Comparative efficacy and safety of Gla-300 versus IDegAsp in insulin-naïve people with type 2 diabetes mellitus uncontrolled on oral anti-diabetics.

AIM: To compare the efficacy and safety of insulin glargine-300 once daily (Gla-300) with insulin degludec/aspart (IDegAsp) once daily in patients with type 2 diabetes (T2D) inadequately controlled on oral anti-diabetic drugs (OADs). MATERIALS AND METHODS: A systematic literature review of randomized controlled trials was followed by an indirect treatment comparison of studies involving insulin naïve adults, inadequately controlled [glycated haemoglobin (HbA1c) ≥7.0%] on OADs, who received Gla-300 or IDegAsp once daily. Outcomes of interest were change in HbA1c, blood glucose, weight and insulin dose, as well as incidence and event rate of hypoglycaemia and other adverse events. RESULTS: Four trials with broadly similar baseline patient characteristics were included in the meta-analyses and indirect treatment comparison. At 24-28 weeks, the indirect comparison of Gla-300 to IDegAsp once daily estimated no statistically significant difference for change in HbA1c (%) from baseline [mean difference of 0.10% (95% CI: -0.20, 0.39; p = .52)]; a statistically significant mean difference of -1.31 kg (95% CI: -1.97, -0.65; p < .05) for change in body weight from baseline; statistically significant odds ratios of 0.62 (95% CI: 0.41, 0.93; p < .05) for incidence of any hypoglycaemia; and 0.47 (95% CI: 0.25, 0.87; p < .05) for incidence of anytime confirmed hypoglycaemia (plasma glucose <3.0-3.1 mmol/L). No significant differences were observed for insulin dose and adverse events. CONCLUSION: In insulin-naïve patients with T2D inadequately controlled on OADs, commencing Gla-300 shows a comparable HbA1c reduction, but with significantly less weight gain and a lower incidence of any and confirmed hypoglycaemia compared with commencing IDegAsp.

Risk Factors for Contracting Invasive Meningococcal Disease and Related Mortality: A Systematic Literature Review and Meta-analysis.

OBJECTIVES: To describe risk factors (RFs) and quantify their effects in invasive meningococcal disease (IMD) and associated mortality across all age groups based on the available published literature. METHODS: A systematic literature review (SLR) was conducted via MEDLINE® and Embase. Study selection, data extraction, and quality assessment were performed by two independent reviewers. Associations between RFs and outcomes were quantified via a meta-analysis (MA). RESULTS: Seventy-four studies (date range 1950 - 2018) were included in the SLR. Statistically significant RFs for contracting IMD identified from the SLR (within-study) included previous IMD infection and young age (0 - 4 years). MA indicated that significant RFs for contracting IMD (11 studies) were: HIV-positive status, passive smoke exposure, and crowded living space. In the MA for IMD-related mortality risk (11 studies), age 25 - 45 years (vs. 0 - 5 years) and serogroup C (vs. serogroup B) were significantly associated with increased risk. CONCLUSIONS: Previous findings of higher risk for IMD contraction with smoke exposure and crowded living conditions in children/adolescents have been extended by this SLR/MA to all age groups. We provide strong evidence for higher risk of IMD in HIV-positive individuals, and confirm previous findings of higher IMD-related mortality risk in adults aged 25 - 45.

Effect of the Repetitions-In-Reserve Resistance Training Strategy on Bench Press Performance, Perceived Effort, and Recovery in Trained Men.

ABSTRACT: Mangine, GT, Serafini, PR, Stratton, MT, Olmos, AA, VanDusseldorp, TA, and Feito, Y. Effect of the repetitions-in-reserve resistance training strategy on bench press performance, perceived effort, and recovery in trained men. J Strength Cond Res 36(1): 1-9, 2022-This study examined the effects of the repetitions-in-reserve (RIR) strategy on resistance exercise performance, perceived effort, and recovery. Fourteen resistance-trained men (24.6 ± 3.0 years, 176 ± 5 cm, 85.7 ± 14.0 kg) completed 2 bench press protocols in a randomized crossover fashion. The protocols consisted of 4 sets at 80% of 1 repetition maximum (1RM) to a self-reported 3-RIR and a fifth set to failure or all 5 sets to failure (0-RIR). Barbell kinetics (velocity, rate of force development, and impulse), repetition volume, total work, and ratings of perceived exertion (RPE) were quantified on each set. Barbell kinetics were reassessed during one set of 3 repetitions at 80% 1RM completed at 24-hour, 48-hour, and 72-hour postexercise. Blood samples were collected before and after exercise at 6 hours, 24 hours, 48 hours, and 72 hours and analyzed for concentrations of creatine kinase (CK). Separate, 2-way repeated-measures analysis of variance revealed significant interactions (p < 0.001) where 3-RIR better maintained repetitions and work at greater average velocity (+0.6 m·s-1) and lower RPE (0-RIR = 10; 3-RIR = 8.2) across all sets. No differences were seen between conditions for CK at 6 hours postexercise (3-RIR: 32.2 ± 55.3%; 0-RIR: 40.8 ± 66.0%) or for CK and barbell kinetics at 24 hours to 72 hours postexercise. Although no differences were seen for recovery, the RIR strategy enabled work to be better sustained across sets at a lower perceived effort and higher average velocity. This strategy could be used to manage fatigue and better sustain effort and volume during a resistance training session.

Efficacy and safety of iGlarLixi versus IDegAsp: Results of a systematic literature review and indirect treatment comparison.

AIM: To assess the efficacy and safety of iGlarLixi, a fixed-ratio combination of basal insulin glargine 100 U/mL and lixisenatide (glucagon-like peptide-1 receptor agonist) versus IDegAsp, a co-formulation of basal insulin degludec 100 U/mL with rapid-acting insulin aspart. MATERIALS AND METHODS: A systematic literature search of randomized controlled trials (RCTs) was performed. Outcomes from eligible RCTs were compared by an indirect treatment comparison using a Bayesian framework. Subanalyses of Japanese and international trials were performed. RESULTS: Eight RCTs (duration 26-30 weeks) were included. Mean difference in HbA1c change with iGlarLixi exceeded that for IDegAsp: -0.64 (95% credible interval -1.01, -0.28) %-units (-7.0 [-11.0, -3.1] mmol/mol) for all trials, -0.39 (-0.55, -0.23) %-units (-4.3 [-6.0, -2.5] mmol/mol) for international, and -0.88 (-1.11, -0.64) %-units (-9.6 [-12.1, -7.0] mmol/mol) for Japanese trials. HbA1c target achievement (<7.0%-units [<53 mmol/mol]) was greater for iGlarLixi in all trials (odds ratio 2.50 [1.06, 5.56]) and Japanese trials (2.17 [1.27, 3.70]), but not in international trials (2.17 [0.42, 11.11]). Analyses suggesting differences in mean postmeal self-measured plasma glucose were significantly lower by 1.0-2.0 mmol/L (18-36 mg/dL) with iGlarLixi in all analyses. Bodyweight change was more favourable (1-2 kg) for iGlarLixi versus IDegAsp for all analyses (P < 0.05). Comparisons of hypoglycaemia were inconclusive owing to differences in definitions between studies. Adverse events were more frequent with iGlarLixi because of gastrointestinal intolerance. CONCLUSIONS: iGlarLixi appears to offer clinical benefit in glucose control and bodyweight change in people needing both basal and meal-time intervention.

Four Weeks of Time-Restricted Feeding Combined with Resistance Training Does Not Differentially Influence Measures of Body Composition, Muscle Performance, Resting Energy Expenditure, and Blood Biomarkers.

Recently, interest in time-restricted feeding (TRF) has increased from reports highlighting improvements in body composition and muscular performance measures. Twenty-six recreationally active males were randomly assigned to either TRF (n = 13; ~22.9 years; 82.0 kg; 178.1 cm; 8 h eating window, 25% caloric deficit, 1.8 g/kg/day protein) or normal diet (ND; n = 13; ~22.5 years; 83.3 kg; 177.5 cm; normal meal pattern; 25% caloric deficit, 1.8 g/kg/day protein) groups. Participants underwent 4-weeks of supervised full body resistance training. Changes in body composition (fat mass (FM), fat free mass (FFM), and body fat percentage (BF%)), skeletal muscle cross sectional area (CSA) and muscle thickness (MT) of the vastus lateralis (VL), rectus femoris, (RF), and biceps brachii (BB) muscles, resting energy expenditure (REE), muscular performance, blood biomarkers, and psychometric parameters were assessed. Significant (p < 0.05) decreases were noted in BM, FM, BF%, testosterone, adiponectin, and REE, along with significant increases in BP1RM, LP1RM, VJHT, VJPP, VLCSA, BBCSA, and BBMT in both groups. Plasma cortisol levels were significantly elevated at post (p = 0.018) only in ND. Additionally, FFM was maintained equally between groups. Thus, a TRF style of eating does not enhance reductions in FM over caloric restriction alone during a 4-week hypocaloric diet.

Isometric Midthigh Pull Performance Is Associated With Athletic Performance and Sprinting Kinetics in Division I Men and Women's Basketball Players.

Townsend, JR, Bender, D, Vantrease, WC, Hudy, J, Huet, K, Williamson, C, Bechke, E, Serafini, PR, and Mangine, GT. Isometric midthigh pull performance is associated with athletic performance and sprinting kinetics in Division I men and women's basketball players. J Strength Cond Res 33(10): 2665-2673, 2019- The relationships between isometric mid-thigh pull (IMTP) force, athletic performance measures, and sprint kinetics in Division I men's and women's basketball players were investigated. Twenty-three (male = 8, female = 15) Division 1 basketball players completed a maximal 20-m sprint trial while tethered to a device that provided kinetic feedback (peak and average sprinting power, velocity and force). Additionally, 1 repetition maximum (1RM) front squat, 1RM hang clean, vertical jump height, and agility (proagility and lane agility) tests were performed. Rate of force development (RFD) at 50, 100, 150, 200 and 250 milliseconds of IMTP and peak force (PF) were also collected. Pearson's product-moment correlation analysis was used to examine the relationships between these measures. Significant (p ≤ 0.05) relationships were observed between IMTP PF and sprint time over all distances (5-20 m; r = -0.62 to 0.69), average sprint velocity (r = 0.50-0.70), peak sprint velocity (r = 0.50-0.54), average sprint force (r = 0.48-0.69), and average sprint power (r = 0.62-0.73). Sprinting kinetic measures (average force and power) over the first 5 m were also significantly (p ≤ 0.05) related to IMTP RFD (50-250 ms; r = 0.42-0.62). Results indicate that IMTP variables are significantly associated with 20-m sprint kinetics. Specifically, IMTP RFD appears to be related to the initial acceleration kinetics of a sprint. Strength and conditioning professionals can possibly implement the IMTP for improved assessment and monitoring of athletic performance and training.

Testosterone and Cortisol Responses to Five High-Intensity Functional Training Competition Workouts in Recreationally Active Adults.

To determine the salivary steroid response to high-intensity functional training (HIFT) competition workouts, saliva samples were collected from ten recreationally trained male and female competitors during a 5-week (WK1⁻WK5) international competition. Competitors arrived at their local affiliate and provided samples prior to (PRE) their warm-up, immediately (IP), 30-min (30P), and 60-min (60P) post-exercise. Samples were analyzed for concentrations of testosterone (T), cortisol (C), and their ratio (TC). Generalized linear mixed models with repeated measures revealed significant main effects for time (p < 0.001) for T, C, and TC. Compared to PRE-concentrations, elevated (p < 0.05) T was observed at IP on WK2⁻WK5 (mean difference: 135⁻511 pg·mL-1), at 30P on WK3 (mean difference: 81.0 ± 30.1 pg·mL-1) and WK5 (mean difference: 56.6 ± 22.7 pg·mL-1), and at 60P on WK3 (mean difference: 73.5 ± 29.7 pg·mL-1) and WK5 (mean difference: 74.3 ± 28.4 pg·mL-1). Compared to PRE-concentrations, elevated (p < 0.05) C was noted on all weeks at IP (mean difference: 9.3⁻15.9 ng·mL-1) and 30P (mean difference: 6.0⁻19.9 ng·mL-1); significant (p < 0.006) elevations were noted at 60P on WK1 (mean difference: 9.1 ± 3.0 ng·mL-1) and WK5 (mean difference: 12.8 ± 2.9 ng·mL-1). Additionally, TC was significantly reduced from PRE-values by 61% on WK1 at 60P (p = 0.040) and by 80% on WK5 at 30P (p = 0.023). Differences in T, C, and TC were also observed between weeks at specific time points. Although each workout affected concentrations in T, C, and/or the TC ratio, changes appeared to be modulated by the presence of overload and workout duration. During periods of elevated training or competition, athletes and coaches may consider monitoring these hormones for consistency and as a means of assessing workout difficulty.

Changes in body composition, bone metabolism, strength, and skill-specific performance resulting from 16-weeks of HIFT.

High Intensity Functional Training (HIFT) is a training modality, characterized by multimodal exercises performed at high-intensity. Little is known about the training adaptations that occur as a prolonged training program. The purpose of this study was to examine changes in body composition, bone metabolism, strength, and skill-specific performance over 16-weeks of HIFT. Twenty-six recreationally active adult males (n = 9; 34.2 ± 9.1 y; 91.5 ± 17.7 kg; 178.5 ± 5.4 cm) and females (n = 17 = 36.4 ± 7.9 y; 91.5 ± 17.7 kg; 162.9 ± 7.0 cm) completed pre and post training assessments of body composition (Dual-Energy X-Ray Absorptiometry) and performance measures. Performance was assessed using three HIFT workouts (WOD 1-3) to assess strength, skill, and metabolic performance. Aside from the body composition measurements, all assessments were carried out at the local training facility. Training included participation in HIFT a minimum of twice a week for 16-weeks. Repeated measures analysis of variance revealed a significant gender x time interaction in Bone Mineral Content (BMC) (p = 0.027), where improvements favored women (1.0% ± 1.1%, p = 0.004) over men (-0.1% + 0.8%, p = 0.625). Further, region-specific analysis indicated that women (2.5% ± 3.0%, p < 0.005) experienced greater improvements in the trunk compared to men (-0.3% ± 1.8%, p = 0.621), while changes in leg BMC were comparable between women (0.8% ± 1.0%, p < 0.001) and men (0.3% ± 0.6%, p < 0.001). Although no other interactions were observed, significant performance improvements were noted for all participants in WOD 1 (18.3% ± 16.8%), absolute 5RM (14.4% ± 9.7%), relative 5RM (15.4% ± 9.2%), WOD 2 (5.7% ± 6.5%), and WOD 3 (-17.3% ± 14.7%). These data indicate that 16-weeks of HIFT resulted in positive outcomes in strength, metabolic conditioning performance, and body composition.

A Resisted Sprint Improves Rate of Force Development During a 20-m Sprint in Athletes.

Mangine, GT, Huet, K, Williamson, C, Bechke, E, Serafini, P, Bender, D, Hudy, J, and Townsend, J. A resisted sprint improves rate of force development during a 20-m sprint in athletes. J Strength Cond Res 32(6): 1531-1537, 2018-This study examined the effect of a resisted sprint on 20-m sprinting kinetics. After a standardized warm-up, 23 (male = 10, female = 13) Division I basketball players completed 3 maximal 20-m sprint trials while tethered to a robotic resistance device. The first sprint (S1) used the minimal, necessary resistance (1 kg) to detect peak (PK) and average (AVG) sprinting power (P), velocity (V), and force (F); peak rate of force production (RFD) was also calculated. The second sprint (S2) was completed against a load equal to approximately 5% of the athlete's body mass. Minimal resistance (1 kg) was again used for the final sprint (S3). Approximately 4-9 minutes of rest was allotted between each sprint. Separate analyses of variance with repeated measures revealed significant (p ≤ 0.05) main effects for all sprinting kinetic measures except VPK (p = 0.067). Compared with S1, increased (p < 0.006) 20-m sprint time (3.4 ± 4.9%), PAVG (115.9 ± 33.2%), PPK (65.7 ± 23.7%), FAVG (134.1 ± 34.5%), FPK (65.3 ± 16.2%), and RFD (71.8 ± 22.2%) along with decreased (p < 0.001) stride length (-21 ± 15.3%) and VAVG (-6.6 ± 4.6%) were observed during S2. During S3, only RFD was improved (5.2 ± 7.1%, p < 0.001) compared with S1. In conclusion, completing a short, resisted sprint with a load equating to 5% of body mass before a short sprint (∼20-meters) does not seem to affect sprinting time or kinetics. However, it does appear to enhance RFD.

Self-reported Measures of Strength and Sport-Specific Skills Distinguish Ranking in an International Online Fitness Competition.

Serafini, PR, Feito, Y, and Mangine, GT. Self-reported measures of strength and sport-specific skills distinguish ranking in an international online fitness competition. J Strength Cond Res 32(12): 3483-3493, 2018-To determine if self-reported performance measures could distinguish ranking during the 2016 CrossFit Open, data from 3,000 male (n = 1,500; 27.2 ± 8.4 years; 85.2 ± 7.9 kg; 177.0 ± 6.5 cm) and women (n = 1500, 28.7 ± 4.9 years; 63.7 ± 5.8 kg; 163.7 ± 6.6 cm) competitors was used for this study. Competitors were split by gender and grouped into quintiles (Q1-Q5) based upon their final ranking. Quintiles were compared for one-repetition maximum (1RM) squat, deadlift, clean and jerk (CJ), snatch, 400 m sprint, 5,000 m run, and benchmark workouts (Fran, Helen, Grace, Filthy-50, and Fight-Gone-Bad). Separate one-way analyses of variance revealed that all competitors in Q1 reported greater (p ≤ 0.05) 1RM loads for squat (men: 201.6 ± 19.1 kg; women: 126.1 ± 13.0 kg), deadlift (men: 232.4 ± 20.5 kg; women: 148.3 ± 14.5 kg), CJ (men: 148.9 ± 12.1 kg; women: 95.7 ± 8.4 kg), and snatch (men: 119.4 ± 10.9 kg; women 76.5 ± 7.6 kg) compared with other quintiles. In addition, men in Q1 (59.3 ± 5.9 seconds) reported faster (p ≤ 0.05) 400 m times than Q3 only (62.6 ± 7.3 seconds), but were not different from any group in the 5,000 m run. Women in Q2 (67.5 ± 8.8 seconds) reported faster (p ≤ 0.05) 400 m times than Q3-Q5 (73.5-74.8 seconds), and faster (21.3 ± 1.8 minutes, p < 0.02) 5,000 m times than Q4 (22.6 ± 2.2 minutes) and Q5 (22.6 ± 1.9 minutes). Faster (p ≤ 0.05) Fran times were reported by Q1 (men: 138.2 ± 13.3 seconds; women: 159.4 ± 28.3 seconds) compared with other groups, while the results of other workouts were variable. These data indicate that the most successful athletes excel in all areas of fitness/skill, while lower-ranking athletes should focus on developing strength and power after achieving sufficient proficiency in sport-specific skills.