Mediterranean Diet Linked With Weight & Blood Pressure Benefits

Prior research indicates that adherence to a Mediterranean (Med) diet pattern, and decreased intake of red/processed meats, refined grains, starches, and added sugars, is associated with re- duced cardiometabolic risk independent of to- tal calorie intake or single nutrients. Researchers who sought to explore whether adherence to a Med diet was associated with risk factor change in the context of a behavioral weight manage- ment trial for US community-dwelling older adults who were at elevated diabetes and cardio- vascular risk examined the impact of 12 weekly group lifestyle sessions on weight and cardio- metabolic risk (BMI, waist circumference, glucose, lipids, and blood pressure) in adults aged 65-80. They observed that median inter- quartile range score improved at 4 months, with 27% low, 63% moderate, and 10% high. Each one-unit Med diet increase was associated with a 0.1 kg/m2 decrease in BMI and a decrease of 1.0 mmHg for systolic blood pressure at 4 months. Women were more adherent than men, the researchers found, and adjusting for sex, higher scores were correlated with older age, lower baseline BMI, and smaller waist. Improve- ments due to Med diet adherence were main- tained at 12 and 24 months.

Diabetes Self-Management Education Linked With Positive Self-Care Practices

Previous studies have shown that diabetes self-management education and support services empower people with diabetes to follow pre- ventive care practices that reduce disease com- plications. Investigators who aimed to describe self-reported receipt of diabetes education and its association with following recommended self-care and clinical preventive care practices analyzed data from the 2017 Behavioral Risk Factor Surveillance System for 42,631 adults (aged 18 or older) with self-reported diabetes. The study team assessed four self-care practices (daily glucose testing, daily foot checks, smoking abstention, and regular physical activity), and six clinical practices (pneumococcal vaccination, biannual A1C test, an annual dilated eye exam, influenza vaccination, healthcare visit for diabetes, and foot exam). Of adults with diabetes, 52.3% reported receiving diabetes education; those who did had a higher predicted probability for three of four self-care practices (daily glucose testing, daily foot check, and regular physical activity) and all six clinical practices (pneumo- nia vaccination, biannual A1C test, annual eye exam, flu vaccination, healthcare visit, and med- ical foot exam). Diabetes education was posi- tively associated with following preventive care practices.

Lifestyle Intervention Effective in Managing FPG in Normal Weight Adults With Prediabetes

Researchers hypothesized that US adults with prediabetes and normal BMI develop diabetes through different pathophysiological mechanisms than those with high BMIs and that, therefore, methods of prevention may differ in the absence of overweight/obesity. They compared the effect of technology-enabled lifestyle health coaching (LHC) on fasting plasma glucose (FPG) in normal weight, overweight, and obese adults with prediabetes who completed a baseline and follow-up evaluation as part of an LHC program. The program included one-on-one behaviorally oriented coaching, predominately via the tele- phone and Internet, on exercise, nutrition, and weight management. The study team observed that BMI decreased significantly in overweight and obese participants but was unchanged in normal-weight participants. In contrast, weekly aerobic exercise increased and FPG decreased significantly in all three groups. FPG was reduced to less than 100 mg/dl in 62.4%, 51.7%, and 43.6% of the normal weight, overweight, and obese participants, respectively. The researchers concluded that LHC is at least as effective in managing fasting plasma glucose (FPG) in normal weight adults with prediabetes as it is in overweight/obese adults with prediabetes.

Long-Term Carbohydrate Restriction Proves Beneficial in Adults With T2D

Carbohydrate restriction (CR) confers greater benefit on health outcomes for adults with T2D if done more frequently throughout 1 year. For a study that examined the extent to which on- going CR is needed to sustain health improve- ment, adults with T2D counseling on CR reported adherence measures by blood beta- hydroxybutyrate (BHB) regularly via a mobile app. Patients enrolled 1 year with a mean BHB greater than 0.3 mM in the first 3 months were split into quartiles based on the percent of BHB logs greater or equal to 0.3 and 0.5 mM during months 4-12. The study team conducted anal- yses of variance to compare the groups’ percent change in weight and A1C from baseline to 1 year. They found that all groups had clinically sig- nificant improvements on average in weight and A1C, but the percent change statistically differed by group. Participants who reported CR more often experienced greater benefit at 1 year. Using a 0.3 mM BHB cutoff and a very consistent re- striction (≥ 95% of the time) yielded significantly greater benefit. A 0.5 mM cutoff demonstrated greater benefit with lower frequencies of reporting (≥ 38% for weight and ≥ 66% for A1C).

Medications Most Effective at Regulating Glucose in Prediabetes

For a meta-analysis, researchers compared the ef- fect of different non-surgical diabetes prevention strategies on regression to normoglycemia among people with prediabetes. They systematically searched medical literature for articles published between January 1, 2000 and May 30, 2017 that included randomized controlled trials test- ing nonsurgical interventions to prevent diabetes or improve glucose tolerance in adults with pre- diabetes, lasting at least 3 months, and reporting regression to normoglycemia rates. Fifty-one studies (25,440 participants, mean age 54, 46% male) were included; of these, 30 study arms test- ed lifestyle modification (LSM), 15 tested medi- cations (60% glucose sensitizers), and eight test- ed supplements plus LSM. Compared with con- trol arms (n = 29) at a mean 1.6 years of follow- up, medications achieved the largest regression rates, followed by LSM, medications plus LSM, and supplements. The study team concluded that medications, particularly glucose sensitizers, are the most effective treatments for restoring nor- mal glucose regulation in adults with prediabetes. They also found that LSM is effective both alone and in combination with medications.