The Influence of Yoga-Based Programs on Risk Profiles in Adults with Type 2 Diabetes Mellitus: A Systematic Review Group Visits for Hmong Adults with Type 2 Diabetes Mellitus: A Pre-Post Analysis Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic review The effectiveness of group medical visits on diabetes mellitus type 2 (dm2) specific outcomes in adults: a systematic review Management of type 2 diabetes in Western Australian metropolitan general practice. Management of Depression in Patients With Cancer: A Clinical Practice Guideline. Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country Overview of Systematic Reviews: Yoga as a Therapeutic Intervention for Adults with Acute and Chronic Health Conditions A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial Community-based care for the management of type 2 diabetes: an evidence-based analysis. Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus Yoga and Mindfulness as Therapeutic Interventions for Stroke Rehabilitation: A Systematic Review Rating the strength of scientific evidence: relevance for quality improvement programs. Lack of effects of pioglitazone on cardiac function in patients with type 2 diabetes and evidence of left ventricular diastolic dysfunction: a tissue doppler imaging study Yoga on Our Minds: A Systematic Review of Yoga for Neuropsychiatric Disorders Completion report: Effect of Comprehensive Yogic Breathing program on type 2 diabetes: A randomized control trial A Smart Web Aid for Preventing Diabetes in Rural China: Preliminary Findings and Lessons A simple clinical score for type 2 diabetes mellitus screening in the Canary Islands. Decrease in blood pressure, body mass index and glycemia after aerobic training in elderly women with type 2 diabetes. Effects of meal preparation training on body weight, glycemia, and blood pressure: results of a phase 2 trial in type 2 diabetes Dairy Products and Prevention of Type 2 Diabetes: Implications for Research and Practice Comprehensive yogic breathing program improves quality of life in patients with diabetes
There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus ( DM 2 ) . However , systematic review s are lacking . This article critically review s the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2 . We performed a comprehensive literature search using four computerized English and Indian scientific data bases . The search was restricted to original studies ( 1970–2006 ) that evaluated the metabolic and clinical effects of  yoga in adults with DM 2 . Studies targeting clinical population s with cardiovascular disorders that included adults with comorbid DM were also evaluated . Data were extracted regarding study design , setting , target population , intervention , comparison group or condition , outcome assessment , data analysis and presentation , follow-up , and key results , and the quality of each study was evaluated according to specific predetermined criteria . We identified 25 eligible studies , including 15 uncontrolled trials , 6 non-r and omized controlled trials and 4 r and omized controlled trials ( RCTs ) . Overall , these studies suggest beneficial changes in several risk indices , including glucose tolerance and insulin sensitivity , lipid profiles , anthropometric characteristics , blood pressure , oxidative stress , coagulation profiles , sympathetic activation and pulmonary function , as well as improvement in specific clinical outcomes .  Yoga may improve risk profiles in adults with DM 2 , and may have promise for the prevention and management of cardiovascular complications in this population . However , the limitations characterizing most studies preclude drawing firm conclusions . Additional high- quality RCTs are needed to confirm and further eluci date the effects of st and ardized yoga programs in population s with DM 2 Hmong refugees with type 2 diabetes mellitus ( DM2 ) have poor glycemic control . For Hmong adults with DM2 , group visits were instituted at a community health center and evaluated for their influence on diabetes management . Pre- and postintervention measures of physical health , mental health , and behavior were collected on 39 participants ( 64 % participation rate ) . Baseline characteristics and clinical outcomes of 39 group visit participants were compared with 22 Hmong DM2 adults who refused to participate and 216 nonparticipating Hmong DM2 adults from a local diabetes registry . Baseline characteristics were similar among the three groups . Although participants received good medical services and their mental health improved ( p < 0.05 ) , clinical outcomes did not significantly improve . Although group visits are feasible for providing medical services for Hmong adults with DM2 , clinical outcomes remain outside of recommended targets . Addressing mental health in this population may be necessary before people can institute behavioral changes that improve diabetes management The effect of practicing yoga for the management of type II Diabetes  was assessed in this systematic review through search ing related electronic data bases and the grey literature to the end of May 2007 using Ovid . All r and omized controlled clinical trials ( RCTs ) comparing yoga practice with other type of intervention or with regular practice or both , were included regardless of language or type of publication . Each study was assessed for quality by two independent review ers . Mean difference was used for summarizing the effect of each study outcomes with 95 % confidence intervals . Pooling of the studies did not take place due to the wide clinical variation between the studies . Publication bias was assessed by statistical methods . Five trials with 363 participants met the inclusion criteria with medium to high risk of bias and different intervention characteristics . The studies ’ results show improvement in outcomes among patients with diabetes type II .  These improvements were mainly among short term or immediate diabetes outcomes and not all were statistically significant . The results were inconclusive and not significant for the long-term outcomes . No adverse effects were reported in any of the included studies . Short-term benefits for patients with diabetes  may be achieved from practicing yoga . Further research is needed in this area . Factors like quality of the trials and other method ological issues should be improved by large r and omized control trials with allocation concealment to assess the effectiveness of yoga on diabetes type II . A definitive recommendation for physicians to encourage their patients to practice yoga can not be reached at present Background The prevalence of diabetes mellitus is ubiquitous . Complications and costs of diabetes are rising and are depleting limited re sources . It is imperative for healthcare professionals and patients alike to confront this chronic condition by exploring new interventions . An innovative health care delivery model has emerged in the last 25 years in the form of the group medical visit . Group medical visits can range from of six to twenty patients scheduled together with time allotted for individual care as well as in the group setting . Objectives The review objective was to conduct a systematic review and meta‐ analysis to synthesize the best available evidence related to effectiveness of group medical visits on HbA1c , blood pressure and cholesterol measurements /levels for adult patients with type II diabetes in outpatient setting s. Search strategy A three‐step literature search for studies in English language from 1990 to 2010 was conducted utilising ( a ) a primary search of Medline , CINAHL , PsycINFO and Cochrane Central Register of Controlled Trials , ( b ) a secondary search of non‐indexed data bases , and ( c ) a search of the grey literature . In addition , a manual review of the reference lists of all identified reports and articles was performed to identify additional studies . Inclusion criteria All r and omised and quasi‐experimental studies of adult patients ( > 18 ) with type II diabetes mellitus seen in outpatient health setting s were considered if they met one or more of the following diagnostic outcome measurements : haemoglobin A1c , systolic and diastolic blood pressure , and low density lipoprotein cholesterol . Critical appraisal , data collection and analysis Each of the eligible articles was review ed by two independent review ers . Disagreements between the review ers were resolved through discussion , or with a third review er . Studies that met the inclusion criteria were assessed for method ological quality using the JBI st and ardized critical appraisal tools . Data extraction was undertaken using the st and ardised data extraction tool from JBI‐MAStARI . Main results The search strategy identified 2,040 articles in the published and unpublished literature . Of these , 11 r and omised controlled trials and 4 quasi‐experimental trials met the inclusion criteria and represented 2240 patients included in the final review . There are clear benefits of group medical visits for patients ' HbA1c levels which are consistent in the post‐intervention and change from baseline effect sizes . The most significant effect observed is with the change from baseline results . Some evidence suggests post‐intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe . There is no evidence that group visits improve LDL cholesterol values of the group visit participants . Conclusions Group medical visits should be considered by clinicians as an effective non‐pharmacologic intervention that can have a positive impact on biologic markers such as haemoglobin A1c and systolic blood pressure . Implication s for practice The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs . Implication s for research Future research should include this GMV intervention in r and omised controlled trials across different health systems and socio‐economic and ethnic groups The purpose of this study was : ( 1 ) to record GP opinions , practice s and outcomes for the care of Type 2 Diabetes Mellitus ( DM2 ) , ( 2 ) compare practice facilities and process of care with a criterion of recommended competent care and ( 3 ) determine if there were any differences between vocationally registered and non-vocationally registered GPs . A r and om sample of 204 metropolitan doctors from 124 practice s was selected and an audit performed on 467 of their patient records . GPs pursued good blood sugar control and advocated lifestyle changes before hypoglycaemic drugs . Over 80 % regard uncomplicated DM2 as a condition for general practice management . However , only 15 % conducted an annual diabetes check , 9 % had a diabetic register , 6 % a diabetic recall system and 8 % used a diabetic health care checklist for monitoring their patients . The most commonly recorded processes of medical audit in the previous 12 months were : blood pressure ( 94 % ) , duration of diabetes ( 72 % ) , blood glucose ( 70 % ) , diet ( 66 % ) , body weight ( 56 % ) , HBA1c ( 52 % ) and ophthalmoscopy ( 50 % ) . The least commonly recorded processes of care were body mass index ( 5 % ) , inspection of the feet ( 18 % ) , enquiries about vaginitis or impotence ( 23 % ) . The amount of exercise , alcohol and tobacco was recorded in only 34 % of records . Hypoglycaemic drugs were used appropriately but the most commonly used drugs for treating hypertension in DM2 patients were thiazide diuretics and beta-blockers .  Vocationally registered ( VR ) doctors had better records , higher process of care scores and more were willing to participate in the study than non-vocationally registered ( NVR ) doctors . However , there was no difference in metabolic control between patients from either group . The use of a Diabetic Health Care Checklist would improve diabetes care especially in the search for early complications and in the recording of HBA1c and other metabolic parameters . The drugs commonly used to control hypertension can have adverse effects on glucose and lipid metabolism and should be replaced with glucose and lipid neutral drugs PURPOSE This report up date s the Cancer Care Ontario Program in Evidence -Based Care guideline for the management of  depression in adult patients with cancer . This guideline covers pharmacologic , psychological , and collaborative care interventions , with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer . METHODS Recommendations were developed by synthesizing information from extant guidelines and review s and search ing for r and omized controlled trials from the date of data base inception ( 1964 for MEDLINE and 1974 for EMBASE ) to January 2015 . Quality assessment of guidelines and systematic review s were conducted by using the Appraisal of Guidelines for Research and Evaluation II ( AGREE II ) , Assessment of Multiple Systematic Review s ( AMSTAR ) , and Cochrane Risk of Bias tools . Final recommendations were developed through a st and ardized Program in Evidence -Based Care multidisciplinary expert and knowledge user review process . RESULTS Two high- quality relevant clinical practice guidelines , eight pharmacologic trials , nine psychological trials , and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed . Eight specific recommendations were made to establish a st and ard of care for the management of depression in patients with cancer . The recommendations and practical management tools were review ed as being well organized and helpful , although systemic barriers to implementation were identified . CONCLUSION This up date d guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and /or pharmacologic interventions , without evidence for the superiority of any specific treatment over another . New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression Background Type 2 diabetes mellitus ( DM2 ) is a disease with high prevalence and significant impact in terms of mortality and morbidity . The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management . The Spanish Diabetes Self-Management Program ( SDSMP ) has proven to be effective in other setting s. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care setting s within the Basque Health Service – Osakidetza ( Spain ) . Method / Design This is a r and omised clinical trial in which patients diagnosed with DM2 , 18–79 years of age , from four health regions within the Basque Health Service will be r and omised into two groups : an intervention group , who will follow the SDSMP , and a control group , who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region . The intervention consists of 2,5 hour-group sessions once a week for six weeks . The sessions cover target setting and problem solving techniques , promotion of physical exercise , basic knowledge of nutrition , proper use of medication , effective communication with relatives and health professionals , and basic knowledge about DM2 and its complications . This content is complemented by educational material : books , leaflets and CDs . The primary outcome measure will be the change in glycated haemoglobin ( HbA1c ) , and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables , cardiovascular risk , quality of life , self-efficacy , number of consultations and drug prescriptions . The results will be analysed 6 , 12 and 24 months after the intervention . Discussion If the intervention were to be effective , the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases . Trial registration Clinical Trials.gov identifier Objectives . Overview the quality , direction , and characteristics of yoga interventions for treatment of acute and chronic health conditions in adult population s. Methods . We search ed for systematic review s in 10 online data bases , bibliographic references , and h and - search es in  yoga-related  journals . Included review s satisfy Oxman criteria and specify yoga as a primary intervention in one or more r and omized controlled trials for treatment in adults . The AMSTAR tool and GRADE approach evaluated the method ological quality of review s and quality of evidence . Results . We identified 2202 titles , of which 41 full-text articles were assessed for eligibility and 26 systematic review s satisfied inclusion criteria . Thirteen systematic review s include quantitative data and six papers include meta- analysis . The quality of evidence is generally low . Sixteen different types of health conditions are included . Eleven review s show tendency towards positive effects of yoga intervention , 15 review s report unclear results , and no , review s report adverse effects of yoga . Yoga appears most effective for reducing symptoms in anxiety , depression , and pain . Conclusion . Although the quality of systematic review s is high , the quality of supporting evidence is low . Significant heterogeneity and variability in reporting interventions by type of yoga , setting s , and population characteristics limit the generalizability of results Background Physical activity is important for a healthy lifestyle . Although physical activity can delay complications and decrease the burden of the disease , the level of activity of patients with chronic obstructive pulmonary disease ( COPD ) or type 2 Diabetes Mellitus ( DM2 ) is often far from optimal . To stimulate physical activity , a monitoring and feedback tool , consisting of an accelerometer linked to a smart phone and webserver ( It ’s LiFe ! tool ) , and a counselling protocol for practice nurses in primary care was developed ( the Self-management Support Program ) . The main objective of this study is to measure the longitudinal effects of this counselling protocol and the added value of using the tool . Methods / Design This three-armed cluster r and omised controlled trial with 120 participants with COPD and 120 participants with DM2 ( aged 40–70 ) , compares the counselling protocol with and without the use of the tool ( group 1 and 2 ) with usual care ( group 3 ) . Recruitment takes place at GP practice s in the southern regions of the Netherl and s. R and omisation takes place at the practice level . The intended sample ( three arms of 8 practice s ) powers the study to detect a 10-minute difference of moderate and intense physical activity per day between groups 1 and 3 . Participants in the intervention groups have to visit the practice nurse 3–4 times for physical activity counselling , in a 4 - 6-month period . Specific activity goals tailored to the individual patient 's preferences and needs will be set . In addition , participants in group 1 will be instructed to use the tool in daily life . The primary outcome , physical activity , will be measured in all groups with a physical activity monitor ( PAM ) . Secondary outcomes are quality of life , general - and exercise - self-efficacy , and health status . Follow-up will take place after 6 and 9 months . Separately , a process evaluation will be conducted to explore reasons for trial non-participation , and the intervention ’s acceptability for participating patients and nurses . Discussion Results of this study will give insight into the effects of the It ’s LiFe ! monitoring and feedback tool combined with care from a practice nurse for people with COPD or DM2 on physical activity . Trial registration Clinical Trials.gov : Purpose Given the public health significance of poorly treatable co-morbid major depressive disorders ( MDD ) among patients with type 2 diabetes mellitus ( DM2 ) and coronary heart disease ( CHD ) , we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease . We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and /or CHD . Methods A cluster r and omized controlled trial , with 27 primary care centers serving as clusters . A total of 236 DM2 and /or CHD patients with subthreshold depression ( nine item Patient Health Question naire ( PHQ-9 ) score ≥ 6 , no current MDD according to DSM-IV criteria ) were allocated to the intervention group ( N = 96 ) or usual care group ( n = 140 ) . The stepped-care program was delivered by trained practice nurses during one year and consisted of four sequential treatment steps : watchful waiting , guided self-help , problem solving treatment and referral to the general practitioner . The primary outcome was the 12-month cumulative incidence of MDD as measured with the Mini International Neuropsychiatric Interview ( MINI ) . Secondary outcomes included severity of depression ( measured by PHQ-9 ) at 3 , 6 , 9 and 12 months . Results Of 236 patients ( mean age , 67,5 ( SD 10 ) years ; 54.7 % men ) , 210 ( 89 % ) completed the MINI at 12 months . The cumulative incidence of MDD was 9 of 89 ( 10.1 % ) participants in the intervention group and 12 of 121 ( 9.9 % ) participants in the usual care group . We found no statistically significant overall effect of the intervention ( OR = 1.21 ; 95 % confidence interval ( 0.12 to 12.41 ) ) and there were no statistically significant differences in the course or severity of depressive symptoms between the two groups . Conclusions This study suggest that Step-Dep was not more effective in preventing MDD than usual care in a primary care population with DM2 and /or CHD and subthreshold depression UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes  : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine the efficacy of specialized multidisciplinary community care for the management of type 2 diabetes compared to usual care . CLINICAL NEED TARGET POPULATION AND CONDITION Diabetes ( i.e. diabetes mellitus ) is a highly prevalent chronic metabolic disorder that interferes with the body 's ability to produce or effectively use insulin . The majority ( 90 % ) of diabetes patients have type 2 diabetes . ( 1 ) Based on the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , intensive blood glucose and blood pressure control significantly reduce the risk of microvascular and macrovascular complications in type 2 diabetics . While many studies have documented that patients often do not meet the glycemic control targets specified by national and international guidelines , factors associated with glycemic control are less well studied , one of which is the provider(s ) of care . Multidisciplinary approaches to care may be particularly important for diabetes management . According guidelines from the Canadian Diabetes Association ( CDA ) , the diabetes health care team should be multi- and interdisciplinary . Presently in Ontario , the core diabetes health care team consists of at least a family physician and /or diabetes specialist , and diabetes educators ( registered nurse and registered dietician ) . Increasing the role played by allied health care professionals in diabetes care and their collaboration with physicians may represent a more cost-effective option for diabetes management . Several systematic review s and meta-analyses have examined multidisciplinary care programs , but these have either been limited to a specific component of multidisciplinary care ( e.g. intensified education programs ) , or were conducted as part of a broader disease management program , of which not all were multidisciplinary in nature . Most review s also do not clearly define the intervention(s ) of interest , making the evaluation of such multidisciplinary community programs challenging . EVIDENCE -BASED ANALYSIS METHODS RESEARCH QUESTIONS What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a registered nurse , registered dietician and physician ( primary care and /or specialist ) for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 1]What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a pharmacist and a primary care physician for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 2 ] INCLUSION CRITERIA English language full-reportsPublished between January 1 , 2000 and September 28 , 2008R and omized controlled trials ( RCTs ) , systematic review s and meta-analysesType 2 diabetic adult population ( ≥18 years of age)Total sample size ≥30Describe specialized multidisciplinary community care defined as ambulatory-based care provided by at least two health care disciplines ( of which at least one must be a specialist in diabetes ) with integrated communication between the care providers . Compared to usual care ( defined as health care provision by non-specialist(s ) in diabetes , such as primary care providers ; may include referral to other health care professionals/services as necessary)≥6 months follow-up EXCLUSION CRITERIA Studies where discrete results on diabetes can not be abstract edPredominantly home-based interventions Inpatient-based interventions OUTCOMES OF INTEREST The primary outcomes for this review were glycosylated hemoglobin ( rHbA1c ) levels and systolic blood pressure ( SBP ) . SEARCH STRATEGY A literature search was performed on September 28 , 2008 using OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , the Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1 , 2000 and September 28 , 2008 . Abstract s were review ed by a single review er and , for those studies meeting the eligibility criteria , full-text articles were obtained . Reference lists were also examined for any additional relevant studies not identified through the search . Articles with unknown eligibility were review ed with a second clinical epidemiologist , then a group of epidemiologists until consensus was established . The quality of evidence was assessed as high , moderate , low or very low according to GRADE methodology . Given the high clinical heterogeneity of the articles that met the inclusion criteria , specific models of specialized multidisciplinary community care were examined based on models of care that are currently being supported in Ontario , models of care that were commonly reported in the literature , as well as suggestions from an Expert Advisory Panel Meeting held on January 21 , 2009 . SUMMARY OF FINDINGS The initial search yielded 2,116 unique citations , from which 22 RCTs trials and nine systematic review s published were identified as meeting the eligibility criteria . Of these , five studies focused on care provided by at least a nurse , dietician , and physician ( primary care and /or specialist ) model of care ( Model 1 ; see Table ES 1 ) , while three studies focused on care provided by at least a pharmacist and primary care physician ( Model 2 ; see Table ES 2 ) . Based on moderate quality evidence , specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in HbA1c of 1.0 % compared with usual care . The effects of this model on SBP , however , are uncertain compared with usual care , based on very-low quality evidence . Specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in both HbA1c of 1.05 % ( based on high quality evidence ) and SBP of 7.13 mm Hg ( based on moderate quality evidence ) compared to usual care . For both models , the evidence does not suggest a preferred setting of care delivery ( i.e. , primary care vs. hospital outpatient clinic vs. community clinic ) . Table ES1 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 1 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.00 [ -1.27 , -0.73]4 % (p=0.37)Moderate- quality Subgroup : Moderate-to-High Quality -0.91 [ -1.19 , -0.62]0 % (p=0.74)Systolic Blood Pressure ( mm Hg)-2.04 [ -13.80 , 9.72]89 % (p=0.002)Very-low quality * Mean change from baseline to follow-up between intervention and control groupsTable ES2 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 2 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.05 [ -1.57 , -0.52]0 % (p=0.75)High- quality Systolic Blood Pressure ( mm Hg)-7.13 [ -11.78 , -2.48]46 % (p=0.17)Moderate quality * Mean change from baseline to follow-up between intervention and control groups Background Individual health education is considered to be essential in the overall care of patients with type 2 diabetes ( DM2 ) , although there is some uncertainty regarding its metabolic control benefits . There have been very few r and omized studies on the effects of individual education on normal care in DM2 patients with a control group , and none of these have assessed the long-term results . Therefore , this study aims to use this design to assess the effectiveness of the PRECEDE ( Predisposing , Reinforcing , Enabling , Causes in Educational Diagnosis , and Evaluation ) education model in the metabolic control and the reduction of cardiovascular risk factors , in patients with type 2 diabetes . Methods An open community effectiveness study was carried out in 8 urban community health centers in the North-East Madrid Urban Area ( Spain ) . Six hundred patients with DM2 were r and omized in two groups : PRECEDE or conventional model for health promotion education . The main outcome measures were glycated hemoglobin A1c , body mass index ( BMI ) , blood pressure , lipids and control criteria during the 2-year follow-up period . Results Glycated hemoglobin A1c and systolic blood pressure ( SBP ) levels decreased significantly in the PRECEDE group ( multivariate analysis of covariance , with baseline glycated hemoglobin A1c , SBP , and variables showing statistically significant differences between groups at baseline visits ) . The decrease levels in diastolic blood pressure ( DBP ) , triglycerides and LDL cholesterol were nonsignificant . PRECEDE increased compliance in all control criteria , except for LDL cholesterol . BMI did not change during the study in either of the two models analyzed . Conclusions PRECEDE health education model is a useful method in the overall treatment in patients with type 2 diabetes , which contributes to decrease glycated hemoglobin A1c and SBP levels and increase the compliance in all the control criteria , except for LDL cholesterol . Trial registration number Clinical Trials.gov Aim . This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of behavioral therapies such as yoga and mindfulness practice s for stroke rehabilitation . Background . The experience of stroke can have a negative impact on both psychological and physical health and on quality of life . Yoga and relevant practice s are promising therapies that have been used with patients with a variety of conditions . In order to draw conclusions on effectiveness for stroke patients , the evidence requires systematic assessment . Methods . A comprehensive search of major biomedical and complementary medicine data bases was conducted . Relevant research was categorized by study type and appraised according to study design . Results . Five r and omized controlled clinical trials and four single case studies were found . Additionally , one qualitative research study was identified . Studies reported positive results , including improvements in cognition , mood , and balance and reductions in stress . Modifications to different yoga practice s make comparison between studies difficult , and a lack of controlled studies precludes any firm conclusions on efficacy . Conclusion . Yoga and mindfulness could be clinical ly valuable self-administered intervention options for stroke rehabilitation . Further research is needed to evaluate these specific practice s and their suitability in stroke rehabilitation OBJECTIVE To summarize an extensive review of systems for grading the quality of research articles and rating the strength of bodies of evidence , and to highlight for health professionals and decision-makers concerned with quality measurement and improvement the available " best practice s " tools by which these steps can be accomplished . DESIGN Drawing on an extensive review of checklists , question naires , and other tools in the field of evidence -based practice , this paper discusses clinical , management , and policy rationale s for rating strength of evidence in a quality improvement context , and documents best practice s methods for these tasks . RESULTS After review of 121 systems for grading the quality of articles , 19 systems , mostly STUDY DESIGN specific , met a priori scientific st and ards for grading systematic review s , r and omized controlled trials , observational studies , and diagnostic tests ; eight systems ( of 40 review ed ) met similar st and ards for rating the overall strength of evidence . All can be used as is or adapted for particular types of evidence reports or systematic review s. CONCLUSIONS Formally grading study quality and rating overall strength of evidence , using sound instruments and procedures , can produce reasonable levels of confidence about the science base for parts of quality improvement programs . With such information , health care professionals and administrators concerned with quality improvement can underst and better the level of science ( versus only clinical consensus or opinion ) that supports practice guidelines , review criteria , and assessment s that feed into quality assurance and improvement programs . New systems are appearing and research is needed to confirm the conceptual and practical underpinnings of these grading and rating systems , but the need for those developing systematic review s , practice guidelines , and quality or audit criteria to underst and and undertake these steps is becoming increasingly clear Background Thiazolidinediones , used for the treatment of patients with type 2 diabetes mellitus ( DM2 ) , are associated with an increased incidence of heart failure . We sought to investigate the effects of pioglitazone on novel echocardiographic indices of left ventricular ( LV ) diastolic function in DM2 patients with LV diastolic dysfunction ( LVDD ) . Methods Eighty-eight asymptomatic DM2 patients on metformin and /or sulfonylureas , aged 64.5 ± 7.7 years , without known cardiovascular disease , with normal LV systolic function and evidence of LVDD were r and omly assigned to pioglitazone 30 mg/day ( n = 42 ) or an increase in dose of other oral agents ( n = 39 ) for 6 months . All patients underwent transthoracic conventional and Tissue Doppler Imaging echocardiography at baseline and follow-up . The primary end-point was change in early diastolic velocity of the mitral annulus ( E ' ) . Results Improvement of glycaemic control was similar in the 2 groups . A significant difference ( p < 0.05 ) between the 2 groups was found in the treatment-induced changes in fasting insulin , the insulin resistance index HOMA , HDL cholesterol , triglycerides , diastolic blood pressure ( all in favor of pioglitazone ) and in body weight ( increase with pioglitazone ) . No significant changes were observed in any echocardiographic parameter in either group and did not differ between groups ( p = NS for all ) . E ' increased non-significantly and to a similar extent in both groups ( p = NS ) . Conclusions In asymptomatic DM2 patients with LVDD , the addition of pioglitazone to oral conventional treatment for 6 months does not induce any adverse or favorable changes in LV diastolic or systolic function despite improvements in glycaemic control , insulin sensitivity , lipid profile , and blood pressure Background : The dem and for clinical ly efficacious , safe , patient acceptable , and cost-effective forms of treatment for mental illness is growing . Several studies have demonstrated benefit from yoga in specific psychiatric symptoms and a general sense of well-being . Objective : To systematic ally examine the evidence for efficacy of yoga in the treatment of selected major psychiatric disorders . Methods : Electronic search es of The Cochrane Central Register of Controlled Trials and the st and ard bibliographic data bases , MEDLINE , EMBASE , and PsycINFO , were performed through April 2011 and an up date d in June 2011 using the keywords yoga AND psychiatry OR depression OR anxiety OR schizophrenia OR cognition OR memory OR attention AND r and omized controlled trial ( RCT ) . Studies with yoga as the independent variable and one of the above mentioned terms as the dependent variable were included and exclusion criteria were applied . Results : The search yielded a total of 124 trials , of which 16 met rigorous criteria for the final review . Grade B evidence supporting a potential acute benefit for yoga exists in depression ( four RCTs ) , as an adjunct to pharmacotherapy in schizophrenia ( three RCTs ) , in children with ADHD ( two RCTs ) , and Grade C evidence in sleep complaints ( three RCTs ) . RCTs in cognitive disorders and eating disorders yielded conflicting results . No studies looked at primary prevention , relapse prevention , or comparative effectiveness versus pharmacotherapy . Conclusion : There is emerging evidence from r and omized trials to support popular beliefs about yoga for depression , sleep disorders , and as an augmentation therapy . Limitations of literature include inability to do double-blind studies , multiplicity of comparisons within small studies , and lack of replication . Biomarker and neuroimaging studies , those comparing yoga with st and ard pharmaco- and psychotherapies , and studies of long-term efficacy are needed to fully translate the promise of yoga for enhancing mental health Background : Yoga has been shown to be beneficial in diabetes in many studies , though r and omized control trials are few . The aim of this r and omized control trial was to see the effect of Sudarshan Kriya and related practice s ( comprehensive yogic breathing program ) on quality of life , glycemic control , and cardiac autonomic functions in diabetes . Diabetes mellitus is a risk factor for sudden cardiac death . Cardiac autonomic neuropathy has been implicated in the causation of sudden cardiac death . Therefore , a maneuver to prevent progression of cardiac autonomic neuropathy holds significance . Material s and Methods : A total of 120 patients of diabetes on oral medication and diet and exercise advice were r and omized into two groups : ( 1 ) Continued to receive st and ard treatment for diabetes . ( 2 ) Patients administered comprehensive yogic breathing program and monitored to regularly practice yoga in addition to st and ard treatment of diabetes . At 6 months , quality of life and postpr and ial plasma glucose significantly improved in the group practicing yoga compared to baseline , but there was no significant improvement in the fasting plasma glucose and glycated hemoglobin . Results : On per protocol analysis , sympathetic cardiac autonomic functions significantly improved from baseline in the group practicing comprehensive yogic breathing . Conclusion : This r and omized control trial points towards the beneficial effect of yogic breathing program in preventing progression of cardiac neuropathy . This has important implication s as cardiac autonomic neuropathy has been considered as one of the factors for sudden cardiac deaths Background Increasing cases of diabetes , a general lack of routinely operational prevention , and a long history of separating disease prevention and treatment call for immediate engagement of frontier clinicians . This applies especially to village doctors who work in rural China where the majority of the nation ’s vast population lives . Objective This study aims to develop and test an online Smart Web Aid for Preventing Type 2 Diabetes ( SWAP-DM2 ) capable of addressing major barriers to applying proven interventions and integrating diabetes prevention into routine medical care . Methods Development of SWAP-DM2 used evolutionary prototyping . The design of the initial system was followed by refinement cycles featuring dynamic interaction between development of practical and effective st and ardized operation procedures ( SOPs ) for diabetes prevention and Web-based assistance for implementing the SOPs . The result ing SOPs incorporated proven diabetes prevention practice s in a synergetic way . SWAP-DM2 provided support to village doctors ranging from simple educational webpages and record maintenance to relatively sophisticated risk scoring and personalized counseling . Evaluation of SWAP-DM2 used data collected at baseline and 6-month follow-up assessment : ( 1 ) audio recordings of service encounters ; ( 2 ) structured exit surveys of patients ’ knowledge , self-efficacy , and satisfaction ; ( 3 ) measurement of fasting glucose , body mass index , and blood pressure ; and ( 4 ) qualitative interviews with doctors and patients . Data analysis included ( 1 ) descriptive statistics of patients who received SWAP-DM2–assisted prevention and those newly diagnosed with prediabetes and diabetes ; ( 2 ) comparison of the variables assessed between baseline and follow-up assessment ; and ( 3 ) narratives of qualitative data . Results The 17 participating village doctors identified 2219 patients with elevated diabetes risk . Of these , 84.85 % ( 1885/2219 ) consented to a fasting glucose test with 1022 new prediabetes and 113 new diabetes diagnoses made within 6 months . The prediabetic patients showed substantial improvement from baseline to 6-month follow-up in vegetable intake ( 17.0 % , 43/253 vs 88.7 % , 205/231 ) , calorie intake ( 1.6 % , 4/253 vs 71.4 % , 165/231 ) , leisure-time exercises ( 6.3 % , 16/253 vs 21.2 % , 49/231 ) , body weight ( mean 62.12 kg , SD 9.85 vs mean 58.33 kg , SD 9.18 ) , and body mass index ( mean 24.80 kg/m2 , SD 3.21 vs mean 23.36 kg/m2 , SD 2.95 ) . The prediabetic patients showed improvement in self-efficacy for modifying diet ( mean 5.31 , SD 2.81 vs mean 8.53 , SD 2.25 ) , increasing physical activities ( mean 4.52 , SD 3.35 vs mean 8.06 , SD 2.38 ) , engaging relatives ( mean 3.93 , SD 3.54 vs mean 6.93 , SD 2.67 ) , and knowledge about diabetes and risks of an imbalanced diet and inadequate physical activity . Most participating doctors and patients viewed SWAP-DM2 as useful and effective . Conclusions SWAP-DM2 is helpful to village doctors , acceptable to patients , and effective in modifying immediate determinants of diabetes at least in the short term , and may provide a useful solution to the general lack of participation in diabetes prevention by frontier clinicians in rural China . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 66772711 ; http://www.controlled-trials.com/IS RCT N66772711 ( Archived by WebCite at http://www.webcitation.org/6OMkAqyEy ) AIM To develop a straightforward risk score for type 2 diabetes ( DM2 ) screening to use in clinical practice . METHODS A sample of 6237 adult inhabitants of the Canary Isl and s ( Spain ) was r and omly divided into two subgroups : one yielded data used to develop the instrument , and the other yielded data used for validation testing . Performance of the instrument was compared in persons with clinical ly diagnosed DM2 and undiagnosed diabetes . The risk score , calculated by multivariate logistic regression , included the potential risk variables that yielded the highest odds ratio in the univariate analysis . A cut-off point for screening purpose s was established at a 99 % negative predictive value . RESULTS In men , variables included in the risk score were age , waist/height ratio , familial antecedents of diabetes , and systolic blood pressure ( ROC curve 0.837 , 95 % CI : 0.803 - 0.871 ) . In women , the risk score contained the same variables plus gestational diabetes history ( ROC curve 0.874 , 95 % CI : 0.847 - 0901 ) . Excluding systolic blood pressure from the score had no significant effect on the area under the curve . This instrument result ed valid only for people aged less than 55 years . CONCLUSIONS This simple risk score for DM2 would be easy to apply in clinical practice BACKGROUND The aging process is associated with the development of several diseases , which can be attenuated by the practice of physical activities . Aerobic training is an effective method to maintain and improve cardiovascular function . Additionally , it has a crucial role in the prevention and treatment of several chronic-degenerative diseases , especially diabetes mellitus . } OBJECTIVE To verify the effect of a 13-week aerobic training program on blood pressure ( BP ) , body mass index ( BMI ) and glycemia levels in elderly women with type-2 diabetes mellitus ( DM2 ) . METHODS Eleven sedentary elderly women with DM2 , aged 61.0 ± 9.1 years , were su bmi tted a 13-week aerobic training program , constituting group G2 . Eleven controlled elderly women ( aged 60.2 ± 6.8 years ) were not su bmi tted to the aerobic training , constituting the control group ( G1 ) . G1 attended educational lectures once a week , whereas G2 walked three times a week . RESULTS Both groups presented a significant decrease in glycemia and diastolic blood pressure levels . No significant decreases in BMI were observed after the aerobic training in either group . CONCLUSION The 13-week aerobic training program was enough to promote significant decrease in the diastolic blood pressure and glycemia levels ; therefore , this type of exercise training decreases the risk factors for cardiovascular and metabolic diseases Background Modest reductions in weight and small increases in step- related activity ( e.g. , walking ) can improve glycemic and blood pressure control in type 2 diabetes mellitus ( DM2 ) . We examined changes in these parameters following training in time- efficient preparation of balanced , low- energy meals combined with pedometer- based step count monitoring . Methods Seventy- two adults with DM2 were enrolled in a 24- week program ( i.e. , 15 three- hour group sessions ) . They prepared meals under a chef ’s supervision , and discussed eating behaviours/nutrition with a registered dietitian . They maintained a record of pedometer- assessed step counts . We evaluated changes from baseline to 24 weeks in terms of weight , step counts , hemoglobin A1c ( HbA1c , glycemic control ) , blood pressure , and eating control ability ( Weight Efficacy Lifestyle WEL Question naire ) . 53 participants ( 73.6 % ) completed assessment s. Results There were improvements in eating control ( 11.2 point WEL score change , 95 % CI 4.7 to 17.8 ) , step counts ( mean change 869 steps/day , 95 % CI 198 to 1,540 ) , weight ( mean change −2.2 % ; 95 % CI −3.6 to −0.8 ) , and HbA1c ( mean change −0.3 % HbA1c , 95 % CI −0.6 to −0.1 ) , as well as suggestion of systolic blood pressure reduction ( mean change −3.5 mm Hg , 95 % CI −7.8 to 0.9 ) . Findings were not attributable to medication changes . In linear regression models ( adjusted for age , sex , ethnicity , insulin use , season ) , a −2.5 % weight change was associated with a −0.3 % HbA1c change ( 95 % CI −0.4 to −0.2 ) and a −3.5 % systolic blood pressure change ( 95 % CI −5.5 to −1.4 ) . Conclusions In this ‘ proof of concept ’ study , persistence with the program led to improvements in eating and physical activity habits , glycemia reductions , and suggestion of blood pressure lowering effects . The strategy thus merits further study and development to exp and the range of options for vascular risk reduction in DM2 A growing body of scientific evidence has linked dairy intake to a reduced  type 2 diabetes ( T2D ) risk . Using an evidence -based approach , we review ed the most recent and strongest evidence on the relationship between dairy intake and the risk of T2D . Evidence indicates that dairy intake is significantly associated with a reduced T2D risk , and likely in a dose-response manner . The association between low-fat dairy and T2D risk reduction appears consistent . A beneficial impact is suggested for regular-fat dairy . The role of specific dairy products needs to be clarified . Potential underlying mechanisms include the role of dairy products in obesity and metabolic syndrome , as well as several dairy components , such as calcium , vitamin D , dairy fat , and specifically trans-palmitoleic acid . To conclude , there is strong , consistent , and accumulating evidence that dairy intake reduces the risk of T2D . More research is needed to better underst and the role of regular-fat and specific dairy products . Well- design ed r and omized controlled trials and mechanistic studies are needed to support these findings . Efforts to translate this evidence into clinical practice and public health guidance are needed Objective : To assess the effect of a comprehensive yogic breathing program on glycemic control and quality of life ( QOL ) in patients with diabetes . Material s and Methods : This is a prospect i ve r and omized controlled intervention trial . Patients having HbA1c between 6 and 9 % for at least 3 months with lifestyle modification and oral antidiabetic medication were included . They were followed-up and r and omized at 6 months into two groups : one group receiving st and ard treatment of diabetes and the other group receiving st and ard treatment of diabetes and taught and told to regularly practice the comprehensive yogic breathing program ( Sudarshan Kriya Yoga and Pranayam ) . Change in fasting and post-pr and ial blood sugars , glycated hemoglobin and QOL as assessed by the World Health Organization QOL WHOQOL BREF question naire were assessed . Results : There was a trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group following st and ard treatment alone , although this was not significant . There was significant improvement in physical , psychological and social domains and total QOL post-intervention in the group practicing the comprehensive yogic breathing program as compared with the group following st and ard treatment alone . Conclusion : There was significant improvement in the QOL and a non-significant trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group that was following st and ard treatment alone
Collectively , findings suggest that yogic practice s may promote significant improvements in several indices of importance in DM2 management , including glycemic control , lipid levels , and body composition .
More limited data suggest that yoga may also lower oxidative stress and blood pressure ; enhance pulmonary and autonomic function , mood , sleep , and quality of life ; and reduce medication use in adults with DM2 .
A growing body of evidence suggests yogic practice s may benefit adults with type 2 diabetes ( DM2 ) .
In this systematic review , we evaluate available evidence from prospect i ve controlled trials regarding the effects of yoga-based programs on specific health outcomes pertinent to DM2 management .