atividade física por semana. A primeira edição do PDM apresentou duração de 18 meses e contou com equipe interdisciplinar (endocrinologista, psicóloga, nutricionista e educador físico) para o planejamento e realização de sessões em grupo com os participantes. A estrutura e a sistemática das sessões foram planejadas utilizando abordagem psicoeducativa para facilitar o processo de mudança de hábitos de vida. Com base na experiência com o PDM, algumas reflexões e recomendações são apontadas. Este estudo aponta caminhos para que profissionais da saúde possam juntos adaptar programas locais para promoção de hábitos de vida saudáveis, atuando sob uma nova perspectiva.

The objective this study was to describe the methodology and implementation of lifestyle change program in individuals at cardiometabolic risk seen at the public health system in Sao Paulo. The Programa de Prevenção de Diabetes Mellitus (PDM) aims at improving the overall metabolic profile of individuals with prediabetes or metabolic syndrome without diabetes; its goals were > 5% weight loss, dietary fiber intake > 20 g per day, saturated fatty acids intake < 10% per day, and > 150 minutes of physical activity per week. The first edition of the PDM lasted 18 months and involved an interdisciplinary team (endocrinologist, psychologist, nutritionist, and physical educator) to plan and conduct group sessions with the participants. The structure and systematic of the sessions were planned using a psychoeducative approach in order to facilitate the process of lifestyle changes. Based on the Experience with the PDM, some reflections and recommendations are made. This study may indicate ways for health professionals to tailor local care conditions and promote a healthy lifestyle, working with a new perspective.

An enlightenment from a chronic disease prevention——the China Da Qing Diabetes Prevention Study / 中华内分泌代谢杂志

To reduce morbidity and mortality and improve quality of life for patients with diabetes,the China Da Qing Diabetes Prevention Study was initiated as health education and behavior intervention in the 1980s in Daqing City.576 subjects with impaired glucose tolerance (IGT) were recruited and randonized into a clinical trial,either to a control group or to one of three active treatment groups:diet only,exercise only,or diet plus exercise.Follow-up evaluation examinations were conducted 2-year intervals over a 6-year period and after 20-year period to identify subjects who developed diabetes mellitus.Diet and/or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year and 20-year period among those with IGT.The implementation of this study indicates that diabetes can be prevented through health education and behavioral intervention,and the prevention of diabetes and other chronic diseases should also focused on strengthening the muhi-sectoral cooperation,developing professional skills of health care providers,re-orientating health care services toward prevention of illness and promotion of health.

Benefits of Nutrition Consultation for Preventing Diabetes According to HbA1c Levels in Overweight and Obese Women

HbA1c was recently adopted as a reliable indicator for screening diabetes. This study investigated the ability of nutrition consultation to prevent diabetes in overweight women (BMI 23 kg/m2 or more) using HbA1c as an indicator. Twenty overweight and obese women (with HbA1c> or =5.7%) completed the 12-week nutritional study, with individual and personalized nutrition counseling performed every 2 weeks. The main study guidelines involved the following: 1) reducing the intake of high fat foods and alcohol, 2) consuming a large amount of vegetables, 3) reducing the intake of simple sugars and empty-calorie foods, and 4) increasing physical activity to > or =30 min/day. Anthropometric (height, weight, BMI, body muscle (kg), body fat (%), waist and hip circumference, blood pressure) and biochemical parameters (fasting blood sugar (FBS), HbA1c, lipid profiles, hs-CRP) were measured before and after the nutrition consultation. After 12 weeks, the HbA1c or =5.7% group, HbA1c, TC, LDL, NON-HDL, hs-CRP and dietary intake of energy, carbohydrate, lipid, protein, and cholesterol significantly decreased (P<0.05). These results suggest that nutrition consultation effectively helps to prevent diabetes in overweight and obese women after applying HbA1c standards. Overall, the improvement in all markers measured suggest that HbA1c is a good indicator for blood glucose regulation, helping to prevent diabetes.

Prevalence, characteristics, and predictors of pre-diabetes in Indonesia.

Background: Pre-diabetes is a state where glucose level higher than normal, but not satisfy the criteria for diabetes. This condition is very critical, so that if subject don’t do lifestyle modification and pharmacology therapy, they could fall to diabetes. This research objective is to describe the prevalence and predictors of pre-diabetes in Indonesia. Methods: A cross-sectional study was conducted by Metabolic Endocrinology Division, Department of Internal Medicine FMUI/RSCM and Jakarta Diabetes and Lipid Center using secondary data from National Health Survey 2007. Total respondents are 24417 subjects from 33 provinces in Indonesia. We analyze characteristics, correlation, predictors, and attributable risks for some predictors of pre-diabetes and diabetes. Results: Prevalence of pre-diabetes (based on impaired glucose tolerance data) in Indonesia is 10%. Predictors of pre-diabetes are male, old-age, high socio-economic status, low education level, hypertension, obesity, central obesity, and smoking. Priority for pre-diabetes and diabetes prevention in Indonesia directed to decrease blood pressure (Attributable Risk/AR 56.5%), reduce waist circumference (AR 47.3%), and stop smoking (AR 44.4%). Conclusion: Prevalence of pre-diabetes in Indonesia is high so that we need a prevention strategy for pre-diabetes and the development from pre-diabetes to diabetes. The implementation of those strategies is compiled in the Indonesian Diabetes Prevention Program.

Study on Survey of Knowledge and Awareness Level of Diabetic Retinopathy in Type 2 Diabetes Patients: Results from Seoul Metro-City Diabetes Prevention Program Survey

PURPOSE: To investigate the knowledge and awareness level of diabetic retinopathy (DR) in type 2 diabetes patients. METHODS: A total of 437 participants with diabetes were recruited in the Seoul Metro-City Diabetes Prevention Program (SMC-DPP). Participants underwent clinical and laboratory examinations and questionnaire survey to evaluate diabetes complications. The DR was diagnosed by grading fundus photographs 5 standard fields taken per eye. RESULTS: The overall prevalence of any DR was 20.4% and only 6.6% of patients were aware of their DR. The DR patients who underwent an eye examination within the previous year were 42.3%, and 50.3% out of 437 patients enrolled were educated on diabetes. Of the survey participants, 83.8% answered positive to 'Evaluation of diabetes mellitus complication must be performed every year', 61.1% answered positive to 'Must control blood pressure and lipid level for diabetes management' and 28.4% believed 'It takes a long time for complications of diabetes to develop'. The DR self awareness was 14.6% and an eye examination within the previous year was 50.6% among the 89 DR participants. CONCLUSIONS: Results of the survey with SMC-DPP type 2 diabetes participants showed a low knowledge and awareness level of chronic complications such as DR.