Michael.Massing + self + care + treatment + behavioral   36

More Magnesium, More Benefit in Prediabetes?
The glucose tolerance of approximately 50% of the patients receiving magnesium supplementation improved from impaired to normal, compared with 7% in the placebo group.

A cross-sectional study also associates hypomagnesemia with an increased risk for diabetic complications, including retinopathy, nephropathy, and foot ulcers.[7]

Supplemental Magnesium

Magnesium intake in clinical studies has been around 400 mg/day, which is the recommended dietary allowance of magnesium for men. For women, 300-310 mg/day is the recommended dietary allowance.[8] Only about 50% of Americans aged 1 year or older receive the recommended amount of dietary magnesium.[9] Thus, it may be reasonable to advise patients who are at risk for diabetes to increase magnesium intake. Foods that have high amounts of magnesium include nuts (eg, almonds, cashews, and peanuts), vegetables (eg, spinach, avocado, and edamame), and whole grains.[10]

For patients who cannot meet magnesium requirements through foods, supplemental magnesium not exceeding 350 mg/day could be used. Supplemental magnesium may cause diarrhea, nausea, and cramping. Patients with renal impairment should avoid magnesium supplements unless prescribed by a healthcare provider.[10] Products containing magnesium may interact with other medications and should be separated by at least 2 hours to prevent drug interactions.[11]

The American Diabetes Association does not support the routine use of magnesium supplementation in patients with diabetes but does recommend intake of vegetables, whole grains, and legumes.[12] Larger studies are needed to determine the role of magnesium supplementation in preventing prediabetes, type 2 diabetes, or complications of diabetes.
magnesium  Mg  supplements  correlation  impaired  fasting  glucose  prediabetes  diabetes  type  2  T2D  peer-reviewed  research  overview  risk  benefit  diet  dietary  foods  retinopathy  nephropathy  foot  ulcers  mitigation  prevention  symptoms  late-stage  complications  behavioral  self  care  treatment  management  tight  control  human  clinical  trial  in  vivo  situ 
march 2016 by Michael.Massing
How Do Mobile Phone Diabetes Programs Drive Behavior Change?
Methods This was a mixed methods observational cohort study. Study participants were members of the University of Chicago Health Plan (UCHP) who largely reside in a working-class, urban African American community. Surveys were conducted at baseline, 3 months (mid-intervention), and 6 months (postintervention) to test the hypothesis that the intervention would be associated with improvements in self-efficacy, social support, health beliefs, and self-care. In addition, in-depth individual interviews were conducted with 14 participants and then analyzed using the constant comparative method to identify new behavioral constructs affected by the intervention.
Results The intervention was associated with improvements in 5 of 6 domains of self-care (medication taking, glucose monitoring, foot care, exercise, and healthy eating) and improvements in 1 or more measures of self-efficacy, social support, and health beliefs (perceived control). Qualitatively, participants reported that knowledge, attitudes, and ownership were also affected by the program. Together these findings were used to construct a new behavioral model.
Conclusions This study’s findings challenge the prevailing assumption that mobile phones largely affect behavior change through reminders and support the idea that behaviorally driven mobile health interventions can address multiple behavioral pathways associated with sustained behavior change.
mobile  health  program  research  behavior  behavioral  change  sustainability  peer-reviewed  hcsm  self  care  treatment  social  media  technology  SMS  texting  txt 
december 2014 by Michael.Massing
30 Years Later, a Landmark Study Lives On: Diabetes Forecast Magazine
The trial ended about a year early because the results were so clear-cut. The risk of the development and progression of complications was significantly lower in the intensive therapy group; members had less than half the risk of developing retinopathy, nephropathy (kidney disease), and neuropathy (nerve damage).

Almost all of the benefit was accounted for by the difference in A1C levels between the two treatment groups. "You didn't have to get to a magic number to see benefit," says Gayle Lorenzi, RN, CDE, study coordinator at the University of California–San Diego. "Any improvement in glucose control resulted in risk lowering. If you went from an A1C of 10 percent to an 8, risk was still reduced."

The benefits weren't limited to those in perfect health at the study's start. The thinking used to be that once a patient had signs of complications, the damage would inevitably worsen, says Rose Gubitosi-Klug, MD, PhD, principal investigator at Case Western Reserve University. But DCCT showed that "even if you have complications, you can slow the progression," she says....

And though we now know intensive glucose control reduces the risk of complications, the health care system doesn't provide free, high-level care like the intensive group received. Many people see just a single provider for two to four visits a year.
diabetes  type  1  tight  control  intervention  behavioral  peer-reviewed  research  clinical  in  vivo  human  randomized  controlled  trial  self  care  blood  glucose  management  T1D  ethics  standard  of  healthcare  DCCT  behavior  treatment  benefit  self-monitored  monitoring  SMBG  retinopathy  nephropathy  risk  mitigation  prevention  symptoms  late-stage  complications  situ 
february 2014 by Michael.Massing
Disordered Eating Behavior in Individuals With Diabetes
Ongoing diabetes treatment exposes patients to situations and emotions known to be associated with the development of DEB. Feelings of loss of autonomy and control are associated with the development of eating disorders in nondiabetic individuals seeking weight loss (31). The relationships are presumed to be similar in patients with diabetes (53). Issues for consideration include but are not limited to: feelings of loss of control because of required monitoring and reporting of food intake, physical activity and blood glucose, feeling loss of autonomy because of parental/spousal/familial concern/vigilance regarding health status (53), increased perfectionism due to accountability to health care providers regarding self-care behaviors and glycemic status (8), lower self-esteem and body image secondary to diagnosis and treatment (56), and weight gain due to the initiation of treatment (36).

Recent studies have examined relationships between personality characteristics and DEB (57–59). Characteristics studied include coping styles (60), unmitigated communion (putting others' needs and opinions before one's own), harm avoidance (avoidance of conflict), and self-directedness (57). Women in particular are prone to unmitigated communion, harm avoidance, and lower self-directedness, characteristics which are hypothesized to place them at risk for DEB. It has been speculated that difficulty adjusting to the diabetes self-care regimen and consequent weight gain may predispose to adoption of maladaptive weight management behavior to avoid disruption in relationships with care providers and family members. Thus, certain personality characteristics in the context of the self-management regimen may make patients susceptible to DEB, independent of other psychological, familial, or societal influences (11).
disordered  eating  behavior  disorder  correlation  risk  food  diabetes  peer-reviewed  research  behavioral  treatment  care  self  intervention  diagnosis 
january 2014 by Michael.Massing
Identification of barriers to appropriate diet... [Diabetes Ther. 2011] - PubMed - NCBI
The survey was administered to 98 patients with a mean age of 51.98 years, a mean duration of diabetes of 9.76 years, and a mean hemoglobin A1c of 7.99%. When asked to rate factors most important in food selection, the highest mean responses were taste (3.97 out of 5) and cost (score of 3.94 out of 5). Barriers that the majority of respondents agreed or strongly agreed were important included: stress causing over-eating or unhealthy food choices, difficulty resisting the temptation to eat unhealthy food, and healthy food being too expensive. The Cronbach's Alpha for the subscales of food selection, importance of life challenges, and barrier were 0.673, 0.853, and 0.786, respectively.
In a low-income, urban, predominantly African American and Caucasian diabetic population, cost of healthy food, stress-related inappropriate eating, and the temptation to eat unhealthy food were the most frequently reported barriers to healthy eating. Diabetes education programs serving similar populations should evaluate the presence of these barriers. The survey instrument was a reliable measure of the constructs it purported to measure.
diabetes  food  barriers  compliance  self  care  cost  taste  peer-reviewed  research  behavioral  behavior  attitude  treatment  factor  etiology  risk  public  health 
january 2014 by Michael.Massing
Use of Short Message Services (SMS) for the Management of Type 2 Diabetes Mellitus | JAFES 28-02 | C Tamban, I Thiele Isip-Tan, C Jimeno
The use of SMS as an adjunct to the standard of DM care improved adherence to diet after 6 months in terms of mean number of meals, improved adherence to exercise after 6 months in terms of mean number of minutes/exercise and significant reduction in HbA1c levels after 3 and 6 months.
SMS  technology  healthware  self  care  diabetes  peer-reviewed  research  type  2  T2D  social  media  support  mhealth  phone  telephone  SoMe  behavior  behavioral  change  adherence  in  vivo  situ  human  treatment  texting  txt  clinical  trial  outcome 
january 2014 by Michael.Massing
Twitter aids weight loss | Turner-McGrievy, B, Translational Behavioral Medicine | via University of South Carolina - News
--Over the six-month period, there were 2,630 Twitter posts.
--Seventy-five percent of the posts were informational, with most characterized as teaching (providing new facts or skills). One of the most frequent types of teaching posts was a status update from a participant (81 percent of all teaching posts), such as "I avoided eating a pastry this morning at a breakfast meeting! I did have a skim Mocha without whipped cream… not too bad”.
--Other types of support present were emotional support, through demonstrating listening (6.6 percent), and esteem support, through providing compliments (4.6 percent).
--Both Podcast only and Podcast + mobile participants achieved a 2.7 percent weight loss at six months. However, those who engaged with Twitter were more successful with losing weight, such that every 10 posts to Twitter corresponded with approximately −0.5 percent weight loss.
--A strength of the study, Turner-McGrievy said, was the researchers' ability to have an in-depth examination of the interactions that took place among a group of people who were actively receiving a behavioral weight loss program.
diabetes  management  self  care  weight  loss  outcome  social  media  HCSM  health  research  peer-reviewed  human  in  vivo  situ  clinical  behavior  behavioral  change  SoMe  support  adherence  treatment  technology  SMS  texting  txt  trial 
august 2013 by Michael.Massing
Do Lifestyle Changes Reduce Serious Outcomes in Diabetes? — NEJM
The participants who received intensive lifestyle modifications experienced other benefits when compared to the diabetes education and support group, including decreased depressive symptoms, less self-reported retinopathy, and decreased risk of kidney disease. Compared to the diabetes support and education group, the intensive lifestyle intervention reduced the average number of hospitalizations per year and the average number of medications per year. Hospitalizations were reduced by 11.9% from 0.193 to 0.17 hospitalizations per year, which translated into savings of $294 per year and $2,600 discounted over 10 years. Moreover, the number of medications was reduced by 6.3% from 4.9 to 4.6 medications per year, translating into a savings of $278 per year and $2,487 discounted over 10 years. Average costs per year were $8,807 for the control group vs. $8,205 for the intervention group, leading to a significant reduction of $602 per year and $5,378 discounted over 10 years. Significant reductions in hospitalizations occurred mainly among CV and pulmonary hospitalization, and significant reductions in medications occurred mainly among diabetes, lipid-lowering and antihypertensive medications. The study ultimately shows that obese or overweight people with type 2 diabetes should increase the amount that they exercise and increase their weight loss.
peer-reviewed  research  cardiovascular  risk  diabetes  obesity  human  in  vivo  physical  activity  type  2  T2D  correlation  support  treatment  self  care  education  depression  comorbidities  intensive  lifestyle  intervention  retinopathy  kidney  disease  hospitalization  morbidity  healthcare  cost  economics  harm  reduction  behavioral  change  management  behavior  tight  control  exercise  body  fat  clinical  trial  stress  distress  factor  therapy  etiology  mitigation  prevention  symptoms  late-stage  complications  benefit  situ 
june 2013 by Michael.Massing
Close Eye on Blood Sugar Aids Glycemic Control
[Some studies have shown that clinicians and patients make little use of self-monitored blood glucose] data in order to improve outcomes. But [this study and other recent work have] shown that monitoring that is highly structured, in terms of both timing and frequency, may help improve outcomes -- even in patients who have a lower HbA1c but aren't quite at glycemic targets....
The researchers also found in the ITT analysis that prescriptions for diabetes medications were changed more often at visits two, three, and four for the intense-monitoring group than for controls...."structured SMBG data prompted clinicians to adjust therapy earlier and more intensively in contrast to the clinical inertia often seen in the management of patients with type 2 diabetes"
T2D  research  babies  type  to  management  control  blood  glucose  sugar  intervention  treatment  self  care  A1c  human  in  vivo  medical  clinical  diabetes  2  peer-reviewed  goals  improvement  benefit  intensive  tight  behavior  behavioral  trial 
june 2013 by Michael.Massing
Peer Mentoring Leads to Large A1C Reductions | Annals of Internal Medicine 2012 | via Diabetes Self-Management
Each percentage point decrease in A1C lowers the risk of long-term diabetes complications by 37%.
Diabetes is more common and often more severe in African Americans. To determine if people in this population could lower their A1C levels by talking regularly with others who had successfully controlled their blood glucose levels, researchers recruited 118 African Americans at the Philadelphia Veterans Affairs Medical Center who hadn’t been successful at lowering their A1C[:]
Those in the usual care group were provided with specific goals for A1C.
Participants in the financial incentive group were given $100 for lowering their A1C by one point (for example, from 7.9% to 6.9%) and $200 for lowering their A1C by two points or for hitting an A1C level of 6.5% or lower.
Those in the peer-mentoring group were connected with someone with diabetes who had once had poor blood glucose control but who had brought it to target levels (an average of 6.7%). The mentors were paid $20 and told to meet with their “mentees” at least once per week for the duration of the six-month study.
Mentors and mentees spoke an average of four times during the first month of the study and twice a month thereafter. The researchers were not sure whether this decrease in contact was due to reduced motivation or to a perceived lack of need for more frequent communication.
[Peer-mentoring participants] achieved the greatest reduction in A1C levels: Among those in the usual care group, A1C was reduced, on average, from 9.9% to 9.8%; among those in the financial incentive group, A1C was reduced from 9.5% to 9.1%; and among those in the peer-mentoring group, A1C was reduced from 9.8% to 8.7%.
“Perhaps the most obvious attraction of this type of peer mentoring is that it is virtually free, almost certainly enhancing its cost-effectiveness relative to more expensive interventions, such as nurse care management, telemedicine, and group medical appointments"...
The researchers note that all participants in the study were veterans, so the sense of camaraderie among them may not translate to other groups of people with diabetes, and they call for future studies that look into whether the blood glucose effects seen in this trial are sustainable....
{T]o find a diabetes mentor, check out the article “Peer Support, Education, and Mentoring,” [link] by certified diabetes educator Martha Mitchell Funnell.
A1c  risk  symptoms  complications  end-stage  effectiveness  efficacy  intervention  mentoring  peer  incentive  health  disparities  diabetes  treatment  self  care  African-American  medical  behavioral  research  peer-reviewed  support  correlation  blood  glucose  monitoring  social  outcome  human  in  vivo  situ  clinical  type  2  T2D  behavior  change  phone  telephone  SMBG  self-monitored  benefit  healthcare  remediation  counseling  incentives  culture  minority  cooperative  economics  management  comorbidities  late  trial 
april 2012 by Michael.Massing
Mentoring Provides Health Benefits for African American Veterans with Diabetes | Long J, Volpp K et al. Annals of Internal Medicine 2012-03-20
Diabetes patients receiving their usual care were notified of their starting levels and recommended goals for HbA1c. Those in the mentor group were assigned mentors who previously had poor glycemic control but now had good control. Mentors participated in hour-long one-on-one training, including motivational interviewing techniques, and were informed that they would receive $20 per month if the diabetes patient confirmed that they had talked at least once a week. Those in the financial incentive group were told they would earn $100 if their HbA1c dropped by one point and $200 if it dropped by two points or to a level of 6.5%.
In the six-month study, intervention by the peer mentors had a statistically significant effect in improving glucose control. On average, diabetes patients in the mentor group saw their HbA1c drop by approximately one percent (from 9.8 to 8.7). HbA1c levels in the financial incentive group dropped from 9.5 to 9.1, while the control group saw the smallest change (from 9.9 to 9.8).
The authors of the study note that several factors may have contributed to the success of the peer mentor intervention. First, those in the mentor group may have benefited from a culture of camaraderie among the veteran participants. Second, social altruism may be a powerful motivator if patients are provided with a mechanism to help each other. Third, a history of mistreatment and distrust in the health care system may make peer support particularly effective for minorities. Finally, mentors were given $20 to talk to the patients at least four times per month. This financial incentive may have motivated mentors to call more frequently.
Previous studies have shown that social support can improve diabetes self-management behaviors, such as adhering to medication, diet, exercise, and blood glucose monitoring. However, these studies generally involved nurse phone calls or home visits from community health workers, which require expensive professional or semi-professional staff members. In addition, support from families and friends is often not a viable alternative because many high-risk patients are socially isolated, while others may not want to engage relatives or friends in discussions about their medical problems. Finding family members and friends who are able to assume caretaker roles is also often a challenge for many patients.
"Our study raises the possibility that a more informal, flexible means of providing one-on-one peer support through peer coaches or mentors could potentially provide larger benefits at low cost."
A1c  risk  symptoms  complications  end-stage  effectiveness  efficacy  intervention  mentoring  peer  incentive  health  disparities  diabetes  treatment  self  care  African-American  medical  behavioral  research  peer-reviewed  support  correlation  blood  glucose  monitoring  social  outcome  human  in  vivo  situ  clinical  type  2  T2D  behavior  change  phone  telephone  SMBG  self-monitored  benefit  healthcare  remediation  counseling  incentives  culture  minority  cooperative  economics  management  comorbidities  late  trial 
march 2012 by Michael.Massing
Clinical Trial Teaches Binge Eaters to Toss Away Cravings
During single sittings, [some] over-eaters consume large servings of high-caloric foods. Sufferers contend with weight gain[, depression, and elevated risk for] heart disease and diabetes. A new clinical trial, called Regulation of Food Cues...aims to treat binge eating by helping participants to identify real hunger and to practice resistance if the stomach is full.

“Most weight-loss treatments for obese adults focus very little on the reduction of binge eating...With this study we use a variety of techniques to train the brain to identify and respond to hunger and cravings and to learn resistance to highly craved foods.”
[Thirty subjects will undergo weekly 60–90 minute sessions for] 12 weeks. Participants will learn how food cravings originate, how to detect and monitor true hunger, how [emotion influences eating, and how to manage cravings and impulses].  

“Binge eaters often consume food in response to their environment, even when they are not hungry. This could be a response to watching TV, long commutes, sitting on the couch, time of day, even loneliness...The goal is to reduce cravings to overeat by up to 50 percent.”

Teaching obese people to recognize hunger signals is based upon the principles of behavioral psychology, which has proven effective in treating conditions such as anxiety and bulimia....Exposure-based treatments help eaters improve their sensitivity to hunger and fullness and reduce their sensitivity to the sight and smell of food.

Similar programs aimed at overweight youths have yielded promising results and an ability to maintain reductions in binge eating at six and 12 months after treatment.

[Subjects] will be asked to complete interviews and surveys before and after treatment groups[, and will complete food logs monitoring] levels of hunger and fullness as well as cravings.
medical  research  clinical  overeating  obesity  binge  eating  behavioral  cognitive  modification  diabetes  anxiety  compulsive  human  in  situ  vivo  behavior  cue  environment  food  management  craving  hunger  self  care  awareness  correlation  association  stimulus  response  T2D  treatment  intervention  trial  environmental 
march 2012 by Michael.Massing
Giving Up on Weight Loss | Kahn, R. Health Affairs 2012-01 | via Diabetes Self-Management
Richard Kahn, formerly the chief medical officer of the American Diabetes Association, claims that we don’t know enough right now about the biological processes underlying the body’s regulation of weight to develop effective weight-loss programs that can be applied on a large scale. In the meantime, he writes, public health officials and medical groups should concentrate on finding ways to help people control their diabetes once it develops. This, he believes, is a better use of valuable time and research dollars, since effectively controlling blood glucose levels has shown to be sustainable and leads to a greatly reduced risk of diabetes complications....
As an article published at DiabetesInControl.com notes, several doctors associated with Boston’s Joslin Diabetes Center released a statement indicating strong disagreement with Kahn. Osama Hamdy, medical director of the center’s Obesity Clinical Program, asserted that Kahn was advocating “a surrender in the face of one of the greatest threats to public health the world faces.” Hamdy goes on to say that while maintaining weight loss is “a lifelong battle,” Joslin programs have shown that weight loss can be sustained for long periods of time. One program, he notes, led to a 50% reduction in diabetes medicines taken by participants and a 27% reduction in overall health-care costs....
Is it foolish to suppose that programs administered by a leading diabetes research center can be effectively duplicated across the country? Or is Kahn’s approach too pessimistic — or even, as one writer suggests, possibly distorted by ties to diabetes drug manufacturers?
[The ADA's conservatism on preventive strategies and intimacy with the post-diagnosis treatment industry has long been a thorn in the side of many.—DMM]
body  fat  weight  loss  diabetes  prevention  what.I'm.reading  maintenance  self  care  glucose  behavior  hatmandu  T2D  research  correlation  health  cost  benefit  economics  behavioral  treatment  intervention 
february 2012 by Michael.Massing
Benefits of Tight Blood Pressure Control in Diabetic Patients With Hypertension
In 2008, when the UK Prospective Diabetes Study (UKPDS) group presented their 30-year findings concerning the possible sustained effects of improved glycemic control after 10 years of extended follow-up in type 2 diabetic patients, a so-called “legacy effect” was reported to address the long-term emergent and/or sustained benefits of early improved glycemic control. Opposite results were obtained by the Hypertension in Diabetes Study (HDS) carried out in the frame of UKPDS, with no evidence of any legacy effect on cardiovascular (CV) outcomes for an initial 4-year period of tight blood pressure (BP) control. Thus, it was concluded that BP control has to be continued over time, since, although it had a short time-to-effect relationship in preventing stroke, BP control was associated with a short persistence of its clinical benefits once the intervention was discontinued. These findings are unique because, whereas most interventional trials in hypertension that included diabetic patients have shown a reduction in CV outcomes shortly after starting treatment, only the UKPDS-HDS specifically explored the possible persistence of clinical benefits after discontinuing intensive BP-lowering intervention. This article aims to provide a critical interpretation of the UKPDS findings of lack of BP legacy, in the context of the currently available evidence on the benefits of antihypertensive treatment. The importance of effective BP control in type 2 diabetic patients to prevent CV outcomes and other diabetes-related complications is underlined, with emphasis on early, tight, and continuous BP control to optimize patients’ protection.
hyperglycemia  hypertension  high  blood  pressure  glucose  intervention  treatment  legacy  effect  early  aggressive  tight  control  what.I'm.reading  self  care  dysglycemia  morbidity  risk  medical  research  diabetes  T2D  correlation  benefit  self-monitored  monitoring  SMBG  behavior  behavioral  peer-reviewed  dcde 
january 2012 by Michael.Massing
Adolescent Body Mass Index Can Predict Young Adulthood Diabetes and Heart Disease
[Increased risk for diabetes and coronary heart disease can be predicted even from "normal" BMI (<25 Kg/m2). Each one-unit rise in BMI correlates to ~10% increased risk for early adulthood DM2, and a 12% increase in heart disease risk. Higher risk is significant at an age-17 BMI of ≥ 23.4 Kg/m2 for diabetes and ≥ 20.9 Kg/m2] for heart disease. <br />
[BMI at age 17 predicts diabetes risk mainly by correlating with BMI later in life. For heart disease, BMI at adolescence and at adulthood independently predict risk].... <br />
"[A teen with relatively high BMI who becomes a lean adult practically eliminates added diabetic risk. That person's heart disease risk remains elevated compared to the lean teen who became a lean adult, though still] lower than that of the heavier teen who became an obese adult.... <br />
[Eating habit modification can halt and even reverse] progression of atherosclerosis, the underlying process of heart disease.
prognostic  medical  research  heart  disease  CVD  cardiovascular  diabetes  risk  BMI  youth  adolescence  factor  prevention  children  child  development  atheroscelosis  reversal  treatment  behavior  modification  via:dLife.com  to:fu  self  care  correlation  type  2  T2D  behavioral  intervention  change  management  etiology  from delicious
april 2011 by Michael.Massing
New Diabetes Education Program Yields Improved Blood Sugar Control
[An intensive, 9-session, problem-solving course taught not only standard diabetes self-management, but problem-solving skills to help manage the financial, social, resource, and interpersonal issues that often stand in the way of managing diabetes. Another] group got a condensed 2-session version of the program.
Participants in the intensive group saw their hemoglobin A1C levels fall by an average of .7. One participant stopped needing insulin. Condensed program subjects saw no improvement.]
Many [in the intensive program also saw high cholesterol and blood pressure drop. Hill-Briggs highlights that A1C levels improved 3 months after the program was over,] in contrast to many diabetes interventions, particularly with lower socioeconomic groups. “When the program stops and support is taken away, the behavior stops and the benefits stop"...
Hill-Briggs [says sustained improvement in her study reflects that successfully taught problem-solving skills improve as people] use them more.
diabetes  intervention  education  strategy  management  poverty  socioeconomic  risk  factor  problem  solving  life  skills  via:dLife.com  self  care  burden  patient  health  literacy  support  blood  glucose  monitoring  social  outcome  research  peer-reviewed  human  in  vivo  situ  clinical  type  2  T2D  correlation  SMBG  self-monitored  behavior  behavioral  treatment  trial  etiology  public  from delicious
april 2011 by Michael.Massing
Experts: Exercise Crucial for Patients With Type 2 Diabetes | Medicine & Science in Sports & Exercise. 2010/12
New guidelines jointly issued by the American College of Sports Medicine and the American Diabetes Association call for [type 2 diabetics] to get at least 150 minutes of moderate-to-vigorous aerobic exercise over the course of at least three days during the week, and not to skip more than two days of exercising. <br />
Strength training, using weights to develop muscle mass, is also important in diabetes management. Resistance training should be part of a diabetes patient’s exercise regimen... <br />
Exercise is critical to reducing the risk of diabetes, as well as helping people with diabetes improve insulin and blood sugar production [sic]. Exercise may also improve a diabetes patient’s lipid profile, such as lowering the levels of cholesterol and other fats in the blood, and also lead to losing weight... <br />
[S]ustained intensity and duration of aerobic activity is important and may likely achieve biological effects that cannot be achieved from mild physical activity alone.
activity  via:diabetes.org  via:WebMD  exercise  sport  treatment  risk  reduction  blood  lipids  fats  body  fat  self  care  behavior  strength  training  insulin  resistance  T2D  diabetes  type  2  research  peer-reviewed  behavioral  intervention  change  management  from delicious
april 2011 by Michael.Massing
Can Renin-angiotensin System Blockade Have a Role in Preventing Diabetic Retinopathy?
[Recent research assessed use of an angiotensin receptor blocker (ARB) in Type 1 and Type 2 diabetes, showing] a clear trend to less severe retinopathy with RAS blockade. A smaller trial, RASS, reported reduced retinopathy progression in Type 1 diabetes from RAS blockade with both the ARB losartan and the angiotensin converting enzyme (ACE) inhibitor enalapril. <br />
Diabetic retinopathy is the most common long-term complication of diabetes and the most common cause of blindness in working-age people in developed countries.... <br />
At the time of [diagnosis, up to 40% of type 2 patients already have some retinopathy. In 30-year-old data, more than 60% of type 2 diabetics and almost all type 1 diabetics have] some retinopathy after 20 years. <br />
[Recent improvements in the treatment of diabetes have produced] lower incidence of retinopathy...<br />
If untreated, a large proportion of people who develop proliferative diabetic retinopathy (PDR) will experience severe loss of vision within 5 years.
risk  benefit  eyes  retinopathy  prevention  ACE  inhibitor  blood  pressure  high  diabetes  late-stage  symptoms  complications  vision  loss  comorbidities  late  end-stage  drug  treatment  intervention  ARB  diagnosis  hypertension  correlation  protection  peer-reviewed  research  mitigation  behavioral  self  care  management  tight  control  human  clinical  trial  in  vivo  situ  from delicious
march 2011 by Michael.Massing
Alcohol Linked to Lower Risk for Diabetes and Less Insulin Secretion
Self-reported alcohol consumption tended to be higher in participants who were men, older, white, and less obese, with higher energy intake and a higher high-density lipoprotein cholesterol concentration. At any level of insulin sensitivity, higher consumption of alcohol was associated with lower insulin secretion. In the metformin and lifestyle modification groups, higher alcohol consumption was associated with lower incidence rates of diabetes (P < .01 and P = .02 for trend, respectively). These associations remained significant after adjustment for multiple baseline covariates but were not observed in the placebo group.

"Despite overall low rates of alcohol consumption, there was a reduced risk of incident diabetes in those who reported modest daily alcohol intake and were assigned to metformin or lifestyle modification," the study authors write. "Moderate daily alcohol intake is associated with lower insulin secretion -- an effect that warrants further investigation."
alcohol  blood  glucose  risk  benefit  self  care  peer-reviewed  research  metformin  treatment  lifestyle  behavioral  diet  exercise  T2D  diabetes  drug  effects  activity  correlation 
october 2009 by Michael.Massing
Barriers to Effective Diabetes Care Revealed | Pun, S & Coates, V. Journal of Nursing and Healthcare of Chronic Illness 2009-03
Eating out...was a frequently mentioned problem[, as was] being offered inappropriate food when visiting...Attitudes[,] physical limitations and discomfort [interfered with] regular exercise....Behavioral and psychiatric disorders, and cultural and language barriers, among both patients and family members, also act as barriers to effective diabetes treatment.
Finance was another significant barrier in keeping a check on blood sugar levels. Even if healthcare was free or funded by insurance, patients still had to spend more money on healthy food, home glucose monitoring kits and transport to and from healthcare appointments.
With a lack of proper knowledge, patients fail to understand the relevance of diet and care plans...[Inability] to maintain good glucose control can cause helplessness and frustration, as can the progression of the disease...[P]atients who received support from family, friends and diabetes clinics appeared to handle self-care better than those who did not.
healthcare  diabetes  self  care  management  burden  barrier  health  cost  support  behavior  food  poverty  income  economics  correlation  peer-reviewed  research  family  social  culture  language  behavioral  treatment  intervention 
april 2009 by Michael.Massing
Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials | Skyler et al. Diabetes Care 32, 2009
[R]andomized controlled trials have demonstrated conclusively that the risk of microvascular complications can be reduced by intensive glycemic control in patients with type 1 and type 2 diabetes. In the Diabetes Control and Complications Trial (DCCT), there was an ~60% reduction in development or progression of diabetic retinopathy, nephropathy, and neuropathy between the intensively treated group (goal A1C <6.05%, mean achieved A1C ~7%) and the standard group (A1C ~9%) over an average of 6.5 years. The relationship between glucose control (as reflected by the mean on-study A1C value) and risk of complications was log-linear and extended down to the normal A1C range (<6%) with no threshold noted.
In the UK Prospective Diabetes Study (UKPDS), participants newly diagnosed with type 2 diabetes were followed for 10 years, and intensive control (median A1C 7.0%) was found to reduce the overall microvascular complication rate by 25% compared with conventional treatment (median A1C 7.9%).
blood  glucose  treatment  diabetes  symptoms  self  care  microvascular  retinopathy  nephropathy  outcomes  intensive  tight  control  management  benefit  late-stage  risk  mitigation  prevention  complications  behavioral  peer-reviewed  research  human  clinical  trial  in  vivo  situ 
april 2009 by Michael.Massing
Low Glycemic Breakfast May Increase Benefits of Working Out | Stevenson, E. The Journal of Nutrition 2009-05 | dLife.com
[Research] suggests that exercise and diet interact to influence health[: e]xercising after short-term fasting (such as before breakfast) may increase the amount of fat burned[;] consumption of a meal eliciting a low blood glucose response prior to exercise may also boost the use of body fat (instead of glucose). [M]ost of these studies have used either trained athletes or recreational exercisers, and none has looked at effects of the type of pre-exercise meal on metabolism during and after exercise. To better understand the effects of pre-exercise meal composition on fat metabolism in more typical (sedentary) individuals, a group of researchers...at the University of Nottingham conducted a controlled human intervention trial....The authors concluded that consuming a LGI breakfast increases fat oxidation during subsequent exercise and improved satiety during recovery in sedentary females. [I]ndividuals trying to shed fat may consider choosing LGI foods....prior to when they exercise.
exercise  body  fat  self  care  glycemic  index  low  loss  weight  behavior  medical  research  peer-reviewed  satiety  meal  planning  timing  individual  personal  responses  food  behavioral  treatment 
april 2009 by Michael.Massing
Diabetics Can Choose Their Energy-Restricted Diets
Average weight loss was similar in both groups--4.0 kilograms (8.8 pounds) in the high-MUFA [monounsaturated fatty acids] group and 3.8 kg (8.4 pounds) in the high-carb group.
There were also similar improvements in body fat, waist circumference, blood pressure, "good" HDL cholesterol, A1C, and glucose and insulin. Among 18 participants from each group who consented to a follow-up assessment 18 months after completion of the main study, the researchers found that weight loss and A1C improvement had been maintained.
"Our study results suggest that high-MUFA diets can be healthy alternatives to conventional lower-fat diets," Brehm and colleagues conclude. Healthcare providers with diabetic patients "can offer ongoing counseling for a variety of diets higher in either carbohydrates or MUFA while controlled in energy," they advise.
Dropping the “one size fits all' philosophy and providing diet options, they suggest, may encourage people with diabetes to stick with a reduced-calorie diet.
diet  wellbeing  behavioral  treatment  behavior  care  self  intervention  maintenance  sustainability 
march 2009 by Michael.Massing
Diabetes News from dLife.com: Lifestyle Intervention Program For Diabetics Improves Mind, Body And Wallet
'The usual-care group [averaged 3.49 lost] work days per year. The lifestyle intervention group lost 0.92 work days...ICAN reduced the probability of lost work days by 64.3%. Disability and physical limitation days were used at a rate of 5.3 days for the usual-care group and 0.94 days for the lifestyle intervention group...[T]he probability of disability days [diminished] by 87.2%. Depression, a strong predictor of work days lost due to diabetes and obesity, resulted in an average of 6.6 missed work days per year for the usual- care participants and 1.7 missed work days for the lifestyle intervention participants. Results were similar for depression’s impact on disability days lost..."[I]f we calculate the return on investment (ROI) based on program costs, savings from averted days missed at work and with disability and physical limitations, the ROI was $2.67 [per dollar invested]...and this does not include the cost savings seen by reducing medical costs—a result we reported earlier.”
healthcare  economics  behavioral  treatment  chronic  debilitating  behavior  care  self  intervention 
march 2009 by Michael.Massing
Home - the Behavioral Diabetes Institute offers Diabetes Workshops, Clinical Programs and Diabetes Behavioral Research
The Behavioral Diabetes Institute (BDI) [is] the world’s first organization dedicated to tackling the unmet psychological needs of people with diabetes. The BDI offers an array of evidence-based clinical programs, all designed to help people overcome the emotional and behavioral obstacles to living well with diabetes. The BDI, a non-profit corporation, is committed to:
* helping people master the unique challenges of diabetes
* conducting behavioral research in diabetes
* providing health care providers with the specialty behavioral training necessary for managing diabetes effectively.
The programs at BDI are designed to help participants develop a more hopeful outlook on life and greater confidence and control over diabetes.
diabetes  behavior  treatment  self  care  behavioral  research  management  intervention  change 
february 2009 by Michael.Massing
Diabetes News from dLife.com: Prevalence Of Disordered Eating Behaviors In Diabetics Probed
Children with diabetes are at an increased risk for developing eating disorders and researchers want to know if it's their disease or treatment that's to blame. "Diabetes treatment prescribes obsessive food behavior, such as carbohydrate restriction," said Dr. Deborah Young-Hyman..."We want to know if those prescribed behaviors contribute to disordered eating and/or whether there are physiological mechanisms which prevent children with diabetes from controlling their eating behavior. For example, treatment with insulin makes you hungry and can cause you to gain weight....If we don't approach weight control as dieting, place less emphasis on food restriction and focus on healthy nutrition and usual eating patterns, we can help patients gain more control over their eating behaviors and their treatment without adoption of maladaptive weight management strategies...[F]eeling in control of your illness is one of the keys to successful treatment and good psychological adjustment."
treatment  insulin  diabetes  eating  disorder  self  care  disordered  behavior  food  children  behavioral  intervention  change  management 
december 2008 by Michael.Massing
(ADVANCE) World's Largest Trial of Intensive Glucose Control in Type 2 Diabetes Finds | ADA 68th Scientific Sessions, 2008-06-06
The world's largest diabetes trial has shown intensive blood glucose control in type 2 diabetes reduces the risk of complications--notably a 21% reduction in risk for kidney disease[, with] no evidence of any increased risk of death...."[M]ajor macrovascular events--heart attack, stroke and death from cardiovascular disease--were not significantly reduced with intensive glucose control, although there was a trend towards improvement in these outcomes. [A]ddressing all the major risk factors including blood pressure and blood lipids is required to prevent macrovascular disease," said Anushka Patel...."[I]ntensive control...reduced the combined risk of macrovascular and microvascular complications by 10%...driven largely by the microvascular results...[T]he 14% reduction in microvascular risk was driven mainly by nephropathy rather than retinopathy....We believe a protective effect [against cardiovascular disease] remains plausible..."
treatment  blood  glucose  risk  research  medical  biological  self  care  microvascular  retinopathy  nephropathy  outcomes  intensive  tight  control  management  benefit  late-stage  symptoms  peer-reviewed  mitigation  prevention  complications  behavioral  human  clinical  trial  in  vivo  situ 
december 2008 by Michael.Massing
Diabetes News from dLife.com: Novel Short-Term Weight-Loss Approach Works Long-Term for Type 2 Diabetes
[Besides weight loss and improved] cardiovascular risk factors, Why WAIT participants also saw significant decreases in the amounts of diabetes medications they were taking...Patients saved, on average, $561 per year on their diabetes medications alone and the study projected an annual decrease of total health care costs of about $1,619 per patient... 21% of participants on short-acting insulin were able to stop it completely by the end of the program. Remaining patients on insulin therapy were able to reduce their daily dose of long-acting [and short-acting] insulin by an average of [54-]55%...Almost 2/3 of patients on sulfonylureas were able to stop them while remaining participants reduced their doses by [from 35-]41% “[W]e have been glucose-focused for several decades. It may be the time to switch our efforts to target body weight as the core of the problem,” he said.
blood  glucose  body  fat  diet  exercise  treatment  intensive  theory  self  care  loss  weight  behavior  medical  research  peer-reviewed  behavioral  intervention  change  management 
october 2008 by Michael.Massing
Diabetes News from dLife.com: For Insulin Sensitive Overweight Patients, 1 Session Of Exercise Improves Metabolic Health
Obesity [is] associated with an abnormal fat metabolism in the muscle. [A]ccumulated fat by-products inside the muscle affect insulin resistance. To avoid the build up of fat by-products, fat must either be oxidized (burned, as in exercise) or stored (as benign fat) in muscle....In one session [five obese] women overate and did not exercise; in a follow-on session they overate and did exercise. The researchers found that:
* the body's fat-burning oxidation rate was reduced after one day of overeating;
* conversely, just one session of exercise increased the rate of fat-burning oxidation; and
* exercise increased the amount of fat that would eventually be stored in the muscle.
The findings indicate that even one bout of exercise helps to reduce the fat by-products inside the muscle, which affects the insulin sensitivity[, and] that a single session of exercise "steers" muscle fat towards oxidation, thereby avoiding the accumulation of fat by-products.
activity  outcome  body  fat  exercise  insulin  treatment  self  care  sensitivity  behavior  resistance  T2D  diabetes  type  2  research  peer-reviewed  behavioral  intervention  change  management 
october 2008 by Michael.Massing
Exercise Reduces Fat In Livers of Diabetics: Study
Regular moderate exercise helps people with diabetes to reduce fat in their livers, in turn potentially preventing liver failure and heart disease, said U.S. researchers. People with type 2 diabetes...often have elevated liver fat levels and are at high risk for a condition called nonalcoholic fatty liver disease. Diabetics who did a six-month program of cardiovascular exercise and weight lifting three times a week cut the fat in their livers by about 40% in the study by researchers at Johns Hopkins University in Baltimore. They said the study, which used magnetic resonance imaging scans, is the first to show exercise can get fat out of the livers of people with type 2 diabetes....["Moderate exercise" included] running on a treadmill, using a stair-climbing machine or riding a bicycle for 45 minutes three times a week, along with 20 minutes of lifting weights....[Exercisers] improved their overall fitness, shedding weight, gaining muscle strength and losing abdominal fat.
body  fat  liver  exercise  loss  behavior  self  care  medical  research  peer-reviewed  risk  fatty  metabolic  syndrome  disorder  etiology  T2D  diabetes  correlation  type  2  treatment  activity  behavioral  intervention  change  management  factor 
september 2008 by Michael.Massing
Ten Dollar Pedometer Decreases Blood Pressure and Weight
Use of a pedometer, especially with a daily step goal, is associated with significant increases in physical activity (additional walking of about a mile a day) and decreases in body mass index and blood pressure.
exercise  treatment  blood  pressure  body  fat  behavior  self  care  behavioral  intervention  change  management 
november 2007 by Michael.Massing

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