Long-term Effects of Modest Weight Loss in Type II Diabetic Patients

Wing, Rena R.; Koeske, Randi; Epstein, Leonard H.; Nowalk, Mary Patricia; Gooding, William E.; Becker, Dorothy

doi:10.1001/archinte.1987.00370100063012

Cited by 402 publications

(168 citation statements)

References 20 publications

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“…A within-patient analysis detected clinically meaningful (Kilpatrick, Rigby, & Atkin, 2008;Wing et al, 1987) and statistically significant improvement in A1C across all patients that completed blood glucose testing at baseline and at 6 months, see Table 4. Additionally, this within-patient clinical improvement of A1C and body mass index (BMI) was also detected within one PCMH (Harold Hamm Diabetes Center [HHDC]).…”

Section: Researchmentioning

confidence: 99%

Measuring the Implementation and Effects of a Coordinated Care Model Featuring Diabetes Self-management Education Within Four Patient-Centered Medical Homes

et al. 2015

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Minority individuals experience a disproportionately greater incidence and prevalence of type 2 diabetes. Innovative approaches are needed to reduce health disparities and associated harms among vulnerable populations with diabetes. This thesis examines the effects of the implementation of a coordinated care model with underserved populations in Patient Centered Medical Homes (PCMH) at four sites (Florida, Ohio, Oklahoma, and Tennessee). The model featured diabetes self-management education (DSME) and a patient support intervention delivered within the PCMH context. The components of the comprehensive intervention included DSME, support for managing diabetes and distress, enhanced access and linkage to care, and improvement to quality of care. The primary dependent measures in this study included four clinical health measures-glycosylated hemoglobin (A1C), blood pressure, body mass index, and lipids-and the AADE7 Self-Care Behaviors TM . Coordinated care teams that delivered the intervention included primary care physicians, nurse care coordinators, certified diabetes educators, health behavior coaches, and diabetes patient supporters. Community health workers and medical assistants provided additional individualized support to patients. Care teams provided DSME as well as customized and coordinated patient support within a PCMH setting.This study was part of a larger participatory evaluation of the Bristol-Myers Squibb Foundation's Together on Diabetes initiative. A statistically significant decrease was seen in A1C, the primary clinical health outcome. This decrease was seen across all four implementation sites; ranging from a decrease of 0.4% to 0.9% after 6 months. This improved A1C level was associated with implementation of the DSME and support intervention. Substantial policy and practice changes were also brought about at two of the four PCMH sites. Use of DSME within the PCMH model is a promising strategy for reducing clinical markers for diabetes among vulnerable populations.iv Systems changes, including policy and practice changes, have the potential to have lasting effects within PCMH practice for reducing the burden of diabetes.

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Section: Researchmentioning

confidence: 99%

Measuring the Implementation and Effects of a Coordinated Care Model Featuring Diabetes Self-management Education Within Four Patient-Centered Medical Homes

et al. 2015

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“…After transport in the sarcoplasm by FABP, and before oxidation, long-chain fatty acids must be activated to long-chain acyl-CoA, then translocated into mitochondria by the enzyme complex, carnitine palmityl transferase (CPT I and CPT II). Activity of CPT I is regarded as a key step in the regulation of fatty acid oxidation within muscle [54]. The muscle isoform of CPT I is sensitive to allosteric inhibition by malonyl CoA, the precursor of fatty acid synthesis [40].…”

Section: Mechanisms Of Skeletal Muscle Triglyceride Accumulation In Tmentioning

confidence: 99%

“…In overweight patients with type 2 diabetes, weight loss can reduce hepatic glucose production [49], improve insulin resistance [50,51], and improve glycemic control [50][51][52]. Weight loss in type 2 diabetes is also associated with a reduction in blood pressure and improvement in the lipid profile [53,54]. The effects of weight loss on patterns of muscle fatty acid metabolism and the accumulation of lipid within muscle, however, are less well-known.…”

Section: Effect Of Weight Loss On Skeletal Muscle Lipid Metabolismmentioning

confidence: 99%

Skeletal muscle triglyceride: Marker or mediator of obesity-induced insulin resistance in type 2 diabetes mellitus?

Goodpaster

Kelley²

2002

Curr Diab Rep

109

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The inability of insulin to stimulate glucose metabolism in skeletal muscle is a classic characteristic of type 2 diabetes, but this insulin resistance entails altered patterns of lipid metabolism as well. An association between intracellular triglyceride and insulin resistance has been well established in both human and animal studies of obesity-related insulin resistance and type 2 diabetes. Skeletal muscle's ability to select substrate for fuel metabolism, a metabolic flexibility, is also lost in insulin resistance, and defects in fatty acid metabolism during fasting or postabsorptive conditions likely play an important role in lipid oversupply to insulin-resistant muscle. These impairments appear to be at least indirectly centered on the ability of mitochondria to oxidize fatty acids, possibly through mediation of lipid metabolite levels such as ceramide or diacylglycerol, which are known to directly attenuate insulin signaling. Moreover, periodic use of muscle triglyceride by exercise may mediate the association between muscle triglyceride and insulin resistance. Thus, it appears that skeletal muscle triglyceride is perhaps a surrogate for other lipid species having a more direct effect on insulin action. Defining mechanisms by which dysregulation of fatty acid metabolism and persistent lipid oversupply alter insulin action may help to target more effective strategies to prevent or treat type 2 diabetes.

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“…The progression of obesity and its comorbidities may be explained by the eVects of lower adiponectin expression in adipose tissue of obese individuals on hormone-sensitive lipase activity and fatty acid oxidation (Bullo et al 2005). With weight loss, circulating adiponectin concentrations typically increase (Shapses and Riedt 2006;Wolfe et al 2004) while insulin sensitivity improves (Wing et al 1987;Hara et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Influences of a dietary supplement in combination with an exercise and diet regimen on adipocytokines and adiposity in women who are overweight

et al. 2008

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The influence of a proprietary blend of modified cellulose and cetylated fatty acids (Trisynextrade mark, Imagenetix, Inc., San Diego, CA 92127, USA) on adipocytokine and regional body composition responses to a weight loss program was examined. Twenty-two women (Supplement group (S) (n = 11): age = 36.8 +/- 7.2 years; weight = 87.1 +/- 6.2 kg; % body fat = 43.4 +/- 4.1; Placebo group (P) (n = 11): age = 38.3 +/- 6.8 years; weight = 86.9 +/- 4.7 kg; % body fat = 44.3 +/- 2.0) completed an 8-week placebo-controlled, double-blind study consisting of a caloric restricted diet and cardiovascular exercise. Body composition and serum insulin, leptin, and adiponectin were assessed at pre-, mid-, and post-intervention. From pre- to post-intervention, significant decreases (P < 0.05) were observed for body weight (S: 87.1 +/- 6.2-77.9 +/- 5.1 kg; P: 86.9 +/- 4.7-82.7 +/- 3.8 kg) (P < 0.05 S vs. P), % body fat (S: 43.4 +/- 4.1-36.1 +/- 3.6; P: 44.3 +/- 2.0-40.6 +/- 1.2) (P < 0.05 S vs. P), leptin (S: 28.3 +/- 3.5-16.2 +/- 2.6 ng ml(-1); P: 29.4 +/- 3.2-19.9 +/- 1.1 ng ml(-1)) (P < 0.05 S vs. P), and insulin (S: 7.3 +/- 0.8-5.1 +/- 0.2 mU l(-1); P: 7.7 +/- 0.9-5.1 +/- 0.3 mU l(-1)). Serum adiponectin increased (P < 0.05) (S: 12.2 +/- 2.4-26.3 +/- 3.0 microg ml(-1): 12.6 +/- 2.0-21.8 +/- 3.1 microg ml(-1)) (P < 0.05 for S vs. P). Supplementation with a proprietary blend of modified cellulose and cetylated fatty acids during an 8-week weight loss program exhibited favorable effects on adipocytokines and regional body composition.

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Long-term Effects of Modest Weight Loss in Type II Diabetic Patients

Cited by 402 publications

References 20 publications

Measuring the Implementation and Effects of a Coordinated Care Model Featuring Diabetes Self-management Education Within Four Patient-Centered Medical Homes

Measuring the Implementation and Effects of a Coordinated Care Model Featuring Diabetes Self-management Education Within Four Patient-Centered Medical Homes

Skeletal muscle triglyceride: Marker or mediator of obesity-induced insulin resistance in type 2 diabetes mellitus?

Influences of a dietary supplement in combination with an exercise and diet regimen on adipocytokines and adiposity in women who are overweight

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