Sarit Polsky

Alcohol consumption and diabetes risk in the Diabetes Prevention Program

BACKGROUND Moderate alcohol consumption is associated with a decreased risk of type 2 diabetes in the general population, but little is known about the effects in individuals at high risk of diabetes. OBJECTIVES The objectives were to determine associations between alcohol consumption and diabetes risk factors and whether alcohol consumption was a predictor of incident diabetes in individuals enrolled in the Diabetes Prevention Program (DPP). DESIGN DPP participants (n = 3175) had impaired glucose tolerance (2-h glucose: 7.8-11.1 mmol/L), elevated fasting glucose (5.3-7.0 mmol/L), and a body mass index (in kg/m(2)) > or =24. Participants were randomly assigned to placebo, metformin, or lifestyle modification and were followed for a mean of 3.2 y. Alcohol intake was assessed at baseline and year 1 by using a semiquantitative food-frequency questionnaire. Diabetes was diagnosed by annual oral-glucose-tolerance testing and semiannual fasting plasma glucose measurement. RESULTS Participants who reported higher alcohol consumption tended to be male, older, white, and less obese and to have a higher calorie intake and a higher HDL-cholesterol concentration. Higher alcohol consumption was associated with lower insulin secretion at any level of insulin sensitivity. We found lower incidence rates of diabetes with higher alcohol consumption in the metformin (P < 0.01 for trend) and lifestyle modification (P = 0.02 for trend) groups, which remained significant after adjustment for multiple baseline covariates. No similar association was observed in the placebo group. CONCLUSIONS 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. Moderate daily alcohol intake is associated with lower insulin secretion-an effect that warrants further investigation. This trial was registered at clinicaltrials.gov as NCT00038727.

The influence of herbs and spices on overall liking of reduced fat food.

Most adults consume more fat than is recommended in the Dietary Guidelines for Americans. We examined whether adding herbs and spices to reduced-fat foods would improve their consumer liking. We recruited adults 18-65 years old to taste three lunch conditions: full fat (FF), reduced fat with no added spice (RF), and reduced fat plus spice (RFS). Subjects rated their liking of a meatloaf entrée, vegetable side dish, pasta side dish, and overall meal on a 9-point hedonic Likert scale. Subjects came weekly for 3 weeks to consume meals and were randomized to the condition order. We enrolled 148 subjects who were predominantly female (n = 101, 68%), had a mean age of 35.9 years, and body mass index of 24.4 kg/m2. Subjects reported habitual diets as 36% of total calories from fat (2005 Block Food Frequency Questionnaire). Reducing fat content alone significantly dropped overall liking of the meal compared with FF and RFS conditions (6.29 RF vs. 7.05 FF, P < 0.0001; 6.29 RF vs. 6.98 RFS, P ≤ 0.0001). The RFS overall meal was liked as well as the FF condition. FF and RFS conditions were liked significantly more than RF conditions for each meal item. Liking of FF and RFS meatloaf and vegetables were not significantly different from one another. Pasta FF and RFS conditions were rated significantly differently from each other (7.33 FF vs. 6.61 RFS, P < 0.0001). Adding herbs and spices to reduced fat foods restored liking of the overall meal, meatloaf, and vegetables to that of FF conditions, and significantly improved the liking of RF pasta. Herbs and spices can be a useful tool to improve liking of foods consistent with national guidelines.

Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Gastric Bypass

IMPORTANCE Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (AGB) are 2 of the most commonly performed bariatric procedures worldwide. However, few large, multisite studies have directly compared the benefits and harms of these procedures. OBJECTIVE To compare the effect of laparoscopic RYGB vs AGB on short- and long-term health outcomes. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 7457 individuals 21 years or older who underwent laparoscopic bariatric surgery from January 1, 2005, through December 31, 2009, with follow-up through December 31, 2010. All individuals were participants in the Scalable Partnering Network, a network of 10 demographically and geographically distributed health care systems in the United States. MAIN OUTCOMES AND MEASURES The primary outcomes were (1) change in body mass index (BMI), (2) a composite end point of 30-day rate of major adverse outcomes (death, venous thromboembolism, subsequent intervention, and failure to discharge from the hospital), (3) subsequent hospitalization, and (4) subsequent intervention. RESULTS We identified 7457 patients who underwent laparoscopic AGB or RYGB procedures with a median follow-up time of 2.3 years (maximum, 6 years). The mean maximum BMI (calculated as weight in kilograms divided by height in meters squared) loss was 8.0 (95% CI, 7.8-8.3) for AGB patients and 14.8 (95% CI, 14.6-14.9) for RYGB patients (P < .001). In propensity score-adjusted models, the hazard ratio for AGB vs RYGB patients experiencing any 30-day major adverse event was 0.46 (95% CI, 0.27-0.80; P = .006). The hazard ratios comparing AGB vs RYGB patients experiencing subsequent intervention and hospitalization were 3.31 (95% CI, 2.65-4.14; P < .001) and 0.73 (95% CI, 0.61-0.88; P < .001), respectively. CONCLUSIONS AND RELEVANCE In this large bariatric cohort from 10 health care systems, we found that RYGB resulted in much greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalizations. On the other hand, RYGB patients had a lower risk of long-term subsequent intervention procedures than AGB patients. Bariatric surgery candidates should be well informed of these benefits and risks when they make their decisions about treatment.

Incident hyperglycaemia among older adults with or at-risk for HIV infection

BACKGROUND HIV infection has been associated with development of prediabetes and diabetes. Optimum screening practices for these disorders in HIV-infected populations remain unclear. METHODS We screened 377 adults, with or at-risk for HIV infection, for incident hyperglycaemia (prediabetes or diabetes) using two oral glucose tolerance tests (OGTTs) a median of 18.6 months apart. We determined proportion of incident cases detected by fasting and 120-min plasma glucose levels. Independent predictors of incident hyperglycaemia were identified using logistic regression. RESULTS The baseline OGTT was consistent with diabetes in 7% of participants and with prediabetes in 31%. Among 352 normoglycaemic and prediabetic participants at baseline, 19 (5%) developed diabetes on follow-up. Among participants normoglycaemic at baseline, an additional 38 (16%) developed prediabetes. Overall 52% of incident hyperglycaemia cases were detected by fasting plasma glucose alone, 33% by a 120-min glucose level alone and 15% by both. Factors independently associated with incident hyperglycaemia included age ≥50 years and body mass index ≥30 kg/m(2). Neither HIV infection nor highly active antiretroviral therapy (HAART) use were associated with increased risk of diabetes. CONCLUSIONS Incident hyperglycaemia is common among older adults with or at-risk for HIV infection. HIV-infected individuals with classic diabetes risk factors should be screened for hyperglycaemia regardless of HAART use. OGTTs might be the preferred screening strategy in HIV-infected individuals at high risk for developing hyperglycaemia.

Using technology to advance type 1 diabetes care among women during the reproductive years and in pregnancy

ABSTRACT The prevalence of diabetes is increasing globally. Technology to improve care among individuals with diabetes is constantly being developed. Women living with Type 1 Diabetes Mellitus (T1DM) have unique challenges affecting their glucose control relating to menstrual cycles, pregnancy, and menopause. The purpose of this review is to examine the literature related to the use of technology to help women with T1DM manage their diabetes during the reproductive years, pregnancy, and beyond. Continuous subcutaneous insulin infusion (CSII) therapy can provider equivalent or better glucose control when compared with multiple daily injections (MDI), with less hypoglycemia, diabetic ketoacidosis, and weight gain. The CSII therapy has features that could help improve glucose control over the menstrual cycle, menopause, and pregnancy, although the most studied of these stages is pregnancy. Continuous glucose monitoring (CGM) can be combined with any insulin delivery system (MDI or CSII) to provide data on glucose values every few minutes and show glucose trends over time. CGM introduction can highlight glucose variability for women with T1DM, may be beneficial during pregnancy, and can reduce hypoglycemia. Sensor-augmented pump therapy and hybrid artificial pancreas (closed-loop) systems are promising tools that improve outcomes among individuals with diabetes. The use of modern technology to improve glucose and metabolic control among menopausal women with diabetes has not been well studied. Internet and phone-based technologies are emerging as important tools that may help with diabetes self-care for women living with diabetes.

Innovative Care Delivery Model to Address Obesity in Older African-American Women: Senior Wellness Initiative and Take Off Pounds Sensibly Collaboration for Health (SWITCH)

To determine the feasibility and acceptability of integrating Take Off Pounds Sensibly (TOPS), a national nonprofit weight‐loss program through which people have lost a clinically significant amount of weight, into a community program that serves African Americans (AAs) and to determine weight change.

Biomarker Profile Does Not Predict Weight Loss Success in Successful and Unsuccessful Diet-Reduced Obese Individuals: a Prospective Study.

Background. Individuals attempting weight reduction have varying success when participating in the same intervention. Identifying physiological factors associated with greater weight loss could improve outcomes. Methods. Sixty-one adults (BMI 27–30 kg/m2) participated in a 16-week group-based, cognitive-behavioral control weight loss program. Concentrations of 12 fasting hormones and cytokines related to adiposity, satiety/hunger, and inflammation were measured using the Milliplex human metabolic human panel before and after weight loss. Participants were grouped based on ≥8% (successful group, SG) or <8% weight loss (less successful group, LSG). Results. The SG had 46 subjects (75.4%), while the LSG had 15 (24.6%). There were no differences in baseline sex distribution, age, weight, BMI, and body composition between groups. In the SG, baseline to the 16-week levels decreased significantly for c-peptide (1,030 versus 891 pg/mL, P = 0.002), insulin (665 versus 541 pg/mL, P = 0.001), and leptin (0.83 versus 0.58 ng/mL/kg fat, P < 0.001). None of the baseline analytes predicted greater weight loss. Conclusions. Successful weight loss was associated with changes in adiposity (less fat mass) and unfavorable hunger signals. No baseline biomarker profile was associated with weight loss success. Behavioral factors may have outweighed physiological signals for determining successful weight loss. This trial is registered with Clinicaltrials.gov NCT00429650.

Continuous glucose monitoring in pregnant women with type 1 diabetes

 Type 1 diabetes (due to autoimmune beta-cell destruction, usually leading to absolute insulin deficiency)  Type 2 diabetes (due to a progressive loss of beta-cell insulin secretion frequently on the background of insulin resistance)  Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation)  Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young), diseases of the exocrine pancreas (such as cystic fibrosis and pancreatitis), and drugor chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation) (EUnetHTA 2018).

Alcohol Consumption, Diabetes Risk, and Cardiovascular Disease Within Diabetes

Purpose of ReviewThe purpose of the study is to examine and summarize studies reporting on the epidemiology, the risk of developing diabetes, and the cardiovascular effects on individuals with diabetes of different levels of alcohol consumption.Recent FindingsMen consume more alcohol than women in populations with and without diabetes. Light-to-moderate alcohol consumption decreases the incidence of diabetes in the majority of the studies, whereas heavy drinkers and binge drinkers are at increased risk for diabetes. Among people with diabetes, light-to-moderate alcohol consumption reduces risks of cardiovascular diseases and all-cause mortality.SummaryAlcohol consumption is less common among populations with diabetes compared to the general population. Moderate alcohol consumption reduces the risk of diabetes and, as in the general population, improves cardiovascular health in patients with diabetes. Type of alcoholic beverage, gender, and body mass index are factors that affect these outcomes.

The Influence of Herbs, Spices, and Regular Sausage and Chicken Consumption on Liking of Reduced Fat Breakfast and Lunch Items

UNLABELLED Adults often consume more fat than is recommended. We examined factors that may improve liking of reduced fat and reduced saturated fat foods, including the addition of herbs and spices and habitual consumption of different high-fat and low-fat food items. We randomized adults to taste 3 different conditions: full fat (FF), reduced fat with no added spice (RF), and reduced fat plus spice (RFS). Subjects rated their liking of French toast, sausage and the overall meal, or chicken, vegetables, pasta, and the overall meal on a 9-point hedonic Likert scale. Overall liking of the RF breakfast and lunch meals were lower than the FF and RFS versions (breakfast: 6.50 RF compared with 6.84 FF, P = 0.0061; 6.50 RF compared with 6.82 RFS, P = 0.0030; lunch: 6.35 RF compared with 6.94 FF, P < 0.0001; 6.35 RF compared with 6.71 RFS, P = 0.0061). RFS and FF breakfast and lunch meals, French toast, chicken, and vegetable likings were similar. FF and RFS conditions were liked more than RF for the breakfast and lunch meals, French toast, chicken entrée, and vegetables. Liking of all 3 sausage conditions was similar. FF pasta was liked more than RFS and RF (7.47 FF compared with 6.42 RFS, P < 0.0001; 7.47 FF compared with 6.47 RF, P < 0.0001). Habitual consumption of roasted chicken was associated with reduced liking of FF chicken (r = -0.23, P = 0.004) and FF pasta (r = -0.23, P = 0.005). Herbs and spices may be useful for improving the liking of lower fat foods and helping Americans maintain a diet consistent with the U.S. Dietary Guidelines. PRACTICAL APPLICATION Americans consume more fat than is recommended in the Dietary Guidelines for Americans. This study shows that you can take foods like French toast, chicken, or a vegetable side and cut the fat and calories by up to 50% while restoring flavor with herbs and spices. People typically use butter, cheese, or fatty meat to enhance the flavor of their food. We found that even when we reduced the fat in our meals by using lower fat dairy and meat products but then added herbs and spices, we were able to deliver the flavor people desire for a fraction of the calories.