OBJECTIVEAlthough the benefits of in-person Diabetes Prevention Program (DPP) classes for diabetes prevention have been demonstrated in trials, effectiveness in clinical practice is limited by low participation rates. This study explores whether text message support enhances weight loss in patients offered DPP classes. RESEARCH DESIGN AND METHODSEnglish-and Spanish-speaking patients with prediabetes (n = 163) were randomized to the control group, which only received an invitation to DPP classes as defined by the Centers for Disease Control and Prevention, or to the text messageaugmented intervention group, which also received text messages adapted from the DPP curriculum for 12 months. RESULTSMean weight decreased 0.6 pounds (95% CI 22.7 to 1.6) in the control group and 2.6 pounds (95% CI 25.5 to 0.2) in the intervention group (P value 0.05). Three percent weight loss was achieved by 21.5% of participants in the control group (95% CI 12.5-30.6), compared with 38.5% in the intervention group (95% CI 27.7-49.3) (absolute difference 17.0%; P value 0.02). Mean glycated hemoglobin (HbA 1c ) increased by 0.19% or 2.1 mmol/mol (95% CI 20.1 to 0.5%) and decreased by 0.09% or 1.0 mmol/mol (95% CI 20.2 to 0.0%) in the control group and intervention participants, respectively (absolute difference 0.28%; P value 0.07). Stratification by language demonstrated a significant treatment effect in Spanish speakers but not in English speakers. CONCLUSIONSText message support can lead to clinically significant weight loss in patients with prediabetes. Further study assessing effect by primary language and in an operational setting is warranted.Approximately one-third of Americans have prediabetes, defined by a blood glucose level above the upper limit of normal but below the threshold for the diagnosis of diabetes. Patients with prediabetes are at elevated risk of developing type 2 diabetes, heart attack, and stroke (1), with low-income and Latino patients representing a disproportionate share of those who progress to diabetes (2,3). Moderate weight loss is effective in preventing progression from prediabetes to overt diabetes, with benefits that persist long-term even with partial weight regain (4-6). Intensive behavioral interventions are effective for diabetes prevention (5,7), with a 16% reduction in risk for every kilogram (2.2 pounds) of weight loss (8).

Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Obes Res. 2005;13:703-709. Objective: To determine whether macronutrient composition of a hypocaloric diet can enhance its effectiveness and whether insulin sensitivity (Si) affects the response to hypocaloric diets. Research Methods and Procedures: Obese nondiabetic insulin-sensitive (fasting insulin Ͻ 10 U/mL; n ϭ 12) and obese nondiabetic insulin-resistant (fasting insulin Ͼ 15 U/mL; n ϭ 9) women (23 to 53 years old) were randomized to either a high carbohydrate (CHO) (HC)/low fat (LF) (60% CHO, 20% fat) or low CHO (LC)/high fat (HF) (40% CHO, 40% fat) hypocaloric diet. Primary outcome measures after a 16-week dietary intervention were: changes in body weight (BW), Si, resting metabolic rate, and fasting lipids. Results: Insulin-sensitive women on the HC/LF diet lost 13.5 Ϯ 1.2% (p Ͻ 0.001) of their initial BW, whereas those on the LC/HF diet lost 6.8 Ϯ 1.2% (p Ͻ 0.001; p Ͻ 0.002 between the groups). In contrast, among the insulin-resistant women, those on the LC/HF diet lost 13.4 Ϯ 1.3% (p Ͻ 0.001) of their initial BW as compared with 8.5 Ϯ 1.4% (p Ͻ 0.001) lost by those on the HC/LF diet (p Ͻ 0.04 between two groups). These differences could not be explained by changes in resting metabolic rate, activity, or intake. Overall, changes in Si were associated with the degree of weight loss (r ϭ Ϫ0.57, p Ͻ 0.05). Discussion: The state of Si determines the effectiveness of macronutrient composition of hypocaloric diets in obese women. For maximal benefit, the macronutrient composition of a hypocaloric diet may need to be adjusted to correspond to the state of Si.

There was not an apparent decline in GDR with age or time since menopause per se. However, E2 action on GDR was dependent on time since menopause, such that there was an apparent benefit early (≤ 6 years) compared to harm later (≥ 10 years) in menopause. E2-mediated effects on insulin action may be one mechanism by which HT reduces the incidence of T2D in early postmenopausal women.