The potential prolonged effect at one-year follow-up after 18-month randomized controlled trial of a 90 g/day low-carbohydrate diet in patients with type 2 diabetes.

OBJECTIVES: To evaluate the effect at a one-year follow-up after an 18-month randomized controlled trial (RCT) of 90 gm/day low-carbohydrate diet (LCD) in type 2 diabetes. RESEARCH DESIGN AND METHODS: Eighty-five poorly controlled type 2 diabetic patients with an initial HbA1c ≥ 7.5% who have completed an 18-month randomized controlled trial (RCT) on 90 g/day low-carbohydrate diet (LCD) were recruited and followed for one year. A three-day weighted food record, relevant laboratory tests, and medication effect score (MES) were obtained at the end of the previous trial and one year after for a total of 30 months period on specific diet. RESULTS: 71 (83.5%) patients completed the study, 35 were in TDD group and 36 were in LCD group. Although the mean of percentage changes in daily carbohydrate intake was significantly lower for those in TDD group than those in LCD group (30.51 ± 11.06% vs. 55.16 ± 21.79%, p = 0.0455) in the period between 18 months and 30 months, patients in LCD group consumed significantly less amount of daily carbohydrate than patients in TDD group (131.8 ± 53.9 g vs. 195.1 ± 50.2 g, p < 0.001). The serum HbA1C, two-hour serum glucose, serum alanine aminotransferase (ALT), and MES were also significantly lower for the LCD group patients than those in the TDD group (p = 0.017, p < 0.001, p = 0.017, and p = 0.008 respectively). The mean of percentage changes of HbA1C, fasting serum glucose, 2 h serum glucose, as well as serum cholesterol, triglyceride, low-density lipoprotein, ALT, creatinine, and urine microalbumin, however, were not significantly different between the two groups (p > 0.05). CONCLUSIONS: The one-year follow-up for patients on 90 g/d LCD showed potential prolonged and better outcome on glycaemic control, liver function and MES than those on TDD for poorly controlled diabetic patients.

Effect of a 90 g/day low-carbohydrate diet on glycaemic control, small, dense low-density lipoprotein and carotid intima-media thickness in type 2 diabetic patients: An 18-month randomised controlled trial.

AIM: This study explored the effect of a moderate (90 g/d) low-carbohydrate diet (LCD) in type 2 diabetes patients over 18 months. METHODS: Ninety-two poorly controlled type 2 diabetes patients aged 20-80 years with HbA1c ≥7.5% (58 mmol/mol) in the previous three months were randomly assigned to a 90 g/d LCD r traditional diabetic diet (TDD). The primary outcomes were glycaemic control status and change in medication effect score (MES). The secondary outcomes were lipid profiles, small, dense low-density lipoprotein (sdLDL), serum creatinine, microalbuminuria and carotid intima-media thickness (IMT). RESULTS: A total of 85 (92.4%) patients completed 18 months of the trial. At the end of the study, the LCD and TDD group consumed 88.0±29.9 g and 151.1±29.8 g of carbohydrates, respectively (p < 0.05). The 18-month mean change from baseline was statistically significant for the HbA1c (-1.6±0.3 vs. -1.0±0.3%), 2-h glucose (-94.4±20.8 vs. -18.7±25.7 mg/dl), MES (-0.42±0.32 vs. -0.05±0.24), weight (-2.8±1.8 vs. -0.7±0.7 kg), waist circumference (-5.7±2.7 vs. -1.9±1.4 cm), hip circumference (-6.1±1.8 vs. -2.9±1.7 cm) and blood pressure (-8.3±4.6/-5.0±3 vs. 1.6±0.5/2.5±1.6 mmHg) between the LCD and TDD groups (p<0.05). The 18-month mean change from baseline was not significantly different in lipid profiles, sdLDL, serum creatinine, microalbuminuria, alanine aminotransferase (ALT) and carotid IMT between the groups. CONCLUSIONS: A moderate (90 g/d) LCD showed better glycaemic control with decreasing MES, lowering blood pressure, decreasing weight, waist and hip circumference without adverse effects on lipid profiles, sdLDL, serum creatinine, microalbuminuria, ALT and carotid IMT than TDD for type 2 diabetic patients.

The effectiveness of a comprehensive geriatric assessment intervention program for frailty in community-dwelling older people: a randomized, controlled trial.

This randomized, controlled trial assessed the effectiveness of comprehensive geriatric assessment (CGA) and subsequent intervention in pre-frail and frail community-dwelling elderly based on the Fried Frailty Criteria (FFC) and the Barthel Index (BI) A total of 310 pre-frail or frail elderly from a single community were identified using the FFC. Of these, 152 were randomly assigned to the intervention group for CGA and appropriate intervention by medication adjustment, exercise instruction, nutrition support, physical rehabilitation, social worker consultation, and specialty referral. Clinical outcome was re-evaluated by the FFC and BI 6 months later. Compared to the control group, the intervention group tended to have a better outcome, with an odds ratio (OR) = 1.19, 95% confidence interval (95% CI) = 0.48-3.04, p = 0.71) and 3.29 (95% CI = 0.65-16.64, p = 0.15), respectively, and were less likely to deteriorate, with an OR = 0.78 (95% CI = 0.34-1.79, p = 0.57) and 0.94 (95% CI = 0.42-2.12, p = 0.88), respectively. Although no significant differences were observed, the CGA and subsequent intervention showed a favorable outcome in frail and pre-frail elderly based on the frailty status and BI. Inability to complete the CGA and poor compliance with the intervention program appear to be the main reasons for unfavorable outcomes.

Validation of the Tutotest in a hybrid problem-based learning curriculum.

The Tutotest is one of the few structured instruments developed for the assessment of students' learning skills in a problem-based learning (PBL) curriculum. This study was designed to validate the Tutotest in a hybrid PBL curriculum. Forty-four tutors completed 370 evaluations on second to fourth year medical students at the end of the first semester in 2004 using the Chinese version of the Tutotest. There was significant correlation between global rating and Tutotest-C (r = 0.44, P < 0.001). The Cronbach's alpha coefficient was 0.97. Two-week test-retest correlation coefficient was 0.85. Factor analysis revealed four factors, where three were similar to the factors of "effectiveness in group", "communication and leadership skills", and "respect for others" identified in the original Tutotest. "Hypothesis forming and testing" instead of "scientific curiosity" became the fourth factor in our data. Our study validated the Tutotest-C in a hybrid PBL curriculum and students from the Chinese educational system. The test-retest reliability measure with a 2-week interval at the end of the PBL tutorial confirmed the stability of the Tutotest, which has not been previously reported. Since most Asian medical schools adopted a hybrid PBL curriculum, a valid student evaluation instrument for this type of curriculum is valuable.

Using senior residents as standardized patients for evaluating basic clinical skills of medical students.

BACKGROUND AND PURPOSE: The use of standardized patients (SPs) is a powerful method for performance evaluation in medical education. It has gained increasing popularity in teaching and evaluation of clinical skills of medical students in the last decade. Maintaining an active and effective SP program requires a tremendous amount of financial and manpower investment, which may be difficult for many medical schools to provide. This study investigated the feasibility and effectiveness of using senior residents as SPs (SRSPs) to alleviate the financial and manpower burdens of an SP program. METHODS: A total of 112 fifth year medical students and 26 third year senior residents from a university hospital participated in this research in 2000. Students at the end of a 9-week rotating clerkship in internal medicine formed groups of 7 members. Senior residents took multiple roles as case developers, SPs, teachers, and evaluators. Test and recess stations were integrated, and sequential individual and group discussion with SRSPs was used to provide feedback immediately after the completion of the examination. Students were given a test report including scores and written narrative feedback. Semi-constructive questionnaires were used for opinion survey from students as well as the SRSPs. RESULTS: All SRSPs demonstrated their ability to function in multiple roles and regarded the SRSP experience as helpful to improve this ability. Most SRSPs (89%) considered the experience beneficial in improving their clinical teaching skills. Ninety percent of SRSPs thought that a case should be portrayed for no more than 4 hours in order to maintain the consistency and accuracy. Seventy two percent of medical students reported that SRSPs' status as teachers did not interfere with their performance, 68% reported being able to treat SRSPs as real patients, and 96% reported that the evaluation was helpful to their professional development. CONCLUSIONS: An SRSP program is feasible, practical, and easy to establish. It can provide benefits to both students and senior residents with clinical training responsibilities, and serve as an alternative method for performance evaluation of students in medical schools with limited resources.