Tolerability and acceptability of real-time continuous glucose monitoring and its impact on diabetes management behaviours in individuals with Type 2 Diabetes - A pilot study.

INTRODUCTION: Emerging evidence suggests us of real-time continuous glucose monitoring systems (RT-CGM), can assist to improve glucose control in Type 2 Diabetes (T2D) treatment, however the impact of these devices on patients' stress levels and behaviour is poorly understood. This study aimed to examine the effects of RT-CGM on tolerance and acceptability of device wear, stress and diabetes management and motivation to change. METHODS: Twenty adults (10 men, 10 women) with T2D (aged 60.6 ±â€¯8.4 years, BMI 34.2 ±â€¯4.7 kg/m2), were randomised to a low-carbohydrate lifestyle plan whilst wearing a RT-CGM or an 'offline-blinded' (Blinded-CGM) monitoring system continuously for 12 weeks. Outcomes were glycaemic control (HbA1c), weight (kg) perceived stress scale (PSS), CGM device intolerance, acceptability, motivation to change and diabetes management behaviour questionnaires. RESULTS: Both groups experienced significant reductions in body weight (RT-CGM -7.4 ±â€¯4.5 kg vs. Blinded-CGM -5.5 ±â€¯4.0 kg) and HbA1c (-0.67 ±â€¯0.82% vs. -0.68 ±â€¯0.74%). There were no differences between groups for perceived stress (P = 0.47) or device intolerance at week 6 or 12 (both P > 0.30). However, there was evidence of greater acceptance of CGM in the RT-CGM group at week 12 (P = 0.03), improved blood glucose monitoring behaviour in the RT-CGM group at week 6 and week 12 (P ≤ 0.01), and a significant time x group interaction (P = 0.03) demonstrating improved diabetes self-management behaviours in RT-CGM. CONCLUSION: This study provides preliminary evidence of improved behaviours that accompany RT-CGM in the context of diabetes management and glucose self-monitoring. RT-CGM may provide an alternative approach to glucose management in individuals with T2D without resulting in increased disease distress.

Increased thiamine intake may be required to maintain thiamine status during weight loss in patients with type 2 diabetes.

During weight loss, erythrocyte thiamine pyrophosphate (TPP) decreased (221±52 to 195±39 nmol/L, P<0.05) on a diet with adequate thiamine (1.1 mg/day) but was unchanged (217±55 vs 218±52 nmol/L, NS) on a high thiamine diet (2.8 mg/day). Attention to thiamine status may be required in patients with diabetes after weight loss.

Comparison of the effects of 52 weeks weight loss with either a high-protein or high-carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males.

BACKGROUND: A high-protein (HP), low-fat weight-loss diet may be advantageous for improving cardiometabolic health outcomes and body composition. To date, only limited research has been conducted in male participants. OBJECTIVE: To evaluate the medium to long-term effects of two, low-fat, hypocaloric diets differing in carbohydrate:protein ratio on body composition and cardiometabolic health outcomes in overweight and obese males. DESIGN: One hundred and twenty males (age 50.8±9.3 (s.d.) years, body mass index 33.0±3.9 kg m(-2)) were randomly assigned and consumed a low-fat, isocaloric, energy-restricted diet (7 MJ per day) with either HP (protein:carbohydrate:fat %energy, 35:40:25) or high carbohydrate (HC; 17:58:25). Body weight, body composition and cardiometabolic risk factors were assessed at baseline and after 12 and 52 weeks. RESULTS: Sixty-eight participants completed the study (HP, n=33; HC, n=35). At 1 year both the groups experienced similar reductions in body weight (HP, -12.3±8.0 kg (-12%); HC, -10.9±8.6 kg (-11%); P=0.83 time × group interaction) and fat mass (-9.9±6.0 kg (-27%) vs -7.3±5.8 kg (-22%); P=0.11). Participants who consumed the HP diet lost less fat-free mass (-2.6±3.7 kg (-4%) vs -3.8±4.7 kg (-6%); P<0.01). Both groups experienced similar increases in high-density lipoprotein cholesterol (8%) and reductions in total cholesterol (-7%), low-density lipoprotein cholesterol (-9%), triglycerides (-24%), glucose (-3%), insulin (-38%), blood pressure (-7/-12%) and C-reactive protein (-29%), (P0.14). CONCLUSION: In overweight and obese men, both a HP and HC diet reduced body weight and improved cardiometabolic risk factors. Consumption of a HP diet was more effective for improving body composition compared with an HC diet.

Self-reported facilitators of, and impediments to maintenance of healthy lifestyle behaviours following a supervised research-based lifestyle intervention programme in patients with type 2 diabetes.

INTRODUCTION: Sustainability of healthy lifestyle behaviours following participation in a research-based supervised lifestyle intervention programme is often poor. This study aimed to document factors reported by overweight and obese individuals with Type 2 diabetes as enhancing or impeding sustainability of lifestyle behaviours following participation in such a programme. METHODS: Thirty patients who completed a 16-week research-based supervised lifestyle intervention programme, incorporating a structured energy restricted diet with or without supervised resistance-exercise training underwent a semi-structured qualitative interview about their experiences in maintaining programme components after 1 year. RESULTS: Participants maintained 8.8 ± 8.9 kg of the 13.9 ± 6.6 kg weight loss achieved with the research-based supervised lifestyle intervention programme. Only 23% of participants indicated continuation of the complete diet programme. Desire for 'variety' (33%) and increased portion size (27%) were the most commonly reported reasons for discontinuation. Participants who undertook supervised exercise training during the programme indicated access to appropriate programmes/facilities (38%), more affordable gym membership (21%) and having a personal trainer/motivator (17%) would have facilitated exercise continuation. CONCLUSION: In overweight and obese individuals with Type 2 diabetes, success of the research-based supervised lifestyle intervention programme was perceived as being primarily due to high levels of professional support and supervision, the discontinuation of which subsequently presented difficulties. The interview data provide insight into what people experience following the completion of a research-based intensive lifestyle intervention programme and suggest that programmes assembled for research purposes with the emphasis on compliance may not necessarily promote sustainable change.

Timing of protein ingestion relative to resistance exercise training does not influence body composition, energy expenditure, glycaemic control or cardiometabolic risk factors in a hypocaloric, high protein diet in patients with type 2 diabetes.

AIM: To investigate timing of protein ingestion relative to resistance exercise training (RT) on body composition, cardiometabolic risk factors, glycaemic control and resting energy expenditure (REE) during weight loss on a high-protein (HP) diet in overweight and obese patients with type 2 diabetes (T2DM). METHODS: Thirty-four men/women with T2DM (age 57 ± 7 years and body mass index 34.9 ± 4.2 kg m(-2) ) were randomly assigned to the ingestion of a HP meal (860 kJ, 21 g protein, 0.7 g fat, 29.6 g carbohydrate) either immediately prior to RT or at least 2 h following RT. All participants followed a 16-week, energy-restricted (6-7 MJ day(-1) ), HP diet (carbohydrate : protein : fat 43 : 33 : 22) and participated in supervised RT (3 day week(-1) ). Outcomes were assessed pre- and postintervention at 16 weeks. RESULTS: There was an overall reduction in bodyweight (-11.9 ± 6.1 kg), fat mass (-10.0 ± 4.4 kg), fat-free mass (-1.9 ± 3.1 kg), waist circumference (-12.1 ± 5.3 cm), REE (-742 ± 624 kJ day(-1) ), glucose (-1.9 ± 1.7 mmol l(-1) ), insulin (-6.1 ± 6.7 mU l(-1) ) and glycosylated haemoglobin (-1.1 ± 0.1%), p ≤ 0.01 time for all variables, with no difference between groups (p ≥ 0.41 group effect). Strength improved and cardiometabolic risk factors were reduced similarly in both groups; single repetition maximum chest press 11.0 ± 8.7 kg, single repetition maximum lat pull down 9.9 ± 6.0 kg, total cholesterol -0.6 ± 0.5 mmol l(-1) , high-density lipoprotein cholesterol -0.1 ± 0.2 mmol l(-1) , low-density lipoprotein cholesterol -0.3 ± 0.5 mmol l(-1) , triglycerides -0.6 ± 0.7 mmol l(-1) , blood pressure (systolic/diastolic) -13 ± 10/-7 ± 7 mmHg (p ≤ 0.04 time effect, p ≥ 0.24 group effect). CONCLUSION: A HP, energy-restricted diet with RT was effective in improving glycaemic control, body composition, strength and cardiometabolic risk factors in overweight/obese patients with T2DM irrespective of altering the timing of protein ingestion relative to RT.

Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients.

OBJECTIVE: To compare the effects of an energy reduced very low carbohydrate, high saturated fat diet (LC) and an isocaloric high carbohydrate, low fat diet (LF) on endothelial function after 12 months. DESIGN AND SUBJECTS: Forty-nine overweight or obese patients (age 50.0 +/- 1.1 years, BMI 33.7 +/- 0.6 kg m(-2)) were randomized to either an energy restricted ( approximately 6-7 MJ), planned isocaloric LC or LF for 52 weeks. Body weight, endothelium-derived factors, flow-mediated dilatation (FMD), adiponectin, augmentation index (AIx) and pulse wave velocity (PWV) were assessed. All data are mean +/- SEM. RESULTS: Weight loss was similar in both groups (LC -14.9 +/- 2.1 kg, LF -11.5 +/- 1.5 kg; P = 0.20). There was a significant time x diet effect for FMD (P = 0.045); FMD decreased in LC (5.7 +/- 0.7% to 3.7 +/- 0.5%) but remained unchanged in LF (5.9 +/- 0.5% to 5.5 +/- 0.7%). PWV improved in both groups (LC -1.4 +/- 0.6 m s(-1), LF -1.5 +/- 0.6 m s(-1); P = 0.001 for time) with no diet effect (P = 0.80). AIx and VCAM-1 did not change in either group. Adiponectin, eSelectin, tPA and PAI-1 improved similarly in both groups (P < 0.01 for time). CONCLUSION: Both LC and LF hypoenergetic diets achieved similar reductions in body weight and were associated with improvements in PWV and a number of endothelium-derived factors. However, the LC diet impaired FMD suggesting chronic consumption of a LC diet may have detrimental effects on endothelial function.

Effect of caloric restriction with and without exercise training on oxidative stress and endothelial function in obese subjects with type 2 diabetes.

AIM: Effects of dietary weight loss on endothelial function, particularly when combined with exercise training, is largely unknown in type 2 diabetes. We sought to determine whether aerobic exercise training provided any additional improvements in endothelial function, oxidative stress or other established markers of cardiovascular risk when combined with an energy-restricted diet in patients with type 2 diabetes. METHODS: In a parallel study design, 29 sedentary, overweight and obese patients with type 2 diabetes (age 52.4 +/- 1.4 years and BMI 34.2 +/- 0.9 kg/m(2)) were randomized to a 12-week moderate energy-restricted diet (~5000 kJ/day and approximately 30% energy deficit) with or without aerobic exercise training [diet only (D), n = 16 and diet plus exercise (DE), n = 13]. Body weight, cardiovascular risk markers, malondialdehyde (MDA, oxidative stress marker), 24-h urinary nitrate/nitrite and flow-mediated dilatation (FMD) of the brachial artery were measured pre- and postintervention. RESULTS: Both interventions reduced body weight (D 8.9%, DE 8.5%, time effect p < 0.001). Significant reductions in body fat, waist circumference, blood pressure, glycated haemoglobin, glucose, insulin resistance, lipids and MDA and increases in urinary nitrite/nitrate were observed in both groups (time effect p < or = 0.05); however, these changes were not different between treatments. At baseline, FMD was similar in both groups (D 2.5 +/- 0.9%, DE 4.2 +/- 1.2%; p = 0.25) and did not change after the interventions (p = 0.59). CONCLUSIONS: These results suggest that lifestyle interventions incorporating diet with or without exercise improve glycaemic control, reduce oxidative stress and improve other cardiovascular risk factors but do not improve FMD in obese subjects with type 2 diabetes.