Sedentary obesity is associated with increased risk of many cardio-metabolic diseases, including type 2 diabetes. Weight loss is therefore a desirable goal for sedentary adults with obesity. Weight loss is also a well-documented side effect of sodium glucose co-transporter 2 (SGLT2) inhibition, a pharmaceutical strategy for diabetes treatment. We hypothesized that, compared with placebo, SGLT2 inhibition as an adjunct to out-patient dietary counselling for weight loss would lead to more favorable modification of body mass and composition, and greater improvement in glucose regulation and lipid profile. Using a randomized, double-blind, repeated measures parallel design, 50 sedentary men and women (body mass index: 33.4 ± 4.7 kg/m2; mean ± SD) were assigned to 12 weeks of dietary counselling, supplemented with daily ingestion of either a placebo or SGLT2 inhibitor (dapagliflozin: up to 10 mg/day). Dietary counselling favorably modified body mass, body fat, glucose regulation, and fasting concentrations of triglyceride and very low-density lipoprotein cholesterol (main effects of counselling: p < 0.05); SGLT2 inhibition did not influence any of these adaptations (counselling × medication interactions: p > 0.05). However, SGLT2 inhibition when combined with dietary counselling led to greater loss of fat-free mass (counselling × medication interaction: p = 0.047) and attenuated the rise in high-density lipoprotein cholesterol (counselling × medication interaction: p = 0.028). In light of these data and the health implications of decreased fat-free mass, we recommend careful consideration before implementing SGLT2 inhibition as an adjunct to dietary counselling for weight loss in sedentary adults with obesity.

Kalron et al. report people with Multiple Sclerosis (PwMS) who fall show a decreased cerebellar volume along with decreased overall cognition compared to non-fallers. While this paper focuses on cerebellar and cognitive alterations in PwMS, these findings may also be explained by additional factors such as aging and have the potential for broader impact in additional clinical populations who simultaneously experience cognitive and mobility dysfunction.

A discussion of the factors which influence competence is presented including variations in situation, task and degree of risk. A critical analysis of four standards of competence is presented, leading to a discussion of the standards which can most successfully promote self-determination in elderly patients. Finally, three classes of competence are suggested which extend the criteria of competence to patients to cognitive deficits.

No abstract

New Findings What is the central question of this study?Low dose carbon monoxide (CO) inhalation plays a role in regulating proteins involved in glucose metabolism; does low dose CO improve glucose and insulin responses to an oral glucose tolerance test in overweight adults? What is the main finding and its importance?Five days of intermittent CO inhalation does not alter the glucose or insulin responses to ingestion of a glucose bolus in overweight adults. Low dose CO is utilized in various physiological assessment procedures; these findings allow researchers and clinicians to utilize these procedures without concern of altering glucose metabolism. Abstract Low dose carbon monoxide (CO) inhalation upregulates several proteins important for glucose metabolism. Such changes could be clinically significant and may be relevant to those who use CO as a research tool. We hypothesized that low dose CO inhalation would improve glucose and insulin responses to an oral glucose bolus in overweight humans. Eleven young adults (5 men, 6 women; body mass index: 25–35 kg m−2) were included in this randomized, placebo‐controlled, single‐blinded crossover study. Following screening, participants completed two 7‐day protocols with a 4‐week washout. Twenty‐four hours prior to and following five consecutive days of either once daily CO (men: 1.2 ml (kg body mass)−1; women: 1.0 ml (kg body mass)−1) or placebo (room air) inhalation, participants underwent oral glucose tolerance tests (OGTT). For key outcome variables, there were no significant main effects or interactions across condition or time point (mean ± SD), including fasting glucose (mg dl−1: pre‐placebo: 85.2 ± 10.1; post‐placebo: 82.9 ± 10.6; pre‐CO: 83.6 ± 7.7; post‐CO: 84.0 ± 9.0), 2 h post glucose (mg dl−1: pre‐placebo: 100.9 ± 20.0; post‐placebo: 98.7 ± 13.1; pre‐CO: 94.2 ± 23.2; post‐CO: 94.4 ± 14.9), or the Matsuda index (pre‐placebo: 16.1 ± 11.5; post‐placebo: 20.3 ± 24.7; pre‐CO: 15.6 ± 15.3; post‐CO: 17.5 ± 16.8). In conclusion, 5 days of low dose CO administration did not influence glucose and insulin responses to an OGTT in overweight adults. Low dose CO inhalation is utilized in a variety of physiological assessment procedures; these findings allow researchers to utilize these procedures without concern of altering glucose metabolism.